Lipid Lowering

Question 1

How do statins work?

Answer 1

Inhibiting HMG-CoA reductase

Inhibits hepatic cholesterol synthesis

Question 2

Adverse effects of statins

Answer 2

Myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase
Liver impairment
Intracerebral haemorrhage?

Question 3

What monitoring should be done with statins?

Answer 3

Check LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

Question 4

What are the risk factors for statin induced myopathy?

Answer 4

Risks factors for myopathy include advanced age, female sex, low body mass index and presence of multisystem disease such as diabetes mellitus.

Question 5

Who should be given statins?

Answer 5

• All pts with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
• QRISK2 >10% 10yr cardiovascular risk
• T1DM diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

Question 6

Dose and timing of statins

Answer 6

At night (esp simvastatin)
1º prevention: 20mg atorvastatin OD
2º prevention: 80mg atorvastatin OD

Question 7

What fruit interacts with statins?

Answer 7

Grapefruit juice

Question 8

What is lipodystrophy syndrome?

Answer 8

Triad of:
Fat redistribution (buffalo hump)
Insulin resistance
Dyslipidaemia (raised LDL etc)

Question 9

What drugs increase the risk of statin induced myopathy?

Answer 9

Erythromycin and clarithromycin