Lipid disorders

Question 1

What happens when there is high LDL levels?

Answer 1

LDL can bind to the subintimal lining where macrophages bind to LDL and become fat globules, and then foam cells which can lead to fatty plaques in the vessel—> atherosclerosis.

Question 2

What are the 3 acquired cause of lipid disorder?

Answer 2

Diabetes: insulin works on lipoprotein lipase and when there is insulin resistance lipoprotein lipase are not function well so high VLDLs

Hypothyroidism: Thyroid hormone stimulates liver to up regulate LDL receptors—> not working—> LDL levels will increase.

Nephrotic syndrome: Decrease albumin in the blood and albumin can carry fatty acid.

Question 3

What drugs can cause lipid disorder? Acronym: BET

Answer 3

Beta blockers
Estrogen
Thiazides
Increase LDLs, VLDLs and decrease HDL molecules.

Question 4

What is used to score patient’s cardiovascular risk?

Answer 4

QRISK2: An individual’s 10-year risk of having a heart attack or stroke.

Question 5

Which one is a MASSIVE risk for CVD.
a. Age (50 years>), gender (men>women), ethnicity
b. High blood pressure, cholesterol, BMI
c. Smoking
d. Alcohol intake

Answer 5

(c) SMOKING

Question 6

Recommended alcohol units.

Answer 6

14 units a week.
Across 5 drinking days.

Question 7

QRISK2 score less than 10% means…

a. 1 in 10 chance of having stroke or heart attack in the next ten years
b. 1-2 chance of having stroke or heart attack in the next ten years
c. 2 in ten chance of having stroke or heart attack in the next ten years

Answer 7

a. 1 in 10 chance of having stroke or heart attack in the next ten years
Moderate risk is 10-20% (b)
High risk is >20% (c)

Question 8

What does the QRISK2 factor in.

Answer 8

Age
Gender
Ethnicity
Family history
Smoking status
Alcohol use
Physical activity
Body Mass index
Cholesterol test
BP
Diabetes

Question 9

What lifestyle modifications can patient make to reduce the QRISK2 score.

Answer 9

Smoking cessation
Weight loss
Adopt healthy diet: eating—> unsalted nuts, seeds and legumes, fish, increase fibre intake (30-40 g). Reducing sugar, saturate fat (<30%), salt & processed food.
Alcohol consumption: 14 units week.
Exercise: 150 minutes per week moderate intensity aerobic cavity.

Question 10

What would you offer medicine in patient with QRISK score >10%? ( primary prevention)

Answer 10

Offer 20 mg Atorvastatin OD literate according to lipid profile if not managed.

Question 11

What other patient would receive atorvastatin 20 mg as primary prevention?

Answer 11

Chronic kidney disease
Diabetes type (I)
Hypercholesterolaemia

Question 12

With type 2 diabetes what dose of statin is given and when?

Answer 12

Given Atorvastatin 40 mg when they QRISK score has been calculated >10%.