Hyperlipidaemia Flashcards
What did NICE update in 2014 regarding hyperlipidaemia management?
NICE updated their guidelines on lipid modification, recommending statins for a significant proportion of the population over 60 years.
What is the 10-year risk percentage for assessing high risk of cardiovascular disease (CVD)?
A QRISK 10-year risk of 10% or greater.
Which tool does NICE recommend for CVD risk assessment in patients aged <= 84 years?
The QRISK2 CVD risk assessment tool.
In which situations should QRISK2 not be used?
- Type 1 diabetics
- Patients with eGFR < 60 ml/min and/or albuminuria
- Patients with a history of familial hyperlipidaemia.
Which populations may QRISK2 underestimate CVD risk?
- People treated for HIV
- People with serious mental health problems
- People taking dyslipidaemia-causing medications
- People with autoimmune/systemic inflammatory disorders.
What lipid levels should be measured before starting a statin?
Total cholesterol, HDL, and a full lipid profile including triglycerides.
What cholesterol level indicates a need to consider familial hyperlipidaemia?
Total cholesterol level greater than 7.5 mmol/L or a personal/family history of premature coronary heart disease.
What is the new cut-off for 10-year CVD risk according to the 2014 guidelines?
10%.
What should be offered to people with a QRISK2 10-year risk of >= 10%?
A statin.
What is the first-line statin recommended by NICE?
Atorvastatin 20mg.
What does NICE recommend for adults with type 1 diabetes regarding statin treatment?
Consider statin treatment for primary prevention of CVD.
What should be offered to patients with chronic kidney disease (CKD)?
Atorvastatin 20mg.
What is the first-line statin for secondary prevention in patients with CVD?
Atorvastatin 80mg.
When should patients started on statins be followed up?
At 3 months.
What should be repeated during the follow-up of patients on statins?
A full lipid profile.
What lifestyle modifications does NICE recommend for patients?
- Cardioprotective diet
- Physical activity
- Weight management
- Alcohol intake
- Smoking cessation.
What are the dietary recommendations for a cardioprotective diet?
- Total fat intake <= 30% of total energy
- Saturated fats <= 7% of total energy
- Dietary cholesterol < 300 mg/day
- Replace saturated fats with monounsaturated/polyunsaturated fats.
What is the recommended physical activity for adults?
At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week.
What is the alcohol intake recommendation for adults?
Men and women are advised not to drink more than 14 units a week on a regular basis.
What should smokers be encouraged to do?
Quit smoking.
What is hyperlipidaemia?
A condition characterized by elevated levels of lipids in the blood, which can lead to the formation of xanthomata.
What are palmar xanthomas?
Xanthomata that may be seen in remnant hyperlipidaemia and less commonly in familial hypercholesterolaemia.
What are eruptive xanthomas?
Multiple red/yellow vesicles on extensor surfaces (e.g. elbows, knees) due to high triglyceride levels.
What causes eruptive xanthomas?
Familial hypertriglyceridaemia and lipoprotein lipase deficiency.
What are tendon xanthomas, tuberous xanthomas, and xanthelasma associated with?
Familial hypercholesterolaemia and remnant hyperlipidaemia.
What are xanthelasma?
Yellowish papules and plaques caused by localized accumulation of lipid deposits, commonly seen on the eyelid.
Can xanthelasma occur in patients without lipid abnormalities?
Yes, they can be seen in patients without lipid abnormalities.
What are the management options for xanthelasma?
Surgical excision, topical trichloroacetic acid, laser therapy, and electrodesiccation.
What do statins inhibit?
Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.
What are the adverse effects of statins?
Adverse effects include myopathy, liver impairment, and potential increased risk of intracerebral haemorrhage.
What is myopathy in relation to statins?
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.
Which statins are more likely to cause myopathy?
Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than in relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin).
What does NICE recommend for liver impairment monitoring?
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.
What is the recommendation regarding statins and intracerebral haemorrhage?
Statins may increase the risk of intracerebral haemorrhage in patients with a history of stroke, and should be avoided in such patients.
What are the contraindications for statins?
Contraindications include macrolides (e.g., erythromycin, clarithromycin) and pregnancy.
Who should receive a statin?
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.
When should statins be taken?
Statins should be taken at night, especially simvastatin, as this is when the majority of cholesterol synthesis occurs.
What does NICE recommend for atorvastatin dosage?
NICE recommends atorvastatin 20mg for primary prevention, increasing the dose if non-HDL has not reduced for >= 40%, and atorvastatin 80mg for secondary prevention.
