Hyperlipidaemia Flashcards
What is hyperlipidemia?
excess of lipids or fats in your blood
can increase your risk of heart attack and stroke
When should Familial hypercholesterolaemia/dyslipidaemias be suspected?
Total cholesterol concentration is greater than 7.5 mmol/L and/or
There is a personal or family history of premature CHD
may see tendon xanthomas or premature arcus senilis
What are some conditions that can cause hyperlipidemia?
CKD
Diabetes
HIV/AIDS
Hypothyroidism
SLE
What drugs can cause hyperlipidemia?
Beta-blockers
Diuretics
Steroids
Immunosuppressants
Retinoids - treat acne
Chemo
Omeprazole
What is primary prevention of CVD?
Treatment in people who haven’t developed CVD
What is secondary prevention of CVD?
Treatment in people with CVD
What is QRISK?
cardiovascular risk assessment tool to make decisions about statin therapy for primary prevention.
When should statins be started?
Primary prevention - people with QRISK of 10% or more
- people with T1DM, CKD or familial hypercholesterolemia
- people aged 85yrs or older
What clinical assessments are required before starting statins?
Smoking status
Alcohol consumption
BP
BMI
Full lipid profile
LFTs
Diabetes status
Creatine kinase
TFTs
Renal function - eGFR, ACR, U&Es
What is the target for primary prevention?
lipid target is a greater than 40% reduction in non-high-density lipoprotein (non-HDL) cholesterol
What treatment is offered for primary prevention of CVD?
Lifestyle changes
high-intensity statin treatment (atorvastatin 20 mg daily)
What treatment is offered for secondary prevention of CVD?
High-intensity statin treatment (atorvastatin 80 mg daily)
Lifestyle changes
What is the target for secondary prevention of CVD treatment?
The lipid target is low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol/L or less
OR non-HDL cholesterol levels of 2.6 mmol/L or less.
What follow ups are required after starting statin treatment and when?
Repeat liver function tests (LFTs) within 3 months of starting treatment, and again at 12 months.
Statin therapy does not need to be routinely excluded unless the serum transaminases are raised above 3 times the upper limit of the reference range.
Checking creatine kinase (CK) if unexplained muscle symptoms (such as pain, tenderness, or weakness) develop
What statin is first line for secondary prevention of CVD?
Atorvastatin 80mg
What primary prevention of CVD is recommended for >85yrs?
Offer statin treatment, QRISK not required
What first line statin is generally recommended for primary prevention of CVD?
Atorvastatin 20mg
What advice is given to T1DM patients for primary prevention of CVD?
Change lifestyle factors
Offer statin therapy to:
People with type 1 diabetes who are aged over 40 years, have had diabetes for more than 10 years, have established nephropathy, or have other CVD risk factors
Could be considered in younger patients too
What advice should be given to CKD patients for primary prevention of CVD?
Change lifestyle factors
Offer statin to:
People with CKD (estimated glomerular filtration rate less than 60 ml per minute per 1.73 m2 and/or albuminuria)
Who should be offered lipid modification based on QRISK score and what level 10 year risk?
All patients with 10 year risk of 10% or more
Including T2DM patients
What are the lipid profile normal ranges?
Total cholesterol: Less than 5 mmol/L
HDL (good cholesterol): More than 1.0 mmol/L for men and more than 1.2 mmol/L for women
Non-HDL (bad cholesterol): Less than 4 mmol/L
Total cholesterol to HDL ratio: Less than 6
LDL (bad cholesterol): Less than 3 mmol/L
