dyslipidaemia Flashcards
what does total cholesterol include?
VLDL, LDL, and HDL
what are the desirable levels for total cholesterol, LDL, and TGs?
total <5, LDL <2.5, TG <2.5
what in the diet tends to raise LDL?
high trans fats and saturated fats (eg butter, cream, animal fat, fried foods)
what in very basic terms do LDL and HDL do?
LDL clogs arteries and HDL removes bad cholesterol from arteries
what are the desirable HDL levels?
> 1.2 in women, >1 in men
higher the better
what is the desirable total cholesterol /HDL ratio?
<4
what are the primary causes of dyslipidaemia?
genetic dyslipidaemia
familial hypercholesterolaemia
what are the secondary causes of dyslipidaemia?
uncontrolled diabetes
obesity, hypothyroidism
smoking
liver disease, excess alcohol intake, nephrotic syndrome
what are some signs of high cholesterol in the body?
tendon
xanthomata
xanthelasmata
corneal arcus
which sign is the most suggestive of familial hypercholesterolaemia?
tendon xanthomata
where are xanthelasmata found?
eyelids
what is corneal arcus?
light ring around iris caused by cholesterol deposits
how do you diagnose FH?
1) take 2 measurements if LDL concentration
clinical diagnosis levels = >13 in adult, >11 in child up to 15yo.
2) use simon broome criteria/dutch lipid network to aid diagnosis
DLCN score >5
3) if clinical diagnosis based on these, refer to specialist for definitive diagnosis
what is the non pharmacological management for high cholesterol?
dietary modifications -replace sat/trans fat with unsaturated fats (avocadoes, olive oil, peanut oil)
lower alcohol
lose weight
stop smoking
more exercise
who is atorvastatin 20mg ON offered to for secondary prevention?
- people with 10%+ QRISK3 score
- people with <10% risk but dyslipidaemia-clinical judgement.
- T1DM +age >40/diabetes for >10y/established nephropathy/CVD risk factors
- people with CKD
what are people with CVD offered for secondary prevention?
atorvastatin 80mg ON
what is the cholesterol target for people on statins?
> 40% reduction in non HDL cholesterol
what reviewing do people on statins need?
annual reviews
ALT 3 and 12 months after starting them
what is the 1stline treatment for FH?
high intensity statin with aim of 50% reduction in LDL from baseline
what is the definition of a high intensity statin?
dose at which a reduction in LDL-cholesterol of greater than 40% is achieved
what are some examples of lipid soluble statins?
atorvastatin, simvastatin
what is a v rare but serious side effect to look out for with statins?
rhabdomyolysis -always do ck if they have any muscle sx.
what is the treatment pathway for FH?
1stline -statin
2ndline -add ezetimibe if tolerating statin, just ezetimibe if statin not good for them
3rdline -specialist led -consider fibrates or bile acid sequestrants
what are 2 examples of fibrates?
fenofibrate
gemfibrozil
what is a risk of fibrates +statins?
muscle related SEs-use with caution together and can’t use gemfibrozil -too big risk
what do you need to do before starting lipid meds?
rule out secondary causes
one full lipid profile (doesn’t need to be fasting)
which levels of cholesterol would prompt specialist assessment?
total cholesterol >9 or non HDL >7.5
which levels of TG would prompt urgent specialist review?
> 20 not explained by excess alcohol or poor glycaemic control
what do you do if someone’s TG levels are between 10 and 20?
do fasting TG measurement 5d-2w after and seek specialist advice if it remains above 10.
