hyperlipidaemia

Question 1

Why are omega 3 polyunsaturated fatty acids beneficial in cardiovascular disease? What is the recommended dose?

Answer 1

• antiplatelet, antithrombotic, antiinflammatory. lipid modifying - reduces serum triglycerides and increases serum HDL (additive to statin therapy) - 500mg/day = 2-3 serves of oily fish/ week

Question 2

Why are phytosterols beneficial in cardiovascular disease? What is the recommended dose? What else should be increased if taking phytosterols?

Answer 2

• reduce LDLs by 10% (additive to statin therapy)- - 2-3g per day - Reduce blood carotenoids so suggest one extra serve carrot/ broccoli per day

Question 3

How is familial hypercholesterolaemia diagnosed? What age is treatment started?

Answer 3

• diagnosis is by DNA or hypercholesteolaemia + typical clinical features eg tendon xanthomas - statins can be used from 8 years if LDL>3.3 after dietary modification

Question 4

Which lipid profiles have the highest risk for cardiovascular disease

Answer 4

• increased LDL and reduced HDL - ratio LDL to HDL > 4

Question 5

With extreme elevation of triglycerides (>10) what non cardiovascular side effect can occur?

Answer 5

pancreatitis

Question 6

What are some potential causes of secondary dyslipidaemia

Answer 6

hypothyroidism, nephrotic syndrome, DM2, cholestasis, anorexia nervosa, obesity, renal impairment, alcohol abuse, smoking

Question 7

How should dydlipidaemia be confirmed?

Answer 7

repeat test at 6-8 weeks

Question 8

What are the targets of lipid treatment?

Answer 8

Total cholesterol 1 LDL

Question 9

What are some non pharmacological measures to reduce cholesterol?

Answer 9

Maintain ideal weight, decrease fat intake, consume mono or poly unsaturated fats, eat fish twice per week, increase fibre, decrease alcohol

Question 10

When should lipids be rechecked after instituting non pharmacological management? If effective at this initial check, when should lipids be rechecked?

Answer 10

• 6-8 weeks - 6 months

Question 11

When should lipid lowering agents be stopped?

Answer 11

during pregnancy or age >75

Question 12

At what lipid level should you begin treatment for a patient with diabetes, familial hypercholesterolaemia, family history of cardiovascular disease, hypertension or peripheral vascular disease, and what should their target total LDL, HDL and TG be?

Answer 12

• lipid level: >6.5mM or total >5.5 and HDL1 - target TG:

Question 13

At what lipid level should you begin treatment for a patient who is male 35-75 or a postmenopausal woman up to 75, and what should their target total LDL, HDL and TG be?

Answer 13

• lipid level: total >7.5mM or TG>4 - target total: 1 - target TG:

Question 14

At what lipid level should you begin treatment for a patient with nil other risk factors, and what should their target total LDL, HDL and TG be?

Answer 14

• lipid level: total>9 or TG >8 - target total: 1 - target TG:

Question 15

In what order are the different classes of antilipid medications started?

Answer 15

1. • statin - ezetimibe - ezetimibe +statin - bile acid sequestering resins - fibrates (if above not tolerated) 2. - nicotinic acid - probucol (slow response, care with hepatic disease) - oestrogen +/- progesterone (postmenopausal women- limited efficacy) 3. resistant LDL - statin + ezetimibe - statin + resin isolated elevated triglycerides - fibrate - nicotinic acid - fish oil (+/- fibrate if TG>10) mixed - If TG4: fibrate

Question 16

What are the use, adverse effects and monitoring of statins?

Answer 16

use: raised total cholesterol adverse effects: muscle pain and raised LFTs monitoring: LFT, CK at 4-6 weeks initially then every 6 months

Question 17

What are the use, adverse effects and monitoring of bile acid binding resins?

Answer 17

use: raised total cholesterol adverse effects: GIT dysfunction, drug interaction monitoring: nil

Question 18

What are the use, adverse effects and monitoring of fibrates?

Answer 18

use: raised triglycerides or mixed hyperlipidaemia adverse effects: GIT dysfunction, myositis, interaction with statins and warfarin monitoring: LFTs and coags

Question 19

What are the use, adverse effects and monitoring of ezetimibe?

Answer 19

use: raised total cholesterol adverse effects: arthralgia, myalgia, myositis, raised liver function tests monitoring: LFTs

Question 20

What are the use, adverse effects and monitoring of nicotinic acid?

Answer 20

use: raised total cholesterol and trigycerides adverse effects: flushing, raised BSL, raised LFTs, increased urate monitoring: BSL, urate, LFTs

Question 21

What are the use, adverse effects and monitoring of fish oil?

Answer 21

use: raised total cholesterol adverse effects: minimal monitoring: bleeding time