Hyperlipidaemia

Question 1

Hyperlipidaemia

Answer 1

is defined by having high levels of cholesterol,triglyceride or both in blood.

Question 2

Hyperlipidaemia can manifest into

Answer 2

cardiovascular disease, Hyperlipidaemia causes atherosclerosis and in turn:
- Coronary heart disease(angina, myocardial infarction)
- Strokes and transient Ischaemic attacks(TIA)
- Peripheral arterial disease

Question 3

Prevention of Cardiovascular disease:
1) Primary prevention

Answer 3

• Type 1 diabetes Mellitus
  
  • Type 2 Diabetes Mellitus only if CVD risk is greater than 10%
    ○ Risk calculators(eg.QRISK2): 10 year CVD risk greater than 10%
    ○ Chronic kidney disease or albuminuria
    ○ Familial hypercholesterolaemia
    ○ 85 years and above(reduce risk of non fatal myocardial infarction)

Question 4

Prevention of Cardiovascular disease:
1) Primary prevention

Answer 4

• Type 1 diabetes Mellitus
  
  • Type 2 Diabetes Mellitus only if CVD risk is greater than 10%
    ○ Risk calculators(eg.QRISK2): 10 year CVD risk greater than 10%
    ○ Chronic kidney disease or albuminuria
    ○ Familial hypercholesterolaemia
    ○ 85 years and above(reduce risk of non fatal myocardial infarction)

Question 5

Secondary prevention

Answer 5

• Established CVD(Coronary heart disease -Angina,MI, cerebrovascular disease-stroke/TIA and peripheral arterial disease

Question 6

The risk calculators:

Answer 6

• Qrisk2 is recommended by NICE, it assess cardiovascular risk in 84 years and under
  10 year CVD risk score of greater than 10% then offer primary prevention

Question 7

Unsuitable in patients at high cardiovascular risk(score will be underestimated)
This include patients that have:

Answer 7

• Type 1 diabetes Mellitus
  
  • Established cardiovascular disease
  • Over 85 years of age
  • CKD(eGFR less than 60 ml/min)
  • Familial hypercholesterolemia

Question 8

Cholesterol Targets:

Answer 8

Hyperlipidaemia diagnosis - 6mmol/L total cholesterol

- Less than or equal to 5mmol/L total cholesterol for healthy adults 
- Less than or equal to 4 mmol/L total cholesterol for high risk adults
- Less than or equal to 3 mmol/L LDL for healthy adults
- Less than or equal to 2 mmol/L  LDL for high risk adults

Question 9

GREATER THAN 1 mmol/L HDL

Answer 9

(good cholesterol - higher the better)
Less than 1.7 mmol/L Triglycerides

Question 10

What are the causes of Hyperlipidaemia:
Drugs:

Answer 10

• Antipsychotics
  
  • Immunosuppressants
  • Corticosteroids
  • Antiretrovirals(HIV Drugs)

Question 11

Conditions

Answer 11

• Hypothyroidism
  
  • Liver or kidney disease
  • Diabetes Mellitus
  • Family history of high cholesterol
  • Lifestyle factors: smoking,excess alcohol consumption, obesity and poor fatty diet.

Question 12

Before starting statins:

Answer 12

• Address any secondary causes of dyslipidaemia
  ○ Hypothyroidism
  ○ Uncontrolled diabetes Mellitus
  ○ Nephrotic syndrome(albuminuria)
  ○ Liver disease eg. Alcoholic cirrhosis

Question 13

Hyperlipidaemia

Answer 13

1)Hyperlipidaemia - Statin is the first choice

Question 14

Primary hypercholesterolaemia and Familial Hypercholesterolaemia(High intensity statin)

Answer 14

if Statin not tolerated or contra- indicated =Ezetimibe can be given)

Question 15

Moderate hypertriglyceridaemia

Answer 15

(If statin not tolerated or contra indicated = Fibrate can be given)

Question 16

Specialist supervision

Answer 16

• If severe Hyperlipidaemia - add on ezetimibe
  
  • If triglyceride still high after LDL reduced: Add fibrate OR nicotinic acid (also lowers LDL)

Question 17

Primary prevention - 10 year cardiovascular risk >=10% OR most type of T1D or CKD if eGFR <60ml/min

Answer 17

Atorvastatin 20mg OD
- If non-HDL has fallen by >= 40% then consider titrating up to 80mg

Question 18

Secondary prevention - knows ischaemic heart disease or cerebra vascular disease or peripheral artierial disease

Answer 18

Atorvastatin 80mg OD