The Curbsiders Internal Medicine Podcast

REBOOT #191 Lipids and Cardiovascular Risk Reduction with Erin Michos MD

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Jul 18, 2022

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Erin Michos MD

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ADVICE

Coronary Calcium Scores Guide Statins

Use coronary artery calcium (CAC) scoring when risk is uncertain to refine statin therapy decisions.
A CAC score of zero may allow deferral of statins, improving patient adherence and personalized risk assessment.

ADVICE

Counsel Patients on Statin Benefits

Discuss the absolute risk and net clinical benefit of statin therapy clearly with patients.
Address patient concerns about side effects with evidence emphasizing safety and low risk of serious events.

ADVICE

Follow-up Labs After Starting Statins

Check lipid labs 4 to 12 weeks after starting therapy to assess response.
Continue follow-up labs at least annually to monitor adherence and ongoing lipid control.

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Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow-up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”! Get the original show notes here!

Prior lipid episodes:

#37 Lipids, PCSK9, and ezetimibe: Lower is better.

#10 Cholesterol, lipids, statins, fish oil. Become a Master Lipidologist.

Sorry, no CME for this reboot episode, but claim CME for past episodes at curbsiders.vcuhealth.org!

Show Segments

Intro
Getting to know Dr. Erin Michos
Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel
Digging into ASCVD Risk Calculator
Who should get 10 year ASCVD Risk assessment and what are the categories?
How Dr. Michos discusses healthy lifestyle and “Primordial Prevention”
What are “Risk Enhancing Factors”?
Who should get biomarker testing vs CAC scoring?
How Dr. Michos discusses statin therapy with her patients
How to address risks of side effects
Primary vs Secondary Prevention
“What should my cholesterol be?”
How often to follow-up labs?
Differences between stain intensity
How to manage side effects
PCSK9 inhibitor discussion
Aspirin, Fibrates and Icosapent Ethyl
High Risk vs Stable ASCVD
Take home points and the future
Outro

Credits

Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli MD
Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA
Infographic: Beth “Garbs” Garbitelli MD
Cover Art: Kate Grant MBChB DipGUMed
Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP
Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio)
Guest: Erin Michos MD MHS

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