hyperlipidaemia

Question 1

what are the healthy levels

Answer 1

total cholesterol - 5 or below
HDL - 1 or above
LDL - 3 or below
non-HDL - 4 or below
triglycerides - 2.3 or below

Question 2

when would you offer lipid lowering agents?

Answer 2

< 85 with 10-year risk of CVD >10%

pt with T2DM 10 year risk of CVD >10%

all type 1 diabetics:
- who > 40
- with diabetes > 10 years
- established nephropathy

CKD patients

pts with familial hypercholesterolaemia

Question 3

statins imp points

Answer 3

atorvastatin, rosuvastatin, fluvastatin, pravastatin

atorvastatin and rosuvastatin - can be taken any time of day

others at night

atorva 80 - strongest - secondary prevention

hypothyroidism should be managed before starting statin

pts at high risk of diabetes - should have fasting blood glucose or hba1c checked before starting statin - repeat after 3 months

Question 4

statins - monitoring

Answer 4

monitoring:
- before initiation full lipid profile, thyroid and renal function assessed

liver function
- LFTs measured before treatment - 3 months - 12 months
- if LFTs are raised 3x the upper limit - stop statin

creatine kinase:
- for people who have had persistent muscle aches
- if level is more than 5x the upper limit remeasure in 7 days
- if still higher than 5x don’t start statin
- if raised but not higher than 5x start at lower dose

Question 5

statins SE’s

Answer 5

myopathy and rhabdomyolysis
- seek medical advice if any muscle symptoms - pain, tenderness

interstitial lung disease
- seek advice if any dyspnoea, cough, weight loss

teratogenic
- should be avoided in pregnancy (discontinue 3 months before conceiving)

Question 6

statin - interactions

Answer 6

cyp450 inducers - reduce plasma level
- Carbamazepine
- Rifampicin
- Alcohol
- Phenytoin
- Griseofulvin
- Phenobarbital
- St Johns Wort

cyp450 inhibitors - increase conc. - increase risk of rhabdomyolysis
- macrolides
- grapefruit juice
hold statin during clari treatment -

fusidic acid (ORAL)
- stop statin during treatment - restart 7 days after last dose

Question 7

max doses of statins with other certain drugs

Answer 7

amiodarone + simvastatin 20mg

amlodipine + simvastatin 20mg

diltiazem/verapimil + simvastatin 20mg

ticagrelor + simvastatin 40mg

ciclosporin + atorvastatin 10mg

tipranavir + atorvastatin 10mg

Question 8

other lipid lowering agents

Answer 8

ezetimibe
- ezetimibe + statin - increased risk of rhabdomyolysis

fibrates
- bezafibrate, fenofibrate, ciprofibrate
- myotoxicity in renal impairment
- LFTs every 3 months for 1st year
- fibrate+statin - increased risk of muscle related side effects