Dyslipidaemia Flashcards
Define Dyslipidaemia?
Elevation of plasma cholesterol, triglycerides or both
What is the aetiology of Dyslipidaemia?
Lipid travels in blood packaged with proteins as lipoproteins
There are 4 classes:
Chylomicrons, VLDL (mainly TG), LDL (Mainly cholesterol) and HDL (mainly phospholipid)
Evidence shows that cholesterol is a big risk factor for CVD
HDL correlates inversely with CVD
What are the risk factors for Hyperlipidaemia?
Family history of hyperlipidaemia
Corneal arcus < 50 yrs old
Xanthomata or Xanthelesmata
What are the different types of Hyperlipidaemia?
Common Primary Hyperlipidaemia: accounts for 70% of hyperlipidaemia. Only LDL high
Familial primary hyperlipidaemia: multiple phenotypes
Secondary hyperlipidaemia - Treat cause first. LDL high
Mixed Hyperlipidaemia- Both LDL and TG high
What is Secondary Hyperlipidaemia due to?
Cushing;s Syndrome
Hypothyroidism
Nephrotic Syndrome or cholestasis
What is Mixed Hyperlipidaemia due to?
T2DM
Metabolic syndrome
Alcohol abuse
Chronic renal failure
What is the epidemiology of Dyslipidaemia?
Half the UK population have a serum cholesterol putting them at significant risk of CVD
What are the presenting symptoms of Dyslipidaemia?
Dyslipidaemia itself doesn’t usually cause symptoms but can lead to symptomatic vascular diseases such as coronary artery disease, stroke and peripheral vascular disease
What are the signs of Dyslipidaemia?
Corneal Arcus Xanthomas Familial Hypercholesterolaemia Xanthelasma Milky white appearance of retina
What is a Corneal Arcus?
Xanthoma of the cornea
Grayish white opacification at the periphery of the cornea
What are Xanthomas?
Tendinous Especially: Achilles Tenon Elbow and knee Tendons All over metacarpophalangeal joints
What other sign is associated with Familial Hypercholesteroaemia?
May also have planar (orange streaks in palmar crease) and tuberous (plaques on elbows and kness) xanthomas
What is Xanthelasma?
Xanthoma of the eyelid
Yellowish plaques occuring mostly commonly near inner canthus of the eyelid
When is the Milky white appearance of the retina commonly seen?
At very high TG levels
What investigations would you do for Dyslipidaemia?
FBC
Fundoscopy
Tests for secondary causes of Dyslipidaemia
What specifically would you look at in a FBC for Dyslipidaemia?
Serum lipid profile:
- Measured total cholesterol
- TG
- HDL
- Cholesterol
- Calculated LDL cholesterol
- VLDL
What tests would you do to find out the secondary causes of Dyslipidaemia?
Fasting glucose HbA1c Liver enzymes Creatinine TSH Urinary Protein
How do we screen for Dyslipidaemia?
Screening involves fasting lipid profile
Screen all those a risk of hyperlipidaemia or of CVD
How can treatment differ in Dyslipidaemia?
Differ for familial or secondary hyperlipidaemia
What it the management plan for Dyslipidaemia?
Lifestyle Advice
Medications
What lifestyle advice do we give for Dyslipidaemia?
Aim for BMI 20-25
Diet with <10% calories from saturated fat, high fibre, fresh fruit and veg, omega-3 fatty acids
Exercise
What medications do you give for Dyslipidaemia?
1st line: statins e.g. simvastatin
2nd line: fibrates e.g. bezafibrate (usually in mixed hyperlipidaemia) or cholesterol absorption inhibitors e.g. ezetimibe
Hypertriglyceridaemia responds best to fibrates, nicotinic acid or fish oil
What are the treatment priorities for Dyslipidaemia?
1st Priority: All those with known CVD
2nd Priority: All those with DM
3rd Priority: Those with 10 yr risk of CVD >20%
Why do we have a treatment priority for Dyslipidaemia?
Using stating in primary prevention may cause side-effects and expensive
What is the aim of treatment in Dyslipidaemia?
Aim for target plasma cholesterol of less than or equal to 4 mmol/L
What are the possible complications of Dyslipidaemia?
Coronary Artery Disease Stroke Peripheral Vascular Disease Very high levels of TGs can cause pancreatis Statin toxicity
What is the prognosis for patients with Dyslipidaemia?
Good if controlled early Total Cholesterol: - < 200 mg/dL = normal -200 - 239: borderline high 240 or more: high
HDl:
- <40 mg/dL - lower than desirable
TG:
-< 150 mg/dL - normal
