Lipid Modification

Question 1

Who should be offered high dose statin treatment for primary prevention?

Answer 1

• <84 with their Q-RISK score measuring over 10%
• T1DM patients who are >40, have had diabetes for >10 years or have other CVD risk factors
• With CKS, or familial hypercholesterolaemia

Question 2

What is high dose statin treatment?

Answer 2

Atorvastatin 20mg

Question 3

Who should receive high intensity statin treatment?

Answer 3

Existing CVD

Question 4

What is high intensity statin treatment?

Answer 4

Atorvastatin 80mg

Question 5

What is the aim of statin treatment?

Answer 5

Greater than 40% reduction in non-HDL-C levels

Question 6

What blood tests should be done before commencing statin treatment?

Answer 6

• Non fasting lipid profile
• LFT’s
• Renal function including eGFR
• Hba1C
• CK (if persistent muscle pain)
• TSH if dyslipidaemia is present

Question 7

When should you suspect familial hypercholesterolaemia?

Answer 7

• Total cholesterol >7.5mmol/L
  and/or
• Personal or family history of premature CHD

Question 8

What else should you assess in a patient with high cholesterol?

Answer 8

• Alcohol consumption
• Blood pressure
• BMI
• Smoking status

Question 9

What are the adverse affects for statin treatment?

Answer 9

• Myopathy*
• Rhabdomyolysis*
• Muscle aches, joint swelling, back pain
• Headache
• GI upset
• Nasopharyngitis
• Hyperglycaemia
• Weight gain

Question 10

How do statins work?

Answer 10

• Inhibit HMG-CoA reductase, an enzyme involved in cholesterol synthesis
• Increases livers ability to clear the LDL-C in the blood

Question 11

What are contraindications to statin treatment?

Answer 11

• People with active liver disease, or abnormal LFT’S
• Pregnancy/breastfeeding
• Fertile women not on contraception

Question 12

What are cautions to statin treatment?

Answer 12

Predisposition to rhabdomyolysis -

• Renal impairment
• Hypothyroidism
• Muscle pains
• Alcoholic liver disease
• History of hemorrhagic stroke

Question 13

What are some important interactions with statins?

Answer 13

• Amiodarone (myopathy risk)
• Ciclosporin (inc statin in blood)
• CCB’S (inc statin in blood)
• Any -azoles
• Ticagrelor (inc statin in blood)

Question 14

What monitoring is required for statins?

Answer 14

• Repeat LFT’S at 3 and 12 months
• Check CK if unexplained muscle symptoms
• HbA1C at 3 months if high risk of diabetes

Question 15

What advise should you give to a patient regarding taking statins?

Answer 15

1. Seek medical advise if muscle symptoms (pain, tenderness, weakness), symptoms of ILD (dyspnoea, non productive cough)
2. No grapefruit juice, no St Johns Wort
3. Atorvastatin any time, others at night
4. Need to be on contraception

Question 16

How are statins eliminated?

Answer 16

• By the liver