Dyslipidaemias

Question 1

Background

Answer 1

Cholesterol can build up on arteries walls and become plaques causing narrow arteries which would restrict blood flow to organs like heart or brain.
- Plaques can rupture and cause blood clots.
- High cholesterol can cause atherosclerosis and increase risk of MI, Coronary arteries disease, stroke.

Cholesterol uses:
makes bile acid, steroid hormones, fat soluble vitamins (A,D,E,K)

Question 2

High cholesterol causes

Answer 2

Gender women r higher than men

Pregnancy

Diabetes - damaged arteries lining making cholesterol more likely to stick and make plaque.

Kidney disease High TC, low HDL more likely to have reduced GFR

PCOS

Under reactive thyroid gland

Drugs: contraceptives, diuretics, beta-blockers, anti-depressants

Question 3

Hypercholesterolaemia and hypertriglyceridaemia (BNF)

Answer 3

1st line - Statin for hypercholesterolemia and moderate hypertriglyceridaemia.

Severe forms of the conditions that NOT controlled with MAX statin dose may need extra treatment with lipid regulating drug like ezetimibe.

Statin are more effective that other lipid regulating drugs at lowering LDL conc. BUT less effective than Fibrates (fenofibrate, bezafibrate) for reducing triglyceride conc.
- Can ADD fenofibrate to statin if triglyceride stay high after LDL is reduced well.

Question 4

Familial hypercholesterolaemia (FH)

Answer 4

Lifelong lipid-modifying therapy and lifestyle advice should be offered to all patients with FH.

FH treatment
1st line High intensity statin
- Titrate up.
ALT ezetimibe alone.

Ppl with heterozygous FH
IF MAX statin dose fails/ Statin change is considered THEN OFFER combo of statin + ezetimibe.
- Treating with fibrate or a bile acid sequestrant (colestyramine or colestipol) Considered (specialist) if statin or ezetimibe inappropriate.

Statin + Fibrate = increase risk of muscle AEs (rhabdomyolysis). only used with specialist.
AVOID gemfibrozil + statin too high increase of muscle AEs.

Primary heterozygous FH where everything above fails - Alirocumab and evolocumab.

Homozygous FH only done with specialist.

Question 5

Cholesterol ideal ranges

Answer 5

Total cholesterol - <5mmo/L
LDL C - <3.5mmol/L
HDL C - >1mmol/L
Triglycerides - <1.7mmo/L

Higher risk people:
Total - <4mmol/L
LDL C - 2mmol/L

Question 6

Other times statins used

Answer 6

NICE -
Primary prevention for ppl with QRISK3 >10% - Atorva 20mg

Secondary prevention:
CVD - usually atorva 80 but if have CKD atorva 20.