FN: Hyperlipidaemia

Question 1

Chylomicrons

Answer 1

Mainly TG

Carry dietary TG tissues

Question 2

VLDL

Answer 2

Mainly TG

Take endogenous TG from liver to tissue

Question 3

LDL

Answer 3

Mainly cholesterol

Carry cholesterol form liver to tissues

Question 4

HDL

Answer 4

Mainly phospholipid

Take cholesterol from tissues - liver for excretion

Question 5

Apolipoproteins

Answer 5

Contained in lipiproteins and control transport and uptake

ApoB contained in LDL and binds to cell receptors - uptake

Question 6

Classification types

Answer 6

Common primary hyperlipidaemia
Familial primary hyperlipidaemia
secondary hyperlipidaemia

Question 7

Common primary hyperlipidaemia

Answer 7

70%
Dietary and genetic factors
Raised LDL only

Question 8

Familial primary hyperlipidaemia

Answer 8

Multiple phenotypes

Very high risk of CVD

Question 9

Secondary hyperlipidaemia

Answer 9

Raised LDL

Mixed

Question 10

Raised LDL

Answer 10

Nephrotic syndrome

• Cholestasis: lipoprotein x
• Hypothyroidism
• Cushings
• Drugs: thiazides, steroids

Question 11

Mixed

Answer 11

Raised LDL and raised TG

• T2DM
• EtOH
• CRF

Question 12

Familial primary hyperlipidaemias

Answer 12

1. primary hypercholesterolaemia
2. Combined hyperlipidaemia
3. Lipoprotein lipase deficiency
4. Hypertruglyceridaemia
5. Remnant particle disease

Question 13

Presentation

Answer 13

CVD
Xanthomata
Pancreatitis (Raised TG)

Question 14

Xanthomata

Answer 14

• Eruptive: itchy nodules in crops (raised TG)
• Tuberous: paques on elbows, knees
• Planar: ornage steaks in palmer creases: remnant hyperlipidiaemia
• Xanthelasma: eyelids
• Arcus: cornea

Question 15

Investigations

Answer 15

Plasma cholesterol
Plasma HDL
Fasting TGs
TC: HDL ratio is best predictor of CV risk

Question 16

Management aims

Answer 16

TC

Question 17

Mx lifestyle

Answer 17

Lose wt.
Reduced saturated fat, increased fibre, increased fruit and veg
Increased excercise

Question 18

Mx treatment priorities

Answer 18

Known CVD
Those with DM
Those with 10yr CVD risk >20% - irrespective of baseline lipids

Question 19

1st line Rx

Answer 19

Statins

e. g. simvastatin 40mg PO nocte
- -> HMG-CoA reductase inhibitors - reduced cholesterol synthess

Question 20

2nd line Rc

Answer 20

Fibrates:
Ezetimibe
Miacin/nicotinic acid

Question 21

Fibrates

Answer 21

PPARalpha, antagonists, reduces TG

Question 22

Ezetimibe

Answer 22

Inhibits cholesterol absorption

Question 23

Niacin/nicotinic acid

Answer 23

Raised HDL

Reduces LDL