Clinical aspects of lipids Flashcards
Define each of the following clinical terms:
- Xanthomata
- Xanthelasma
- Corneal arcus
- Milky blood/serum
- Xanthomata - is a deposition of yellowish cholesterol-rich material that can appear anywhere in the body in various disease states.
- Xanthelasma - are yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Xanthelasma palpebrarum is the most common cutaneous xanthoma.
- Corneal arcus - It’s a condition you get when cholesterol forms deposits around the outside of your cornea – the clear cover over the front of your eye. It looks like a white or gray ring around the iris – the colored part of your eye.
- Milky blood/serum
What do xanthomata characterisitcally signify ?
Hyperlipidaemia
Can xanthelasma be seen in patients without an underlying lipid abnormality ?
Yes
For patients aged ≤ 84 years, what should be done to assess their CVD risk?
The QRISK2 CVD risk assessment tool
When should the QRISK2 score not be used to assess someones risk of CVD ?
- Patients with T1DM
- Patients with an eGFR < 60 &/or albuminuria
- Patients with a history of familial hyperlipidaemia
- Patients ≥ 85 years are at high risk of CVD already due to their age.
What lipid levels are measured when using the QRISK2 score to calculate someones CVD risk?
Total cholesterol and HDL
For primary prevention of CVD what should all patients with the following recieve:
- All patients with a QRISK2 10-year risk of ≥ 10%
- T1DM (>40 y/o or with disease for > 10years)
- All patients with CKD
Atorvastatin 20mg should be offered first-line.
What should all patients with known CVD be taking as secondary prevention of further CVD ?
Atorvastatin 80mg should be offered first-line.
What should also be ckecked besides total cholestrol & HDL before starting a statin ?
A full lipid profile (Total cholesterol, HDL cholesterol, non‑HDL cholesterol and triglyceride concentrations)
What lifestyle modifications should be made for someone with hyperlipidaemia ?
- Cardioprotective diet
- Reduce alcohol intake, stop smoking, follow recommended guidelines for exercise
List the main points of the cardioprotective diet
- Total fat intake should be ≤ 30% of total energy intake
- Saturated fats should be ≤ 7% of total energy intake
- Intake of dietary cholesterol should be < 300 mg/day
- Saturated fats should be replaced by monounsaturated and polyunsaturated fats where possible
- Replace saturated and monounsaturated fat intake with olive oil, rapeseed oil or spreads based on these oils
- Choose wholegrain varieties of starchy food
- Reduce their intake of sugar and food products containing refined sugars including fructose
- Eat at least 5 portions of fruit and vegetables per day
- Eat at least 2 portions of fish per week, including a portion of oily fish
- Eat at least 4 to 5 portions of unsalted nuts, seeds and legumes per week
What is familial hypercholestrolaemia ?
An autosomal dominant conditions which results in high levels of LDL-cholesterol which, if untreated, may cause early cardiovascular disease (CVD).
When should familial hypercholestrolaemia be suspected in adults ?
If they have:
- A total cholesterol concentration more than 7.5 mmol/litre and
- A family history of premature coronary heart disease (<60 y/o)
Arrange for specialist assessment of people with a total cholesterol > 9.0 or a non‑HDL cholesterol > 7.5 even in the absence of a first‑degree family history of premature coronary heart disease.
When should familial hypercholestrolaemia be suspected in children?
- If one parent is affected, arrange testing in children by age 10
- If both parents affected, arrnage testing by age 5
How is familial hypercholestrolaemia diagnosed ?
In adults total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l or children TC > 6.7 mmol/l and LDL-C > 4.0 mmol/l, plus:
- for definite FH: tendon xanthoma in the patient or 1st or 2nd degree relatives or DNA-based evidence of FH
- for possible FH: family history of MI < 50 years in 2nd degree relative, < 60 in 1st degree relative, or a family history of raised cholesterol levels
