Hypercholesterol + Statins

Question 1

What is familial hyper cholesterol

Answer 1

AD

Resulting in high levels of LDL and early CVD disease

Question 2

When do you suspect

Answer 2

Cholesterol >7.5

FH or personal of premature IHD <60

Question 3

What criteria to Dx

Answer 3

Simon Broome

Question 4

What is diagnostic

Answer 4

Total >7.5
LDL >4.9
Tendon xanthoma

Question 5

How do you treat

Answer 5

Specialist lipid clinic

High dose statin = 1st line

Question 6

What else can be used

Answer 6

Ezetimibe - lipid lowering drug if statin CI or not controlled

Question 7

What else should you do

Answer 7

Screen relatives

Children at 10 if one parent or 5 if both parents

Question 8

What causes hyperlipidaemia

Answer 8

DM
Obesity
Alcohl
Chronic renal / liver
Thiazide
BB
Unopposed oestrogen

Question 9

What causes hyper cholesterol

Answer 9

Nephrotic
Cholestasis
Hypothyroid

Question 10

What score is used to calculate risk

Answer 10

QRISK 2 or ASSIGN

Question 11

What else should you do

Answer 11

Total cholesterol and HDL

Question 12

What do you do before starting a statin

Answer 12

Full lipid profile

Question 13

When do you follow up

Answer 13

3 months with full lipid

Increase dose if not fallen 40%

Question 14

What are lifestyle factors

Answer 14

Diet
Exercise - 150 minutes + 2 strength
Weight loss
Alcohol
Quit smoking

Question 15

What is given as primary prevention

Answer 15

Artovastatin 20mg OD

Question 16

Who gets a statin as primary prevention

Answer 16

10 year CVS risk >20%
Type 1 DM
CKD <60

Question 17

What DM

Answer 17

> 40
10 years
Nephropathy
Other RF

Question 18

What is given as secondary prevention

Answer 18

Atorvastatin 80mg

Question 19

Who gets 2 prevention

Answer 19

Known IHD / cerebrovascular / PAD

Question 20

What is bad cholesterol

Answer 20

LDL

Triglycerides

Question 21

What is good cholesterol

Answer 21

HDL

Question 22

What is dangerous levels

Answer 22

Total = 5+ 
- If >8 need treatment with statin
- If 5-8 can try diet control 
LDL = 3+
Triglycerides = 2.3+

Question 23

What are SE of statin

Answer 23

LFT dysfunction
Rhabdomyolysis leading to AKI
Type II DM
Haemorrhage = rare

Question 24

What do you do if patient on statin and has muscle pain

Answer 24

Stop

Check CK

Question 25

How do you monitor when starting on statin

Answer 25

Baseline LFT and 3 months and 12 months

Lipid profile