Cholesterol Flashcards
What are the modifiable factors of CVD?
Smoking, diet, exercise, alcohol and weight
What are the non-modifiable factors of CVD?
Age, gender - males at higher risk, genetics, ethnicity
How is CVD risk assessed?
Assessed with QRISK, QRISK2, QRISK3, JBS3, or ASSIGN [Scotland].
But QRISK is not required in high risk patients - give them statin regardless.
What is considered a high risk patient?
- Type 1 diabetes and aged 40+
- Type 2 diabetes if CVD risk is >10%
- Chronic kidney disease (CKD)
- Familial hypercholesterolaemia - give high intensity statin - atorvastatin or rosuvastatin to achieve more than 50% reduction
- 85 years of age and over (esp if they smoke and have hypertension)
- 10-year CVD risk >10%
- Established CVD - like angina, MI, stroke, hypertension etc
- Hypertension
- Influenza
- Serious mental health
- Dyslipidaemia
What do QRISK, JBS3 and ASSIGN assess?
The risk of someone’s chances of having a heart attack OR stroke in the next 10 years
JBS3 - estimates lifetime risk of CVD
At what % risk must a statin be given?
If 10-year risk is greater than 10% = give a statin for primary prevention.
What should high risk patients be given?
They should be given a statin regardless of cholesterol
What do statins do?
Reduce the risk of CVD by reducing cholesterol levels.
They are the drug of choice for primary and secondary prevention of CVD
What is Hyperlipidaemia?
high cholesterol, high triglycerides, or both
How is Hyperlipidaemia diagnosed?
When total cholesterol is 6mmol/L or higher
What are the different causes of Hyperlipidaemia?
- Liver or kidney disease
- Family history
- Diabetes
- Hypothyroidism
- Lifestyle factors e.g. obesity, smoking
- Medicines e.g. antipsychotics, immunosuppressant, antiretrovirals, corticosteroids
What are high intensity statins?
Statins that reduces LDL by more than 40%
Examples of high intensity statin and the % of reduction for each station and dose?
Atorvastatin:
20mg - 43%
40mg - 49%
80mg - 55%
Rosuvastatin:
10mg - 43%
20mg - 48%
40mg - 53%
Simvastatin:
80mg - 42%
What is the recommended statin for primary prevention?
A high intensity statin - Atorvastatin 20mg
What is the recommended statin for secondary prevention?
Atorvastatin 80mg
But check lipid ranges/profiles beforehand and 3 months after starting statin.
Which patients are always given secondary prevention?
Given to all patients with type 1 diabetes (esp those over 40 years, had diabetes for over 10 years, established nephropathy, or other risk factors for CVD)
What are the lipid ranges?
High Density Lipids (HDL Cholesterol) - >1mmol/L
Triglycerides - <1.8mmol/L
Low Density Lipids (LDL Cholesterol) for high-
risk patients - <2mmol/L
Low Density Lipids (LDL Cholesterol) - <3mmol/L
Total Cholesterol for high-risk patients - <4mmol/L
Total Cholesterol for healthy adults - <5mmol/L
Hyperlipidaemia diagnosis - > and equal to 6mmol/L
What must be monitored before starting a statin?
- Lipid profile
- Liver enzymes 3 months + 12 months
- Creatine kinase
- HbA1c or fasting blood glucose
- Thyroid function - hypothyroidism
- Renal function
What must be monitored after starting a statin?
Liver enzymes - 3 month & 12 months after starting
HbA1c or fasting blood glucose - 3 months after starting.
What is the mechanism of action for statins?
They competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A
(HMG CoA) reductase, an enzyme involved in cholesterol synthesis, in the liver.
What drug can be used if statins aren’t tolerated or effective?
Ezetimibe
As monotherapy and co-current use
What should be done if patients can’t take a statin or ezetimibe?
They should be referred to a specialist for a
bile acid sequestrant, a fibrate, or nicotinic acid.
What drugs can be given if statins and ezetimibe cannot be tolerated?
Bile acid sequestrant, a fibrate, or nicotinic acid.
What should be done if triglyceride levels are high?
Add a fibrate
