B1 dyslipidaemia Flashcards
What is hypercholestrolaemia?
Elevated plasma cholesterol levels which leads to athlerosclerosis
What is athlerosclerosis ?
Focal lessons (plaques) on the inner surface of an artery. (Hardening)
What can athlerosclerosis lead to ?
- IHD: inadequet bloood flow to the heart
- Peripheral vascular disease (PVD): leg arteries
become narrows causing pain on excersise - Cerebrovascular disease (pre dipose towards a stroke)
What are the risk facters for athlerosclerosis?
Genetics Hypercholesterolaemia (raised LDL or lowered HDL) Hypertension Smoking Obesity Hyperglycaemia Reduced physical activity Infections ? Poor dental hygine?
What drugs can induce athleroschlerosis (dyslipidaemia)?
* no need to lear
Beta-blockers Thiazides Corticosteroids Retinoids Oral contraception Anti HIV drugs
What is hypercholesterolaemia associated with in terms of how much LDL and HDL are in the plasma?
- High levels of LDL or and low levels if HDl
What is Xanthomata and what are symptoms its symptoms ?
Sign of hypercholestrolaemia
- yellow streak
- yellow plaque on eyes and wrists
Indication to examin cholesterol levels
Decribe the pathway of atherogenisis
- Smoking, hypertension turbulent flow can all cause damage to the endothelial thelium
- Draws macrophages (white blood cells) to the site causing inflamation.
- Reactive oxygen species (ROS) causes oxidative damage by oxidising LDLs= oxLDL
- OxLDLs can damage the receptor and prevent teh correct uptake of LDL
- This causes foam cells (cholesterol rich) to depostit beneth the endothelial
- Cholesterol rich plaque the accumulates in the connective tissue/
- This can narrow the blood vessel
- The plaque can rupture o anc platlets can start sticking to the surface forming a clot
- his can block the artery or can cause an embolism which can cause a heart attack or a stroke
How can you manage athlerosclerosis ?
Stop smoking
Treat high blood pressure and diabetic militus
Excercise
If drug-induced consider changng medication
Low cholesterol diet however most of the cholesterol is synthesised by the liver therefore changing diet may have little effects
What do statins do?
Lower cholesterol levels
Inhibits the HMG-coA reductase from converting Hydromethylglutaryl into mevalonate
This is the rate determining step therefore if inhibited produces the greatest effect onn the reduction of cholesterol.
Inhibits cholesterol synthesis
This leads to an uprehulation of hepatic LDL receptors, promoting LDL uptake
Therefore increases the uptake of cholesterol from the plasma by the liver
When should you consider giving a patient statin treatment?
Consider stating to all high risk patients
Why should statins be taken at night?
Cholesterol synthesis by the liver occurs at night in most statins except atrvastatin
Atorvastatin has a long plasma half life therefore it soesnt matter when the patietn takes it .
what are the adverse effects of statins?
Muscle pain- can lead to rhabdomyolysis
Increased develpment of diabetes
Nocebo effect
What is more favourable to use, simvastatin or atrovastatin?
Atorvastatin
what are the NICE guidlines for primary prevention in people ar high risk of cardiovascular disease?
Treat patients with a >10% risk of CV over the next 10 years
Asses via Qrisk3
40mg atorvastatin- low intensity
