Hypercholesterolaemia

Question 1

Pharmacological Management

Answer 1

1 - Statins
- Atorvastatin 80mg PO OD / Rosusvastatin / Simvastatin
- SE Muscle pain, ^ ALT
- If ALT > 3*ULN, reduce dose or change statin.
2 - Ezetimibe 10mg PO OD
- SE Muscle pain, mild ^ ALT
3 - Bile Acid Resins
- Cholestyramine 4mg PO OD
- Colestipol
- Contra: High Triglycerides. Will worsen them.
3 - Fenofibrates 145mg PO OD Dose adjustment to renal function
- Lowers TAGS
- Use in Diabetic Retinopathy

Question 2

Management of Statin-Associated muscle symptoms

Answer 2

CK > 5ULN?
- Cease statin for 6-8 weeks until symptoms resolve -> Low dose statin and titrate up.

CV < 5ULN
- Cease statin for 2-4 weeks until symptoms resolve the restart at same or lower dose.

Question 3

Non-pharmacological Management of Hypercholesterolaemia

Answer 3

• Reduce intake of saturated and trans fats
• Increase intake of soluble fibre
• Intoduce sterol-enriched milk / margarine and cheese products.
• Weight loss and exercise as per heart health guidelines.