Hyperlipidaemia Flashcards
What does hyperlipidaemia refer to?
Raised levels of one or more of:
* total cholesterol (TC)
* low-density lipoprotein cholesterol (LDL-C)
* triglycerides (TG)
Hyperlipidaemia can indicate an increased risk for cardiovascular diseases.
What is dyslipidaemia?
An umbrella term that includes:
* hypercholesterolaemia
* hyperlipidaemia
* mixed dyslipidaemia (high LDL-C, low HDL-C)
Dyslipidaemia is often associated with metabolic disorders.
What is primary hyperlipidaemia?
Familial hypercholesterolaemia due to mutations in low-density lipoprotein receptor (LDLR) gene, autosomal dominant
Primary causes are genetic and often require lifelong management.
What are some causes of secondary hyperlipidaemia?
Causes include:
* Hypothyroidism
* Pregnancy
* Nephrotic syndrome
* Drugs (e.g. diuretics, glucocorticoids, ciclosporin)
* T2DM
* CKD
* Abdominal obesity
* Excess alcohol
* Hepatocellular disease
* Drugs (e.g. beta-blockers, glucocorticoids)
Secondary hyperlipidaemia is often reversible with treatment of the underlying condition.
What are common clinical features of hyperlipidaemia?
Features include:
* Usually asymptomatic
* Acute pancreatitis (due to significantly elevated levels of TG)(Sudden onset severe abdominal pain, Shock, Abdominal and skin discolouration)
Acute pancreatitis can be a life-threatening complication of severe hyperlipidaemia.
What are tendon xanthomata?
Hard, painless nodules on knuckles and achilles tendon
Tendon xanthomata are associated with high cholesterol levels.
What investigations are used for hyperlipidaemia?
Investigations include:
* Lipid profile (serum levels of TC, LDL-C, HDL-C, TG)
* TC/HDL ratio (best estimate of cardiovascular risk)
The TC/HDL ratio is utilized in the QRISK2 score for assessing cardiovascular risk.
What is the aim of managing hyperlipidaemia?
To reduce the risk of cardiovascular diseases
Management strategies include lifestyle changes, medication, and sometimes surgical interventions.
What are the three routes of management for hyperlipidaemia?
The three routes are:
* Conservative
* Medical
* Surgical
Each route has specific strategies tailored to the patient’s needs.
What does conservative management for hyperlipidaemia include?
Includes:
* Lifestyle modifications
* Diet low in saturated fats and cholesterol
* Exercise at least 150 mins per week
* Reduce alcohol intake
* Smoking cessation
Lifestyle changes are often the first step in managing hyperlipidaemia.
What are examples of lipid-lowering drugs?
Examples include:
* HMG-CoA reductase inhibitors (statins)
* Bile-acid sequestrants
* Fibrates
* PCSK9 inhibitors
* Ezetimibe
* Niacin
Each drug class has a different mechanism of action and potential side effects.
What is the mechanism of action of statins?
Inhibits a cholesterol precursor
Statins are commonly prescribed due to their efficacy in lowering LDL cholesterol.
What complications can arise from lipid-lowering drugs?
Complications include:
* Rhabdomyolysis (muscle pain, dark urine, raised CK >5x upper limit normal)
Monitoring for muscle-related side effects is important in patients taking statins and fibrates.
What is a surgical option for managing hyperlipidaemia?
Liver transplant
Surgical options are considered in severe cases where other treatments have failed.
Which drug is contraindicated with statins?
Erythromycin/clarithromycin
Should statins be continued in pregnancy?
No
What is the target reduction in non-HDL cholesterol for primary prevention across three months?
> 40% reduction
