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Endocrine > Dyslipidaemia > Flashcards

Dyslipidaemia Flashcards

1
Q

Define Dyslipidaemia?

A

Elevation of plasma cholesterol, triglycerides or both

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2
Q

What is the aetiology of Dyslipidaemia?

A

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

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3
Q

What are the risk factors for Hyperlipidaemia?

A

Family history of hyperlipidaemia
Corneal arcus < 50 yrs old
Xanthomata or Xanthelesmata

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4
Q

What are the different types of Hyperlipidaemia?

A

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

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5
Q

What is Secondary Hyperlipidaemia due to?

A

Cushing;s Syndrome
Hypothyroidism
Nephrotic Syndrome or cholestasis

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6
Q

What is Mixed Hyperlipidaemia due to?

A

T2DM
Metabolic syndrome
Alcohol abuse
Chronic renal failure

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7
Q

What is the epidemiology of Dyslipidaemia?

A

Half the UK population have a serum cholesterol putting them at significant risk of CVD

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8
Q

What are the presenting symptoms of Dyslipidaemia?

A

Dyslipidaemia itself doesn’t usually cause symptoms but can lead to symptomatic vascular diseases such as coronary artery disease, stroke and peripheral vascular disease

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9
Q

What are the signs of Dyslipidaemia?

A 
Corneal Arcus 
Xanthomas 
Familial Hypercholesterolaemia
Xanthelasma
Milky white appearance of retina
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10
Q

What is a Corneal Arcus?

A

Xanthoma of the cornea

Grayish white opacification at the periphery of the cornea

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11
Q

What are Xanthomas?

A 
Tendinous
Especially:
Achilles Tenon 
Elbow and knee Tendons
All over metacarpophalangeal joints
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12
Q

What other sign is associated with Familial Hypercholesteroaemia?

A

May also have planar (orange streaks in palmar crease) and tuberous (plaques on elbows and kness) xanthomas

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13
Q

What is Xanthelasma?

A

Xanthoma of the eyelid

Yellowish plaques occuring mostly commonly near inner canthus of the eyelid

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14
Q

When is the Milky white appearance of the retina commonly seen?

A

At very high TG levels

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15
Q

What investigations would you do for Dyslipidaemia?

A

FBC
Fundoscopy
Tests for secondary causes of Dyslipidaemia

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16
Q

What specifically would you look at in a FBC for Dyslipidaemia?

A

Serum lipid profile:

  • Measured total cholesterol
  • TG
  • HDL
  • Cholesterol
  • Calculated LDL cholesterol
  • VLDL
17
Q

What tests would you do to find out the secondary causes of Dyslipidaemia?

A 
Fasting glucose
HbA1c
Liver enzymes 
Creatinine 
TSH 
Urinary Protein
18
Q

How do we screen for Dyslipidaemia?

A

Screening involves fasting lipid profile

Screen all those a risk of hyperlipidaemia or of CVD

19
Q

How can treatment differ in Dyslipidaemia?

A

Differ for familial or secondary hyperlipidaemia

20
Q

What it the management plan for Dyslipidaemia?

A

Lifestyle Advice

Medications

21
Q

What lifestyle advice do we give for Dyslipidaemia?

A

Aim for BMI 20-25
Diet with <10% calories from saturated fat, high fibre, fresh fruit and veg, omega-3 fatty acids
Exercise

22
Q

What medications do you give for Dyslipidaemia?

A

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

23
Q

What are the treatment priorities for Dyslipidaemia?

A

1st Priority: All those with known CVD
2nd Priority: All those with DM
3rd Priority: Those with 10 yr risk of CVD >20%

24
Q

Why do we have a treatment priority for Dyslipidaemia?

A

Using stating in primary prevention may cause side-effects and expensive

25
Q

What is the aim of treatment in Dyslipidaemia?

A

Aim for target plasma cholesterol of less than or equal to 4 mmol/L

26
Q

What are the possible complications of Dyslipidaemia?

A 
Coronary Artery Disease
Stroke
Peripheral Vascular Disease 
Very high levels of TGs can cause pancreatis
Statin toxicity
27
Q

What is the prognosis for patients with Dyslipidaemia?

A 
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

Endocrine (29 decks)

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