Hyperlipidaemia Flashcards
Lipid modification
- Reduction of CVD which is caused by blood clots
Atherosclerosis
- Build up of fatty deposits in artery causing it to narrow restrict flow and harden not elastic
Cardiovascular conditions caused by atherosclerosis
- CHD
- Stroke
- Transient ischaemic attack
- Peripheral arterial disease
Primary prevention Cardiovascular events
- Alter modifiable risks and reduce incidence in disease free individual
- CVD risk review ongoing over 40
- Q risk analysis
Secondary prevention
- Use strategies to target individuals that have an event use statin
Healthy level cholesterol
5mmol/L or below
Total HDL less then 6
Formal risk assessment
- QRISK 3 for patient aged 25-84 with type 2 diabetes
- Do not do risk assessment for high risk CVD and type 1 diabetes
- May underestimate risk if previous HIV or recent smoke quit
When do you use 3-lifetime assessment
- Cardiovascular risk under 10% or under 40 with CVD
Pharmacological treatment
- Discuss with patients the risks and benefits
- Aim of treatment is to achieve a greater than 40%
reduction in non-HDL-C levels
Baseline Tests
- Non-fasting lipid profile
- Liver function test
- Renal function and GFR rate
- Creatine kinase - due to muscle pain
- Thyroid test
Starting recommendation for satins
- 20mg of Atorvastatin
- if ages 84 and younger with 10% QRISK
- Give anyway if having type 1 diabetes
- Chronic kidney disease no requirement for QRISK
Secondary prevention pharmacological treatment
- 80mg Atorvastatin give for those who had a heart attack, angina and stroke.
Family Hyperlipidemia
- Inherit high cholesterol present from birth developing CVD
Clinical signs and hypercholesterolemia
- Tendon xanthoma (ankle bulge)
- Xanthelasmas eye lids skin flaky
- Corneal arcus - white ring around eye
Children Familial hyperlipidaemia
- Usually start at lower dose from age of 10
Atorvastatin side effects
- Muscle effects and toxicity
- GI disturbances
- Sleep disorders
- Nose bleed
When can statins be taken
- Atorvastatin and rosuvastatin taken any time other statins at night
Function of statins
- Blocks enzymes involved in cholesterol synthesis
What do you monitor for statins
- Liver function and lipids
- Ask patients to report severe muscle pain
- Use contraception while on drug
Other medication instead of statins
- Consider ezetimibe, co-administered with atorvastatin for people
with primary hypercholesterolaemia
Ezetimibe function
- 10mg inhibits the intestinal absorption of
cholesterol
Side effects of Ezetimibe
- GI disturbances
- asthenia
- muscle pain - uncommon
Ezetimibe with bempedoic acid
- If it doesn’t control levels alone use the bempedoic acid
Bempedoic acid function
- Inhibits cholesterol synthesis in the liver,
thereby lowering LDL-cholesterol
Side effects of Bempedoic acid
- anaemia
- gout
- hyperuricaemia
- GI disturbances
Counselling for Bempedoic acid
Avoid pregnancy and breastfeeding
Fibrates
- Not routinely given to people as primary or secondary prevention
- Sometimes used for Family history
Colestyramine
- Not routinely given to people as primary or secondary prevention
- Sometimes used for Family history
Inclisiran
- Patient that are high risk due to previous CV events
- Patients with recurrent polyvascular disease
- Patients with HeFH
Function of Inclisiran
- limits production of PCSK9, increasing uptake
of LDL-cholesterol and thereby lowering levels in blood
Counselling for inclisiran
- Should not be used outside
- If a dose is more than 3 months late, treatment
should be re-initiated.
