Hyperlipidemia Flashcards
Hyperlipidemia Risks
Cardiovasc diseases: coronary heart disease (angina, MI), cereberovasc disease (stroke/TIA), peripheral arterial disease
Primary prevention
T1DM T2DM if CVD risk >10% (QRISK2) CKD/albuminuria Familial hypercholesterolemia 85+ (reduces risk of non-fatal MI)
Secondary prevention
Established CVD : coronary heart disease (angina, MI), cereberovasc disease (stroke/TIA), peripheral arterial disease
QRISK2 criteria
assesses CV risk in 84 and under ( >10% risk in 10 yrs= primary prevention)
Unsuitable if high cardiovascular risk ( eg DM, established CVD, CKD, 85+, familial hypercholesterolemia
Lipid `targets
(hyperlipidemia diagnosis at >6mmol/L)
<=5mmol/L total in healthy adults, <=4 in high risk adults
<= 3mmol/L LDL in healthy adults, <=2 in high risk adults
>1 HDL in all adults (higher=better), <1.7 TG in all adults
Hyperlipdemia causes
Drugs: antipsychotics, corticosteroids, immunosuppressants, antiretrovirals
Conditions: hypothyroidism, liver/kidney disease, DM, familial hyper., lifestyle factors (smoking, alcohol, diet)
Statin MOA
Lowers LDL cholesterol synthesis by inhibiting HMG-CoA reductase (indirectly reduces TGs and increases HDL) Taken at night as cholesterol produced more at night
Statin High intensity
Atorvastatin (1st choice): PP 20mg, SP 80mg. Rosuvatstain: 10mg
Simvastatin: 80mg (MHRA warning-high risk of rhabdo)
Hyperlipidemia treatment
Statin first choice
Primary and familial hyperchol. high intensity statin -> ezetimibe if statin CI/not tolerated
Moderate triglycerydemia, high intensity statin -> fibre if statin CI/not tolerated
Before statin initiation
address secondary causes (hypothyroidism, uncontrolled DM, nephrotic syndrome(albuminuria), liver diseases such as alcoholic cirrhosis)
Statin ADRs
Myopathy, myositis (muscle inflammation), rhabdo - counsel re muscle pain/weakness
High risk of muscle toxicity in familial, excess EtOH, renal impairment, hypothyroidism
^ myopathy risk with ezetimibe, fibrates (esp. Gemfibrozil), fuscidic acid (restart statin 7 days after finished course)
Interstitial lung disease - counsel to report SOB, cough, weight loss
Diabetes - statins can inc HbA1c and glucose levels
Statin monitoring
Baseline lipid profile, renal, thyroid function, HbA1c. Discontinue if transaminases 3x normal, CK 5x normal, muscle symptoms
Statin interactions
Increased exposure = increased risks
amiodarone, CCBs, antifingals, grapefruit juice (increase exposure)
Macrolides - stop statin whilst on macrolide - rhabdo risk
ezetimibe, fibrates (esp. Gemfibrozil), fuscidic acid (stop 7/7 post course) - increase myopathy risk
Statin dose adjustments
Simva: 10mg max w/ fibre
Simva: 20mg max w/ amiodarone, amlodipine, Diltiazem and verapamil,
Atorva: 10mg max with ciclosporin
Rosuva: 5mg initially, max 20mg with clopidogrel
Statins and pregnancy
Teratogenic. use effective contraception during therapy. stop 3/12 before conception, only restart when breastfeeding stopped
Ezetimibe MOA
Reduces blood cholesterol by inhibiting absorption of cholesterol by small intestine
Fibrate MOA
Lower blood TG levels by reducing the liver’s production of VLDL (triglyceride carrying substance in blood) and speeding up removal of TG from blood.
Fibrate examples and indication
Bezafibrate, fenofibrate, ciprofibrate, Gemfibrozil
Hypertriglyceridemia >10mmol/L or statins not tolerated/CI
Bile acid sequestrants MOA
bind/sequester bile, meaning liver produces more bile acids using excess cholesterol (reduces LDL)
Bile acid sequestrant examples and interactions
colesevelam, colestyramine, colestipol
Impair absorption of fat soluble vitamins (ADEK) & other drugs, give other drugs 1 hr before/4h after.
