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Year 6 Endocrinology > Hyperlipidaemia > Flashcards

Hyperlipidaemia Flashcards

1
Q

What did NICE update in 2014 regarding hyperlipidaemia management?

A

NICE updated their guidelines on lipid modification, recommending statins for a significant proportion of the population over 60 years.

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2
Q

What is the 10-year risk percentage for assessing high risk of cardiovascular disease (CVD)?

A

A 10-year risk of 10% or greater.

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3
Q

Which tool does NICE recommend for CVD risk assessment in patients aged <= 84 years?

A

The QRISK2 CVD risk assessment tool.

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4
Q

In which situations should QRISK2 not be used?

A
  1. Type 1 diabetics
  2. Patients with eGFR < 60 ml/min and/or albuminuria
  3. Patients with a history of familial hyperlipidaemia.
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5
Q

Which populations may QRISK2 underestimate CVD risk?

A
  1. People treated for HIV
  2. People with serious mental health problems
  3. People taking dyslipidaemia-causing medications
  4. People with autoimmune/systemic inflammatory disorders.
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6
Q

What lipid levels should be measured before starting a statin?

A

Total cholesterol, HDL, and a full lipid profile including triglycerides.

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7
Q

What cholesterol level indicates a need to consider familial hyperlipidaemia?

A

Total cholesterol level greater than 7.5 mmol/L or a personal/family history of premature coronary heart disease.

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8
Q

What is the new cut-off for 10-year CVD risk according to the 2014 guidelines?

A

10%.

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9
Q

What should be offered to people with a QRISK2 10-year risk of >= 10%?

A

A statin.

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10
Q

What is the first-line statin recommended by NICE?

A

Atorvastatin 20mg.

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11
Q

What does NICE recommend for adults with type 1 diabetes regarding statin treatment?

A

Consider statin treatment for primary prevention of CVD.

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12
Q

What should be offered to patients with chronic kidney disease (CKD)?

A

Atorvastatin 20mg.

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13
Q

What is the first-line statin for secondary prevention in patients with CVD?

A

Atorvastatin 80mg.

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14
Q

When should patients started on statins be followed up?

A

At 3 months.

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15
Q

What should be repeated during the follow-up of patients on statins?

A

A full lipid profile.

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16
Q

What lifestyle modifications does NICE recommend for patients?

A
  1. Cardioprotective diet
  2. Physical activity
  3. Weight management
  4. Alcohol intake
  5. Smoking cessation.
17
Q

What are the dietary recommendations for a cardioprotective diet?

A
  1. Total fat intake <= 30% of total energy
  2. Saturated fats <= 7% of total energy
  3. Dietary cholesterol < 300 mg/day
  4. Replace saturated fats with monounsaturated/polyunsaturated fats.
18
Q

What is the recommended physical activity for adults?

A

At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week.

19
Q

What is the alcohol intake recommendation for adults?

A

Men and women are advised not to drink more than 14 units a week on a regular basis.

20
Q

What should smokers be encouraged to do?

A

Quit smoking.

21
Q

What is hyperlipidaemia?

A

A condition characterized by elevated levels of lipids in the blood, which can lead to the formation of xanthomata.

22
Q

What are palmar xanthomas?

A

Xanthomata that may be seen in remnant hyperlipidaemia and less commonly in familial hypercholesterolaemia.

23
Q

What are eruptive xanthomas?

A

Multiple red/yellow vesicles on extensor surfaces (e.g. elbows, knees) due to high triglyceride levels.

24
Q

What causes eruptive xanthomas?

A

Familial hypertriglyceridaemia and lipoprotein lipase deficiency.

25
Q

What are tendon xanthomas, tuberous xanthomas, and xanthelasma associated with?

A

Familial hypercholesterolaemia and remnant hyperlipidaemia.

26
Q

What are xanthelasma?

A

Yellowish papules and plaques caused by localized accumulation of lipid deposits, commonly seen on the eyelid.

27
Q

Can xanthelasma occur in patients without lipid abnormalities?

A

Yes, they can be seen in patients without lipid abnormalities.

28
Q

What are the management options for xanthelasma?

A

Surgical excision, topical trichloroacetic acid, laser therapy, and electrodesiccation.

29
Q

What do statins inhibit?

A

Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.

30
Q

What are the adverse effects of statins?

A

Adverse effects include myopathy, liver impairment, and potential increased risk of intracerebral haemorrhage.

31
Q

What is myopathy in relation to statins?

A

Myopathy includes myalgia, myositis, rhabdomyolysis, and asymptomatic raised creatine kinase. Risk factors include advanced age, female sex, low body mass index, and multisystem disease like diabetes mellitus.

32
Q

Which statins are more likely to cause myopathy?

A

Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than in relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin).

33
Q

What does NICE recommend for liver impairment monitoring?

A

NICE recommends checking LFTs at baseline, 3 months, and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.

34
Q

What is the recommendation regarding statins and intracerebral haemorrhage?

A

Statins may increase the risk of intracerebral haemorrhage in patients with a history of stroke, and should be avoided in such patients.

35
Q

What are the contraindications for statins?

A

Contraindications include macrolides (e.g., erythromycin, clarithromycin) and pregnancy.

36
Q

Who should receive a statin?

A

All people with established cardiovascular disease, those with a 10-year cardiovascular risk >= 10%, patients with type 2 diabetes mellitus, and certain patients with type 1 diabetes mellitus.

37
Q

When should statins be taken?

A

Statins should be taken at night, especially simvastatin, as this is when the majority of cholesterol synthesis occurs.

38
Q

What does NICE recommend for atorvastatin dosage?

A

NICE recommends atorvastatin 20mg for primary prevention, increasing the dose if non-HDL has not reduced for >= 40%, and atorvastatin 80mg for secondary prevention.

Year 6 Endocrinology (27 decks)

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