1: Hyperlipidaemia Flashcards
How do lipids travel in the blood
Bound to lipoproteins
What are the four types of lipid and lipoprotein
- Chylomicrons
- VLDL
- LDL
- HDL
What are VLDLs
Triglycerides
What are LDLs
Cholesterol
What are HDLs
Phospholipids
What are the two types of hyperlipidaemia
Primary hyperlipidaemia
Secondary hyperlipidaemia
What are the two types of primary hyperlipidaemias
- Common primary hyperlipidaemia
What % of primary hyperlipidaemia are common primary hyperlipidaemia
70%
What is raised in common primary hyperlipidaemia
LDL (Cholesterol)
What is secondary hyperlipidaemia
Raised LDL due to another underlying disease process
How does secondary hyperlipidaemia present
Raised LDL (Cholesterol)
give 4 causes of secondary hyperlipidaemia
- Cushing’s disease
- DM
- Hypothyroidism
- Nephrotic syndrome
- Cholestasis
what is a mixed hyperlipidaemia
Raised LDL (Cholesterol) and VLDL (TGs)
what is another method to classify hyperlipidaemia
Congenital and Acquired
who classified familial hyperlipidaemias
Freidrickson
what is type I
Familial Hyperchylomicronaemia
what is the inheritance pattern of familial hyperchylomicronaemia
Autosomal Recessive
what causes familial hyperchylomicronaemia
Apo C deficiency
Lipoproteinlipase deficiency
how does familial hyperchylomicronaemia present clinically
- Recurrent acute pancreatitis
- Eruptive xanthomas
- Hepatosplenomegaly
- Lipemia retinalis
- Bile duct stenosis
what is the main feature of familial hyperchylomicronaemia
Recurrent acute pancreatitis
what defect is present in familial hyperchylomicronaemia
- High chylomicrons
- High VLDLs (triglycerides)
how prevalent is familial hyperchylomicronaemia
rare
what is type IIa
Familial hypercholesterolaemia
what % of familial hyperlipidaemias are familial hypercholesterolaemia
10
what is the inheritance pattern of familial hypercholesterolaemia
Autosomal Dominant
what cause familial hypercholesterolaemia
LDL Deficiency
what are the 4 symptoms of familial hypercholesterolaemia
- Xanthelasma
- Tendon Xanthoma
- Corneal Arcus
- Premature atherosclerosis
what causes tendon xanthomas
Familial Hypercholesterolaemia
what deficit is present in familial hypercholesterolaemia
High LDL (Cholesterol)
what is type IIb familial hyperlipidaemia
Familial Combined Hyperlipidaemia
what % of individuals have type IIb
10%
what is the inheritance pattern of familial combined hyperlipidaemia
Autosomal Dominant
what is the cause of familial combined hyperlipidaemia
ApoB100 deficiency
how does familial combined hyperlipidaemia present
Corneal Arcus
Xanthelasma
what is the abnormalities in lipids in familial combined hyperlipidaemia
High LDL
High VLDL
what is type III familial hyperlipidaemia
familial dysbetalipoproteinaemia
what is the inheritance pattern of dysbetalipoproteiaemia
autosomal recessive
what % of individuals have dysbetalipoproteinaemia
5
what causes dysbetalipoproteinaemia
Autosomal Recessive
what defect is present dysbetalipoproteinaemia
ApoE deficiency
what are 3 symptoms of dysbetalipoproteinaemia
Palmar striae
Pre-mature atherosclerosis
Tubero-eruptive xanthoma
what defect is present in dysbetalipoproteinaemia
Increase VLDL (triglycerides) Increase chylomicrons
what is the most common familial hyperlipidaemia disorder
Familial hypertriglyceridaemia (70%)
what is the inheritance pattern of familial hyper triglycerdiaemia
AD
what causes familial hypertriglyceridaemia
Overproduction of VLDL by the liver
what are symptoms of familial hypertriglyceridaemia
- Premature atherosclerosis
- Eruptive xanthoma
- Lidipaemia retinalis
- Hepatosplenomegaly
what defect is present in familial hypertriglyceridaemia
Raised LDL
how should individuals at risk of hyperlipidaemia be screened
Fasting Lipid Profile
what are the two ‘at-risk’ categories
- Those at risk of hyperlipidaemia
- Those at risk of CVD
what are 3 indicators of ‘at risk’ of hyperlipidaemia
- FH
- Corneal Marcus before 40-years
- Xanthomata
what is an eruptive xanthoma
Itchy yellow nodules
what is an tuberous xanthoma
Yellow nodules on knees or elbows
who are individuals at risk of CVD
- FH
- Known CVD
- Diabetes
- IGT
- HTN
- Smoking
- High BMI
explain gender changes in cholesterol
Males have higher cholesterol until menopause - then females
how do patients with high lipids usually present
Asymptomatic. May have xanthomas
which lipid has greatest risk for coronary artery disease
LDL
how is LDL measured
LDL = Total serum cholesterol - HDL - TG/5
what is the effect of HDL
protective: transports LDL from tissues to the liver
explain cholesterol (LDL) to HDL ratio
Lower LDL:HDL - the lower risk of CAD. A ratio of 10 doubles CAD
what is first line investigation in hyperlipidaemia
Lipid screen
if lipid screen is abnormal, what is ordered
If LDL or HDL abnormal on lipid screen order fasting lipid profile
when is fasting lipid profile the first-investigation
- FH Hyperlipidaemia
- Corneal arcus under 50-years
- Xanthoma
- FH CVD under 60
- CVD
- Smoker
- Higher BMI
- HTN
what is first-line management of hyperlipidaemia
Statin
what dose of atorvastatin is given for primary prevention
20mg
what are indications for primary prevention
T1DM
GFR <60
QRISK2 >10%
what dose is given for secondary prevention
80mg
what are indications for secondary prevention
CVD, CAD, PAD
what is aim when individual is put on statin
non-HDL reduction by 40%
what is second line for high lipids
Ezetimibe
what is ezetimibe
Prevents absorption of cholesterol
when is ezetimibe used
Statins not tolerated or 40% reduction in HDL cannot be achieved
how much does familial hypercholesterolaemia (IIa) increase risk of CAD
40-times.
50% will have MI by 60-years if untreated
