Hyperlipidaemia/ cholesterolaemia

Question 1

Compare the 2 types of causes of Hypercholesterolaemia

Answer 1

Familial Hypercholesterolaemia;

• Suspect if Total C>7.5 or PMH/ FHx of premature CHD
• May see tendon Xanthoma or Premature Arcus Senilis (<45)
• High CVD risk, need high intensity lipid-lowering treatment

2ndary Hypercholesterolaemia;
- Conditions or Drugs

Question 2

List the 3 statin intensities and give examples

Answer 2

Low;
- Simvastatin 10mg

Medium;

• Simvastatin 20, 40mg
• Atorvastatin 10mg

High;
- Atorvastatin 20,40,80mg

Question 3

State the normal Total Cholesterol, Non HDL-C, HDL-C

Answer 3

Total: <5mM

Non HDL-C: <4mM

HDL-C: >1 for men, >1.2 for women

Question 4

List 3 statin-alternative drugs to treat Hypercholesterolaemia

Answer 4

• Fenofibrates
• Cholesterol absorption inhibitors
• NPC1L1 inhibitors

Question 5

What is the target for lipid modification?

Answer 5

> 40% reduction in non HDL-C levels

Question 6

What assessment and blood tests are needed before starting statin treatment?

Answer 6

Alcohol, Smoking, BMI, BP

Non-fasting lipid profile (Total cholesterol, HDL-C, non-HDL-C, TAGs)

LFTs, Renal function (eGFR)
HbA1c, Creatine Kinase

TSH, if Dyslipidaemia is present

Question 7

Outline the follow-up of statin treatment

Answer 7

• Lipid profile: 3mths after starting treatment
• LFTs: 3mths AND 12mths after starting treatment
• Statin treatment: Review annually
• If unexplained symptoms: Check CK (Stop treatment if x5 of normal), Explore other causes

Question 8

Who should be offered Lipid-lowering Primary Prevention based on their QRISK?

Answer 8

• People <85 with QRISK of 10% or more

• Type 1 diabetics;
	◦ Aged >40
	◦ Have had diabetes for >10 yrs
	◦ Have established Neuropathy 
	◦ Other CVD RFs

• People with CKD
• People with Familial Hypercholesterolaemia

Question 9

Which pt groups don’t need formal risk assessment before starting lipid-lowering primary prevention?

(Already at CVD risk)

Answer 9

• Type 1 DM
• CKD
• Familial Hypercholesterolaemia