Hyperlipidaemia Flashcards
Two possible causes of raised cholesterol
- Familial hypercholesterolaemia/dyslipidaemia
- secondary hypercholesterolaemia
Defenition of familial hypercholesterolaemia
an inherited condition characterized by high cholesterol present from birth
it is autosomal dominant, so pts only need one gene mutation
When should familial hypercholesterolaemia be suspected - 2
- if total cholesterol concentration is greater than 7.5mmol
- there is personal or family history of coronary heart disease
Complication of familial hypercholesterolaemia
coronary heart disease
Investigations into familial hypercholesterolaemia - 4
- Two measurements of LDL cholesterol concentration shold be taken
- Clinical findings such as tendon xanthomata and arcus senilis (white ring in iris)
- Exclude secondary hypercholesterolemia
- Simon Broome or Dutch Lipid Clinic Network criteria should be used to make a clinical diagnosis
Management of familial hypercholesterolaemia
- Lifestyle advice
- Lipid modification therapy - high intensity statin or ezetimibe
- All adults should be referred for specialist genetic testing
Mechanism of action of statins and examples
Atorvastatin, simvastatin and rosuvastatin
Inhibits HMG-CoA-reductase (enzyme that produces cholesterol) Low cholesterol stimulates LDL receptor synthesis in the liver, so more LDLs are taken up which decreases blood circulation.
ADRs (4) and Contraindications (3) of Statins
ADRs:
* Myalgia
* Gi disruption (constipation, diarrohea, flatulence
* headahce
* sleep disturbance
Contras:
* active liver disease / abnormal LFTs
* pregnant
* renal issues
Mechanism of action of Ezetimibe
Inhibits NPC1L1 transporter in the small intestine, which reduces dietary absorption of cholesterol
ADRs (2) and Contras (3) of Ezetimibe
ADRs
* GI upset
* abdo pain
Contras
* CKD
* Active liver disease
* breastfeeding women
Causes of secondary hypercholesterolaemia - 7
- Hypothyroidism
- Liver disease
- Nephrotic syndrome
- cushings
- anorexia nervosa
- DM
- Drugs
Which drugs may cause secondary hypercholesterolaemia - 6
- Corticosteroids
- Thiazide diuretics
- Roaccutane (Isotretinoin)
- COCP
- Alcohol
- Anticonvulsants
What is the difference between primary and secondary prevention of CVD
Primary prevention refers to treatment in people who have not developed CVD. Secondary prevention refers to treatment in people with CVD.
What blood tests should be done before starting statin trx - 5
- non-fasting lipid profile (to get baseline)
- LFTs
- eGFR
- HbA1c
- Creatine Kinase (to get baseline incase they get myalgia)
What follow up is needed and at what intervals when starting statins
At 3 months:
* do lipid profile - aiming for 40% reduction
* do LFT check
At 12 months
* LFT testing
