Lecture 17: Lipid treatment Flashcards
What are the major CVD risk factors?
High blood pressure High blood cholesterol Smoking Obesity Diabetes Physical inactivity
What is meant by a QRISK3 score of over 10?
10% risk of CVD event over the next ten years - indicates that primary prevention with lipid lowering therapy (such as statins) should be considered
What is QRESEARCH?
A large consolidated database derived from the health records
What is calculated by the JBS3 risk calculator?
Heart age (compared to people of same age, gender, ethnicity)
Healthy years (expected life without a heart attack or stroke)
When would FH be considered possible?
TC more than 7.5mmol/L and family history of hypercholesterolaemia (TC >7.5, LDL>4.9 mmol/L) or premature coronary heart disease
What TC and LDL values would suggest FH?
TC >7.5
LDL>4.9 mmol/L
What dose of statin would be given for primary prevention (Qrisk>10 with no previous history of CVD)?
20mg atorvastatin
What dose of statin would be given for secondary prevention (Qrisk>10 with previous history of CVD)?
80mg atorvastatin
Why treat lipid disorders?
To reduce the atherosclerotic process and the incidence of clinical vascular disease
To prevent pancreatitis which is associated with grossly increased serum triglyceride (>10mmol/L, usually >20mmol/L)
What is ezetimbe?
Inhibitor of cholesterol absorption in the small bowel.
Reduces contribution of dietary and biliary cholesterol - reduces the flux of cholesteryl esters into VLDL
At 10 mg/day shown to induce an about 20% reduction in LDLC and 8% reduction in TG.
What are bile acid sequestrates (resins)?
Bind bile acids in the intestine - interrupt the enterohepatic circulation of bile
Increase conversion of cholesterol into bile acids in liver
Treatment limited by constipation and flatulence
Older resins cause oesophageal irritation
What are fibrates?
Increase peripheral lipolysis by activating lipoprotein lipase
Decrease hepatic triglyceride production
Stimulation of reverse cholesterol transport
Reduction of triglyceride by 25–50% and increase of HDL-C by 15–25%
How do Omega 3 (fish oils) work?
Inhibit lipogenesis and stimulate β-oxidation
Reduced rate of secretion of very low density lipoprotein (VLDL) triglyceride
How to PCSK9 inhibitors work?
Monoclonal antibodies that increase availability of LDLR to remove LDLC from the circulation
What are the 5 classes of drugs used to reduce levels of LDL-C in circulation?
Ezetimbe Bile acid sequestrates Fibrates Omega 3s PCSK9 inhibitors
