Hyperlipidaemia Flashcards
The main risk of developing CVD according to Framingham Heart study.
High BP High blood cholesterol Smoking Obesity Diabetes Sedentary lifestyle
Limitations of Framingham scores
Since the study was based in North America, it overestimates risk in Europe.
Underestimates risk in:
Diabetics
South Asian men
Those who are socially deprived.
QRISK2 calculator
Developed from risk factors identified in Framingham study: Age Sex HDL-C: cholesterol ratio Blood pressure Smoking status Diabetes.
Also includes: Ethnicity Social deprivation BP treatment BMI
QRISK> 10 = primary prevention (statin) considered
Modifiable risks for CVD
Smoking
Obesity
Sedentary lifestyle
Diabetes
High cholesterol
Hypertension
Alcohol intake
Un-modifiable risks for CVD
Age- those older than 50 have higher risk
Gender: under 64, men more likely to die from CVD
Genetic factors/ family history
Ethnicity
NICE lipid modification guideline for lipid measurement
Lipid measurements:
TC, HDL, non-HDL, TG.
Use clinical findings and family history to judge familial lipid disorder- lipid cut off values are no relied on.
Exclude secondary causes of dyslipidemia: XS alcohol Uncontrolled diabetes Hypothyroidism Liver disease
NICE guideline for lipid referrals
TC> 7.5 mmol/L + family history of hypercholesterolaemia or coronary heart disease= familial cholesterolaemia.
TC> 9.0mmol/L, non-HDL-C> 7.5 mmol/L= specialist referral.
Primary prevention
Applied if QRISK score> 10%
Statin given- atorvastatin 20 mg
Does not apply if;
- Previous history of angina or MI.
- History of coronary heart procedures
- Peripheral artery disease
- Aortic aneurysm.
- Symptomatic coronary artery disease.
Primary prevention
Statin given when there is:
- History of angina or MI.
- History of coronary artery procedures.
- Aortic aneurysm
- Symptomatic coronary artery disease.
Atorvastatin 80 mg.
TC limit
<5 mmol/L
<4 ideal.
TG limit
<1.7 mmol/L
HDL-C and LDL-C limits
HDL-C: >1 mmol/L
LDL-C: < 3, < 2 ideally.
Non-HDL cholesterol limit
<2.8 mmol/L
<2.5 on statins
Pancreatitis and hyperlipidaemia
Grossly increased serum TG is associated with pancreatitis
When TG> 10, 20 mmol/L
Ezetimibe
Drug that selectively inhibits absorption of cholesterol in the small bowel.
Reduces dietary and biliary cholesterol- decreases cholesterol esters into VLDL
10 mg/day given=
- 20% reduction in LDL-C
- 8% reduction in TG.
