cholesterol Flashcards
when do you use QRISK2 CVD risk assessment tool?
patients under 84yo
when do you start primary prevention of cholesterol?
10 yr cardiovascular risk 10% or above
or most type 1 diabetics
or ckd IF Egfr<60
when do you start secondary prevention of cholesterol?
known ischaemic heart disease
or cerebrovascular disease
or peripheral arterial disease
when is it not recommended to use QRISK2 CVD risk assessment tool?
85 and up- high risk
type 1 diabetes
eGFR<60 +/- albuminuria
familial hyperlipidaemia
in what situations does QRISK2 underestimate CVD risk?
treated for HIV
mental health
medications that can cause dyslipidaemia eg antipsychotics, corticosteroids or immunosuppressant drugs
autoimmune/systemic inflammatory disorders eg SLE
when do you consider familial hypercholesterolaemia?
total cholesterol>7.5
personal/FH premature coronary heart disease
what ages do you do blood tests for children of affected parents with familial hypercholesterolaemia?
if one parent affected- test child by age 10
if both parents affected- test child by age 5
what is involved in clinical diagnosis of familial hypercholesterolaemia according to Simon Broome criteria?
adults: TC>7.5 + LDL>4.9
child TC>6.7 + LDL?4
possible FH: FH MI<50 in 2nd degree relative, <60 1st degree relative, FH raised cholesterol levels
definite FH: tendon xanthoma in patients or 1st/2nd degree relatives or DNA based evidence of FH
start with high dose statin
when do you offer statins as primary prevention and what dose?
QRISK2 10% and above
atorvastatin 20mg
when should you consider atorvastatin 20mg for people with type 1 diabetes?
if had DM1 more than 10yrs
40yo or up
established nephropathy
other CVD risk factors
when would you increase dose of atorvastatin 20mg for people with CKD?
if eGFR>30 + not achieved greater than 40% reduction in non-HDL cholesterol - increase to 80mg
if eGFR<30- d/w renal team before increasing dose
what dose of atorvastatin is given in secondary prevention?
secondary prevention- 80mg
primary prevention- 20mg
what is the follow-up when you have commenced a statin?
blood test: repeat full lipid profile at 3 months
if non-HDL cholesterol has not fallen by at least 40% then increase dose and discuss lifestyle changes + concordance
what is a cardioprotective diet?
total fat intake <30% total energy intake
saturated fat <7% total energy intake
dietary cholesterol <300mg/day
saturated fats replaced by monounsaturated + polyunsaturated fats
replace saturated + monunsaturated fat intake with olive oil, rapeseed oil
wholegrain starchy foods
reduce sugar intake/refined sugars including fructose
5 portions of fruit + veg/day
2 portions of fish/week- oily fish
4-5 portions unsalted nuts, seeds + legumes/week
what physical activity is recommended?
150 mins moderate aerobic activity/week
or 75 mins vigorous aerobic
muscle-strengthening 2+ days/week
