Lipids

Question 1

Secondary causes of high lipids?

Answer 1

Diet
Alcohol

Diabetes
Hypothyroidism

Nephrotic syndrome

Cholestasis

Steroid Use

Question 2

1/ What is the first line of therapy if predominant LDL increase?
2/ every increase in dose of statin decreases LDL by?

Answer 2

1/ Statins
2/ 5-10%

(Ref etg)

Question 3

Indications for ceasing statins?

Answer 3

ALT 3x upper limit of normal
CK x10 ULN
CK x5 ULN + symptoms 
persistent unexplained ongoing muscle weakness or muscle pain  
(Ref etg)

Question 4

MOA of Ezetimibe
Decreases LDL by?
Synergistic decrease of LDL with statin by?
Improves cardiovascular outcomes?

Answer 4

1. blocks intestinal absorption of cholesterol from the enterocytes
2. 10-15%
3. 20-25%
4. NO!
   Ref: NPS: Managing lipids, reducing cvd risk issue 71, 2011)

Other ref: ETG

Question 5

MOA + when to use?

1. bile acid binding resin
2. nicotinic acid
3. Fibrates

Answer 5

1. If LDL not controlled, Ezetimibe not tolerated –> use alone or + statins
2. is poorly tolerated
3. use alone or + statins (not gemfibrozil –> + statin = severe myositis)

Question 6

When should triglyceride elevation be treated?

Answer 6

Total TG’s >10
Total TG’s >4 and HDL <1.0 in
TG elevation associated with increased CVD risk
Other ref: ETG

Question 7

Which is the best treatment for increased TG’s?

Answer 7

Fenofibrate 145mg daily (renal dose adjust required)
Fish oil 1.2- 3.6grams
Can add nicotinic acid (note all Grade C evidence)

Question 8

Statins are useful as monotherapy for management of severe triglyceride elevation.

T or F

Answer 8

It is not appropriate to manage severe triglyceride elevation (more than 10 mmol/L) with statin monotherapy; maximum doses of fish oil and fibrate are usually needed

(ref etg)

Question 9

What is the most appropriate therapy in the following:
1/ CVD is high, LDL elevated, TG’s up to 4mmol/L
2/CVD is high, LDL elevated TG’s >4mmol/L →

Answer 9

1/Statins
2/ Fibrates
(Statin alone → unlikely to achieve ideal levels of both triglycerides and total cholesterol, Ref etg)

Question 10

What are the targets when on lipid lowering therapy?

Target those high-risk patients who have had a coronary event?

Answer 10

• TC <4.0 mmol/L
• HDL-C ≥1.0 mmol/L
• LDL-C <2.0 mmol/L
• Non HDL-C <2.5 mmol/L
• TG <2.0 mmol/L.

(ref: heart foundation)

LDL < 1.8

Question 11

When should fibrates be commenced in addition (or on their own if patient is intolerant) to statins in Diabetes?

Answer 11

fasting triglycerides are greater than or equal
to 2.3mmol/l; or HDL is low
(Ref: National Evidence based guideline on secondary prevention of CVD)