CVR 15 hyperlipidaemia Flashcards
what is the absolute benefit of statin therapy
lowering LDL by 2mmol for 5 years in 10 thousand prevent major vascular event in 1000 10%
Should we use tredaptive which is a combination of nicotinic acid and laropiprant?
No in 2012 25000 patents saw a worse effect and was recalled in 2013
How are bile acid binding resins used
in conjunction with statin if patient fails to repsond. 13% decrease in cholesterol
What are the side effects of bile acid binding resin
bloating and dyspepsia and can interfere with drug absorbitoion
What does bile acid do
Very safe and not absorbed in gut. They increase LDL receptor activity
What do fibrates do?
Clofibrate, fenofibrate, Bexafibrate, gemfibrozil incrase activity of peripheral lipoprotein lipase which reduces VLDL producition and uptake of LDL. Decreases TG and mild increase in HDL
Whats an adverse effect of combining gemfibrozil and statin
GI disturbance
Myotoxicity
elevated liver enzyme
How do fibrates work
probably ivovled PPAR transcription factor which regulates lipid metabolism
What drugs interfere with statin oxidation
Those metabolised by CYP3A4 Gemfibrozil macrolide antibiotic (erythromycin) Azole antifungals cyclosporine Amioderone HIVE protease inhibitor
What are the proven adverse effects of statins
myopathy
diabetes 100/10000
strokes 10/10000
What is myopathy
muscle pain and wekaness due to blood increase of CK
What are the most potent drugs at reducing LDL cholestoerl
HMG CoA reductase inhibitors
ACE
Whats the best drug at raising HDL
nicotinic acid
What is most effective at lowering triglycerides
Fibrates
What are the secondary causes of hyperlipidemia
DM hypothyroid obesity alchohol Renal Liver Drugs - thiazides steroids
How do we classify hyperlipdeamia
frederickson - which protein is increased
Primary and Secondary
How are triglycerides assosiated with CHD events
related to low HDL and high athergenic LDLD
When to use bariatric and drugs
drugs bmi over 30 and 1 assosiated comorbid condition
surgery - above 40 bmii and have not responded to drugs
obesity is over 30
Risks of obesity
hypertension dslipidemia DM type 2 CHD stroke gall baldder osteoarthritis apnea cancer
What are the 4 statin benefit groups
1 = ASCVD 2= LDL over 4.9 3 = 40-75 yrs with diabetes and LDLC 1.8-4.8 4 = ASCVD or diabetes 40-75 with 10 year ASCVD risk of 7.5% or more
What drugs rais HDL and whats the problem
Torcetrapib japanese island. May raise `bp
CETP chelsterol ester transfer prtoent
How do we classify lipoprotiens
Density chylomicron VLDL IDL LDL HDL
Structure of lipoproteins
They are made up of a central hydrophobic lipid core (TG and cholesterol esters) encased in a hydrophilic coat (phospholipids, free cholesterol and apolipoproteins)
Water insoluble lipids are core components, Water soluble components etc on outside.
What do lipoproteins do
transport triglycerides and cholesterol.
Central hydrophobic lipd co
