Hyperlipidaemia

Question 1

Who should you screen for hyperlipidaemia?

Answer 1

Those at risk of hyperlipidaemia.

Those at risk of CVD.

Question 2

Risk of hyperlipidaemia.

Answer 2

FH of hyperlipidaemia

Corneal arcus if below 50 yo

Xanthoma or xanthelasma

Question 3

Those at risk of CVD.

Answer 3

Known CVD

FH of CVD <60 years old.

DM or impaired glucose tolerance

HTN

Smoker

High BMI

Low socioeconomic or indian asian background.

Question 4

Types of hyperlipidaemia.

Answer 4

Common primary hyperlipidaemia

Familial primary hyperlipidaemias

Secondary hyperlipidaemia

Mixed hyperlipidaemia

Question 5

Explain common primary hyperlipidaemia btiefly.

Answer 5

Common hypercholesterolaemia is the most common primary hyperlipidaemia.

Cholesterol = 6.5-9

Trig < 2.3

Increased LDL only.

Question 6

Classifications of familial primary hyperlipidaemias.

Answer 6

Question 7

Causes of secondary hyperlipidaemia.

Answer 7

Hypothyroidism

Cushing’s

Obesity

DM

CKD

Nephrotic syndrome

Dysglobulinaemia

Alcohol

COCP

Thiazides

Corticosteroids

Question 8

Causes of mixed hyperlipidaemia.

Answer 8

Increase in both LDL and trigs.

T2DM

Metabolic syndrome

Alchohol abuse

Chronic renal fialure

Question 9

Management of hyperlipidaemia.

Answer 9

Identify whether primary or secondary.
Lifestyle advice

Treat underlying condition

Medical algorithm…

Question 10

Lifestyle advice for hyperlipidaemia.

Answer 10

Aim BMI 20-25

Mediterranean diet with more fruits, veggies, fish and unsaturated fats.

Less red meat

More exercise

Question 11

Medical algorithm of hyperlipidaemia.

Answer 11

1st line - Atorvastatin 20mg PO at night - 80mg for secondary prevention and primary for those with kidney disease.
Can also give simvastatin as alternative.
Aim for target of plasma cholesterol reduction of > 40% in those with CVD.

2nd line - Ezetimibe. Can be used in combination with statin or instead of statin if intolerant.

3rd line - Alirocumab. Can also use fibrates e.g.

In hypertriglyceridaemia fibrates, nicotinic acid or fish oils may be used.

Question 12

Primary prevention of cardiovascular disease.

Answer 12

Perform QRISK 3 score.

If they have more than 10% risk of having an event in 10 years then you should offer a statin (atorvastatin 20mg at night)

All patients with CKD or T1DM for over 10 years should be offered atorvastatin 20mg.

Question 13

Review of primary prevention of CVD

Answer 13

Check lipids at 3 months and increase the dose if non-HDL cholesterol has not decreased by >40%.
Check adherence and ADRs as well.

Check LFTs within 3 mo of starting a statin and then also at 12 months.

After this you do not need to keep monitoring the LFTs.

You monitor statin use annually

Question 14

Secondary prevention of CVD.

Answer 14

This is for anyone who has already an established cardiovascular disease.

They should then be started on atorvastatin 80 mg.

Remember the 4 As;

Aspirin (+clopidogrel) for 12 months

Atorvastatin 80mg

Atenolol or bisoprolol titrated to maximum tolerated dose.

ACEi like ramipril titrated to maximum tolerated dose.

Question 15

Noteable side effects of statins.

Answer 15

Myopathy/myalgia/rhabdomyolysis

T2DM

Haemorrhagic stroke (very rare)