Dyslipidaemias: diagnosis, pharmacotherapy and prevention

Question 1

causes of secondary dyslipidaemia

Answer 1

diabetes, hypothyroidism, CKD, Chronic liver disease, Obesity, smoking, meds (bendroflumethiazide), alcohol excess (high TGs)

Question 2

causes of primary dyslipidaemia

Answer 2

high intake, high synthesis, abnormal lipoprotein structure, abnormal lipoprotein receptors.

Question 3

Arcus Senilis

Answer 3

corneal arcus: present in >50% aged>50. can be a sign of dyslipidemia in pts <45 years

Question 4

Fredrickson Classification different types diseases

Answer 4

familial hypercholestraemia type I, familial hypercholestraemia type IIa, familial combined hyperlipidaemia type IIb, familial dysbetalipoproteinaemia type III, familial hypertriglyceridaemia type IV

Question 5

familial hypercholestraemia type I

Answer 5

elevated chylomicrons, low LDL or ApoC-II, normal to high levels of cholesterol levels and HIGH triglycerides

Question 6

familial hypercholestraemia type IIa

Answer 6

elevated LDL, low LDL receptors, high cholesterol, normal triglyceride

Question 7

familial combined hyperlipidaemia type IIa

Answer 7

elevated LDL+VLDL, high ApoB-100, high cholesterol and high TGs

Question 8

familial dysbetalipoproteinaemia type III

Answer 8

elevated IDL + chylomicrons, APoE mutation, high cholesterol, HIGH TGs

Question 9

familial hypertriglyceridaemia type IV

Answer 9

elevated VLDL, abnormality unknown, normal to high cholesterol and high TGs

Question 10

familial hypercholestraemia type IIa

Answer 10

high cholesterol and normal TG

1. 0.5% of the population
2. autosomal dominant
3. very high LDL cholesterol (>5)
4. consider diagnosis if total cholesterol (7.5)
5. triglyceride near normal
6. due to specific mutations that lead to absence or low levels or LDL receptors.
7. causes severe atherosclerosis-> may see IHD in young adults , esp men

Question 11

familial combined hyperlipidaemia IIa

Answer 11

high cholestrol and high TGs

1. c.10% of the population
2. autosomal dominant
3. moderately high levels of both cholestrol and TGs
4. insulin resistance and obesity
5. all the bad lipids are elevated LDL, VLDL, TGs
6. multiple genetic defects, commonly polygenetic
7. most involve the overproduction of ApoB-100
8. accounts for 20% premature IHD

Question 12

familial hypertriglyceridaemia IV

Answer 12

normal cholesterol and high TGs

1. 1% of the population
2. high TGs (>5)-> relatively normal cholestrol -> HDL often low
3. insulin resistance and obesity
4. risk of acute pancreatitis if TG>10-> due to pancreatic capillary obstruction
5. not strongly associated with IHD
6. multiple genetic defects

Question 13

familial hypercholestraemia type I

Answer 13

1. due to lipoprotein lipase deficiency (autosomal recessive)
2. very high TG, normal cholestrol
3. spun blood is creamy
4. pancreatitis, not IHD

Question 14

familial dysbetalipoproteinaemia type III

Answer 14

1. due to a deficiency of ApoE (autosomal recessive)
2. poor lipoprotein clearance by the liver
3. chylomicrons and LDL remain in the blood
4. modest elevations of cholesterol and TGs
5. high risk of IHD
6. palmar xanthomas