Cholesterol

Question 1

Where do we get our Cholesterol from?

Answer 1

Most cholesterol is synthesised in the liver and we get some from diet.

Question 2

Why is cholesterol important in the body?

Answer 2

Important for membrane integrity and is a precursor in the production of steroid hormones, bile acids and vitamin D.

Question 3

Why is HDL cholesterol known as the “good cholesterol”.

Answer 3

HDL carries cholesterol away from the circulation and into the liver for re-cycling.

Question 4

Why is LDL cholesterol known as the “bad cholesterol”

Answer 4

It plays a big role in the build up of plaques and the development of atherosclerosis.

Question 5

Why is cholesterol screening important?

Answer 5

Its a part of CVD screening and is used to predict 10 year CVD risk.

Question 6

What are the two methods used in cholesterol screening and what do they measure?

Answer 6

1. ) Capillary (pin prick test) - measures total and HDL cholesterol
2. ) Venous test - measures total, HDL, non-HDL and triglycerides (will be present post meal - convert energy not needed into fat)

Question 7

What HDL cholesterol level is deemed to be high risk?

Answer 7

over 6 mmol/L

Question 8

What is primary prevention?

Answer 8

Identifying those who may be at risk and trying to eliminate risk factors / change lifestyle e.g. reduce dietary cholesterol, stop smoking, alcohol, control HT, BMI. Before starting treatment need to assess renal and liver function.
Will be screened and if CV risk of over 10% will start treatment with low dose statin

Question 9

What is secondary prevention?

Answer 9

In peolple with established CVD (already had MI or unstable angina), start stain treatment to manage modifiable risk factors.

Question 10

What is the MoA of statins?

Answer 10

Competitive inhibitor of HMG-CoA reductase - involved in the first rate limiting step in the production of cholesterol in the mevalonte pathway in the liver. They also increase the expression of LDL receptors = more of the “bad cholesterol” is taken up from the blood.

Question 11

List 4 benefits of statins in the body

Answer 11

1. ) Improve endothelium stability - reduce plaque formation
2. ) Maintain plaque stability
3. ) Prevent the formation of a thrombus
4. ) Modulate inflammatory responses

Question 12

What is the treatment for primary prevention?

Answer 12

Atorvastatin 20mg OD

Question 13

What is the treatment for secondary prevention?

Answer 13

Atorvastatin 80mg OD for life

Question 14

What is the aim of statin therapy?

Answer 14

To reduce the levels of non-HDL cholesterol by 40% after 3 months

Question 15

What is familial hypercholesterolaemia ?

Answer 15

Mutation in the LDL receptors = less LDL is taken up from circulation

Question 16

What is a common SE of statin treatment?

Answer 16

Pain, tenderness and weakness of muscles

Question 17

What fruit should be avoided when taking statins and why?

Answer 17

Grapefruit juice. Statins are metabolised in the liver by CYP3A. Grapefruit inhibits CYP3A = increases plasma levels.