Dyslipidaemia

Question 1

2 types

Answer 1

Familial and acquired

Question 2

Acquired causes:
Endocrine
Hepatic 
Renal 
Others

Answer 2

Hypothyroidism, hypopituitarism

Alcohol excess
Cholestasis

Nephrotic syndrome
CKD

Pregnancy
Anorexia
Gout

Question 3

What is xanthoma?

Signs:

• eyelids
• eyes - the white ring can happen around the iris. what is this called? - THIS IS ONLY PATHOLOGICAL WHEN SOMEONE IS UNDER 45.
• what is tendon xanthoma
• Xanthoma tuberous can occur. Where does this happen?
• palms and flexures

Answer 3

Lipid deposits

Xanthelasma - also seen in smokers

Corneal arcus and retinal deposits

Achilles and digital extensor tendons have deposits (run finger and thumbs along to feel for lumps)

Knnes and elbows

Palmar Xanthoma

Question 4

Investigations

Answer 4

Lipid profile
Kidney disease tests - U&E, urinalysis,

LFT
TFT
Glucose
Uric acid - gout - can cause hyperlipidaemia

Question 5

Management

Answer 5

Consider secondary cause 
Look for familial cause 
Carry out CV risk assessment - QRISK 2 
Lifestyle changes 
Meds after all this tried

Question 6

Statins:

Examples - 3 s, a, r

Indications

Why do you take them in the evening?

Answer 6

Simvastain
Atorvastatin - usually first line
Rosuvastatin

Increased CVD risk

When most cholesterol is synthesised

Question 7

Statins:

What monitoring is needed?

What is one big side effect of it?

Other side effects

Answer 7

LFT’s at 3 and 12 months
Lipid levels - aiming for 40% reduction

Myalgia due to raised CK

Hepatitis 
Rash 
GI symptoms 
Altered sleep 
DM

Question 8

How is familial hypercholesterolaemia diagnosed?

What score can be used to guide diagnosis?

Answer 8

Diagnosis of exclusion

Dutch Lipid Scoring - Diagnostic criteria for Familial Hypercholesterolemia