Hyperlipidemia

Question 1

What is hyperlipidaemia?

Answer 1

Hyperlipidaemia refers to raised levels of one or more of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) in the blood

Question 2

What is dyslipidaemia?

Answer 2

an umbrella term which includes hypercholesterolaemia, hyperlipidaemia and mixed dyslipidaemia

Question 3

What is mixed dyslipidaemia?

Answer 3

raised total triglycerides and LDL but low levels of HDL

Question 4

What is primary hyperlipidaemia?

Answer 4

hyperlipidaemia die to genetic mutations (Familial hypercholesterolaemia)

Question 5

What gene is mutated in familial hypercholesterolaemia?

Answer 5

LDL receptor gene

Question 6

Does familial hypercholesterolaemia have an autosomal dominant or recessive inheritance pattern?

Answer 6

autosomal dominant

Question 7

What is secondary hyperlipidaemia?

Answer 7

hyperlipidaemia caused by other diseases, drugs and environmental factors

Question 8

Give 7 causes of secondary hypercholesterolaemia?

Answer 8

1) hypothyroidism
2) pregnancy
3) anorexia nervosa
4) nephrotic syndrome
5) diuretics
6) antiretroviral agents
7) ciclosporin

Question 9

Give 8 causes of secondary hypertriglyceridemia?

Answer 9

1) obesity
2) alcohol
3) beta blockers
4) T2 diabetes
5) hepatocellular disease
6) chronic kidney disease
7) antiretroviral agents
8) glucocorticoids

Question 10

Give 3 examination signs of hyperlipidaemia:

Answer 10

1) tendon xanthoma
2) xanthelasma
3) corneal arcus

Question 11

Describe a rare presentation of hyperlipidaemia seen in cases of significantly elevated triglycerides:

Answer 11

presents with features of acute pancreatitis such as sudden onset severe central abdominal pain radiating to the back, shock and abdominal skin discolouration

Question 12

What blood test is used to investigate hyperlipidaemia?

Answer 12

lipid profile

Question 13

Give 5 lipids measured in a lipid profile:

Answer 13

1) total cholesterol
2) non-HDL cholesterol
3) LDL-C
4) HCL-C
5) triglycerides

Question 14

What lipid ratio provides the best estimate for cardiovascular risk?

Answer 14

triglyceride/HDL

Question 15

Name 4 lipid lowering medications:

Answer 15

1) statins
2) ezetimibe
3) bile acid sequestrants
4) PCSK9 inhibitors

Question 16

What is the mechanism of statins:

Answer 16

HMG-CoA reductase inhibition

Question 17

Give 2 examples of statins:

Answer 17

1) atorvastatin
2) simvastatin

Question 18

What is the first line medication for hyperlipidaemia?

Answer 18

Statin

Question 19

What is the second line medication for hyperlipidaemia when statins are contraindicated?

Answer 19

ezetimibe

Question 20

What is a potential side effect of lipid lowering drugs?

Answer 20

rhabdomyolysis (AKI, dark urine, muscle pain)

Question 21

What is the mechanism of ezetimibe?

Answer 21

prevents intestinal absorption of cholesterol

Question 22

Give an example of a bile acid sequestrant:

Answer 22

cholestyramine

Question 23

What is the mechanism of bile acid sequestrants?

Answer 23

they prevent intestinal absorption of bile acids

Question 24

When are bile acid sequestrants indicated?

Answer 24

If statins and ezetimibe are contradicted

Question 25

Give two examples of PCSK9 inhibitors:

Answer 25

1) aliorcumab 2) evolocumab

Question 26

What is the mechanism of PCSK9 inhibitors?

Answer 26

inactivation of LDL receptor degradation hence increasing LDL clearance from the blood

Question 27

When would PCSK9 inhibitors be indicated for hyperlipidaemia?

Answer 27

in poorly controlled hyperlipidaemia despite maximal tolerated lipid lowering therapy

Question 28

When would liver transplant be indicated for hyperlipidaemia?

Answer 28

severe uncontrolled familial hypercholesterolaemia

Question 29

Give 6 complications of hyperlipidaemia:

Answer 29

1) ischaemia heart disease 2) acute coronary syndrome 3) stroke 4) peripheral vascular disease 5) erectile dysfunction 6) mesenteric ischaemia