CVD - HYPERLIPIDAEMIA

Question 1

What is a QRISK score?

Answer 1

Assesses CVD risk in patients aged 84 and under

Question 2

Which patient groups are NOT suitable for QRISK?

Answer 2

T1DM, Established CVD, >85, CKD eGFR (<60ml/min), Familial hypercholestrolaemia

Question 3

Which drugs cause hypercholestrolaemia?

Answer 3

Antipsychotics, Corticosteroids, Antiretrovirals (HIV drugs), Immunosuppressants = ACAI

Question 4

What are the risk factors for high cholesterol?

Answer 4

Hypothyroidism, Liver or kidney disease, DM, Family history, Lifestyle

Question 5

What are the general guidelines for high cholesterol (refer to NICE for detail)?

Answer 5

Primary prevention - Atorvastatin 20mg

Secondary prevention - Pts often started on Atorvastatin 80mg. Lower dose is used if there are drug interactions.

Alternative to Atorva = Ezetemibe

If severe = add ezetemibe onto statin therapy

Question 6

What are the categories of lipid regulating drugs?

Answer 6

Statins

Fibrates (bezafibrate, fenofibrate, gemfibrozil)

Ezetemibe

Bile acid sequestrants (colesevelam, colestipol, colestyramine)

Omega 3 fatty acids (lomitapide, alirocumab)

Question 7

What is the general treatment for moderate hypertriglyceridemia?

Answer 7

Statin

If contraindicated - fibrate

If high - add fibrate or nicotinic acid

Question 8

What are the side effects of statins?

Answer 8

Myopathy, myositis, rhabdomyolysis

Question 9

Before starting a statin, if the patient is complaining of muscle pain what do you do?

Answer 9

Measure creatinine kinase

If its more than 5 times the normal limit, measure again after 7 days. If its still high don’t start the statin

If <5 - start at a low dose

Question 10

What can lead to an increased risk of myopathy?

Answer 10

Concomitant ezetemibe or fibrates, especially gemfibrozil

Concomitant use with fusidic acid - stop statin and restart 7 days after last fusidic acid dose

Question 11

What do you monitor if a pt is on a statin?

Answer 11

Baseline liver profile

Renal and thyroid function

HbA1c if pt at risk of developing diabetes

Severe muscle symptoms

If liver transaminases are more than 3x normal then discontinue statin

If creatinine kinase are more than 5x normal then discontinue statin

Question 12

What are the interactions with statins?

Answer 12

Macrolides - increase risk of myopathy - stop statin until course has finished

Ezetemibe and fibrates

Fusidic acid - restart statin 7 days after last fusidic acid dose

Inhibitors e.g. amiodarone, CCBs, grapefruit juice

Question 13

What are the interactions of bile acid sequestrants (colesevelam, colestipol, colestyramine)?

Answer 13

Impairs absorption of fat soluble vitamins ADEK and other drugs

Take other drugs 1 hour before (4 hours for colesevelam) or 4 hours after bile acid sequestrants