HYPERLIPIDAEMIA: LIFESTYLE TREATMENT

Question 1

What is
“Cardiovascular disease (CVD)”?

Answer 1

• A group of disorders affecting the heart and blood vessels
• CAUSES: atherosclerosis and thrombosis

Question 2

CVD risk factors

Answer 2

• Diabetes mellitus (particularly Type 1)
• Chronic kidney disease (eGFR < 60)
• Albuminuria
• Familial hypercholesterolaemia
• 85+
• 10-year risk of cardiovascular disease of 10% or more

Question 3

QRISK 2

Answer 3

The tool is used to
“assess CVD risk for the primary prevention of CVD “ (NICE)

Question 4

Which patients are not recommended by NICE for calculating risk of
CVD via QRISK2?

Answer 4

Unsuitable for those at risk of CVD
- 85 +
- T1DM
- Familial hypercholesterolaemia
- CKD (eGFR < 60)/Albuminuria

Question 5

What other factors may be considered when calculating CVD
risk other than co-morbidities and lipids?

Answer 5

• Ethnicity (e.g. CVD risk higher in South Asians)
• BMI
• Family history of premature
  CVD
• Socioeconomic status
• Gender (CVD risk greater in males)

Question 6

What is a
cardioprotective diet?

Answer 6

1. Choose wholegrain varieties of starchy food
2. Reduce intake of refined sugars e.g. fructose
3. At least 5 portions of fruit and vegetables per day
4. Eat at least 2 portions of fish per week, including a portion of oily fish
5. Eat at least 4-5 portions of unsalted nuts, seeds and legumes per week

Question 7

What is the limit with regards to saturated fat, total fat, and
dietary cholesterol for a cardioprotective diet?

Answer 7

• Total fat is 30% or less of total energy intake
• Saturated fats are 7% or less of total energy intake (Also try to replace them with mono/ poly-unsaturated fats)
• Dietary cholesterol is less than 300mg/day

Question 8

What is a good source of mono-unsaturated fats?

Answer 8

• Olive oil
• Rapeseed oil

Question 9

What is the advice with regards to pregnant women and consumption of fish?

Answer 9

• To eat no more than 2
  portions per week
• AVOID marlin, shark and swordfish

Question 10

Which type of fish should pregnant women avoid?

Answer 10

• Marlin
• Shark
• Swordfish

Question 11

What is the advice from NICE with regards to physical activity?

Answer 11

1. TO DO EVERY WEEK:
   - minimum 150 minutes of moderate intensity aerobic activity
   OR
   - 75 minutes of vigorous-intensity aerobic activity (or a mix of vigorous and moderate intensity)
2. Muscle-strengthening activities on 2 or more days of the week to work all major muscle groups (e.g. legs, hips, back, abdomen, chest, shoulders, arms)

Question 12

What is the limit for alcohol for men and women?

Answer 12

Both genders 2 units a day
Or 14 units a week

Question 13

Which patients should
AVOID plant stanols and sterols for the prevention of CVD?

Answer 13

• Primary prevention of CVD
• Secondary prevention of CVD
• CKD
• Diabetes Mellitus (Type 1 and 2)

Question 14

What are the treatment options for those who need primary prevention of CVD?

Answer 14

• Lifestyle modifications
• If inappropriate/effective, add statin (as first-line drug treatment)
  Lifestyle modifications and statins must be combined (if drug therapy is offered)