Dyslipidaemia Flashcards
What is dyslipidemia?
The elevation of Cholesterol, Triglycerides or both; or the lowering of HDL, which contributes to atherosclerosis
What are apoproteins function?
Stabilization of lipoproteins
Regulator of lipoprotein metabolism
Secretion of lipoproteins
Carry protective effect to prevent atherosclerosis
What mainly causes high LDL plasma levels?
Low LDL receptor activity or receptor defects
HDL’s two fold protective effect
Reverse cholesterol transport
Anti oxidative activity
Altered TG levels increase risk of?
Pancreatitis
Retinal vein thrombosis
What drugs can cause dyslipidaemia?
Steroid hormones
Retinoic acids
HAART
Lipoprotein status of Primary isolated hypertriglyceridemia
High VLDL output by liver
High ratio of TG to ApoB
HDL & LDL levels are low.
Recurrent abdominal pain and pancreatitis
What is the treatment of Primary isolated hypertriglyceridemia and what is it aimed at?
Fibrates, Fish oils & Nicotinic Acid
Treatment aimed at reducing risk pancreatitis
What is the treatment of Familial hypercholesterolemia?
Aggressive lipid lowering
Typical features of metabolic syndrome
Abdominal obesity
Hypertension
Abnormal lipid profile
High glucose levels
Lipid profile of metabolic syndrome
High TG
Low HDL
High Apo B
Statins are used in what level of prevention?
Secondary
Who needs secondary prevention?
DM 1 with target organ damage DM 2 Familial hypercholesterolemia Chronic kidney disease Established CVD
WHen would you need an immediate drug intervention?
High risk >2.5 LDL
Very high risk >1.8 LDL
What lipid lowering drug is used for predominant hypercholesterolaemia?
Statin
Bile acid sequestrants
In primary dyslipidaemia, what does lipid lowering treatment try to achieve?
LDL-C 50% reduction
What dietry factors promote CVD?
Saturated fatty acids Trans fatty acids Total cholesterol (LDL) High sodium intake Excessive alcohol intake
Mechanisms of omega 3
Decrease arrhythmias
Antithrombotic
Decrease T-chol and TG
Inhibit atherosclerotic inflammation
Increase HDL
Exercise
Healthy diet
Stop smoking
Moderate alcohol intake
Risks of treatment
Muscle damage
Liver damage
Cost
Who should be treated?
Secondary prevention candidates
When is the Framingham algorithm used?
In primary prevention
What treatment strategy is used in primary prevention?
Treat cause of dyslipidaemia
Lifestyle modification
Modify other risk factors
What drug Rx is used for predominant hypertriglyceridaemia?
Fibrate therapy Nicotinic acid (not tolerated well)
What statin is low risk and cost and has a long half-life?
Atorvastatin
When are statin usually given and why?
At night as this is when cholesterol synthesis peaks
AE of fibrates
GIT symptoms
Raised liver enzymes
Myopathy
What is the function of Ezetimibe?
Cholesterol absorption inhibitor
AE of nicotinic acid?
Intense cutaneous flushing (take aspirin before)
Loss of glycaemic control
High pill burden
