Hyperlipidaemia

Question 1

Aetiology of Predominantly Hypertriglycerideaemia (6).

Answer 1

1. Diabetes Mellitus.
2. Obesity.
3. Alcohol.
4. Chronic Renal Failure.
5. Medications : Thiazides, Non-Selective B-Blockers, Unopposed Oestrogen.
6. Liver Disease.

Question 2

Aetiology of Predominantly Hypercholesterolaemia (3).

Answer 2

1. Nephrotic Syndrome.
2. Cholestasis.
3. Hypothyroidism.

Question 3

Clinical Features of Hyperlipidaemia.

Answer 3

1. Xanthomata.

2. Xanthelasma.

Question 4

What is a Xanthelasma?

Answer 4

Yellowish papule and plaque caused by localised accumulation of lipid deposits commonly seen on the eyelid.

Question 5

Management of Xanthelasmata (4).

Answer 5

1. Surgical Excision.
2. Topical Trichloroacetic Acid.
3. Laser Therapy.
4. Electrodesiccation.

Question 6

Sites of Xanthomata (2).

Answer 6

1. Palmar Xanthoma - rare in familial.
2. Tendon Xanthoma - commoner in familial.
3. Eruptive Xanthoma - extensor surfaces (red/yellow vesicles).

Question 7

Aetiology of Eruptive Xanthoma (2).

Answer 7

1. Familial Hypertriglycerideaemia.

2. Lipoprotein Lipase Deficiency.

Question 8

Investigations of Familial Hypercholesterolaemia (2).

Answer 8

1. Total Cholesterol > 7.5.

2. Personal/Family History of Premature Coronary Heart Disease.

Question 9

Management of Hyperlipidaemia.

Answer 9

1. Primary Prevention - Atorvastatin 20mg OD.

2. Secondary Prevention - Atorvastatin 80mg OD.

Question 10

What tool is used to identify those at risk of CVD?

Answer 10

QRISK2 CVD Risk Assessment Tool - 10 year risk of 10% or greater.

Question 11

Who can this tool be used in?

Answer 11

In patients below the age of 85 - cannot use in Type I Diabetics, eGFR < 60/Albuminuria, Familial Hyperlipidaemia.

Question 12

Monitoring with Statin Drugs.

Answer 12

1. Full Lipid Profile before Starting.
2. At 3 Months - Repeat Full Lipid Profile, non-HDL Cholesterol should fall by at least 40% concordance.
3. Check Baseline LFTs, 3 months and 12 months and stop if Transaminase rises above and PERSISTS at 3x upper limit of normal.

Question 13

Mechanism of Action of Statin.

Answer 13

Inhibit action of HMG-CoA Reductase - rate-limiting enzyme in hepatic cholesterol synthesis.

Question 14

Indications of Statin (4).

Answer 14

1. Established CVD.
2. QRISK2 > 10%.
3. Type II Diabetes Mellitus.
4. Type I Diabetes Mellitus/CKD.

Question 15

Contraindications of Statins (2).

Answer 15

1. Macrolide Use e.g. Clarithromycin (Statin-Induced Myopathy (increased CK)).
2. Pregnancy.

Question 16

Adverse Effects of Statins (3).

Answer 16

1. Myopathy - Myalgia, Myositis, Rhabdomyolysis, Asymptomatic Raised CK.
2. Liver Impairment (LFTs).
3. Intracerebral Haemorrhage.

Question 17

Intake of Statins.

Answer 17

At night = majority of Cholesterol synthesis takes place.