Lipids and cardiovascular disease Flashcards
what are modifiable risk factors for heart disease?
- smoking
- diet
- BMI
- exercise
cholesterol
-BP
what are non modifiable risk factors for heart disease?
- family history
- sex
- age
- ethnicity
what other illnesses are linked with hyperlipidaemia?
- MI
- acute pancreatitis
- xanthelasma
what are clinical signs of hyperlipidaemia?
Tendon xanothoma
- corneal arcus
- thickening of the achilles
what are causes of secondary hyperlipidaemia?
Diabetes Hypothyroidism Renal Disease Liver disease Alcohol
what baseline investigations should be done on all patients with lipid disorders?
- lipid profile
- U and E
- LFT
- ggT
- fasting glucose
- TFT
- urine dipstick
what is the cut off for a specialist referral due to hyperlipidaemia?
TC>9 or non HDL>7,5 even if there is no family history
what is the defect in autosomal dominant hypercholesterolaemia?
defect of LDL APO B receptor gene
Less cholesterol efflux
what is PCSK9?
A serine protease
what is the effect of PCSK9?
When they bind to LDL it causes both of their degradations
why are PCSK9 inhibitors a potential treatment for hyperlipidaemia?
PCSK9 causes destruction of LDL receptors meaning less clearance
when inhibited more LDL receptors can be recycled to the cell surface to take up more LDL cholesterol
what is the role of LDLRAP1?
mediates the position of the LDL receptors to the coated pits
what is remnant disease?
There is accumulation of LDL remnant particles
Will have high lipids and triglycerides
what is the defect in remnant disease?
In apoE2
how is hyperlipidaemia classified?
Depending on triglycerides and cholesterol levels
what is type IIA?
Just very high cholesterol
Can be familial hypercholesterolaemia
what is type IIB?
Very high cholesterol
slightly high triglycerides
can be familial combined hyperlipidaemia
what is type III?
High cholesterol and high triglcyrides
Increased in IDL
what is type IV?
Very high triglyceride and cholesterol
Often secondary
what is type I/V?
Very high triglycerides with a slightly raised cholesterol
what is the NICE specified risk scoring system for cardiovascular disease?
QRISK2
What does QRISK2 take into account?
- age
- gender
- ethnicity
- smoking
- diabetes
- family history
- AF
- medications
- RA
what lipoproteins does the Apo A1 test measure?
HDL
what lipoproteins does the Apo B100 test measure?
LDL
IDL
VLDL
Values above which number for the Lp test are associated with increase CVD risk?
300mg/l
values above which score on CRP are associated with increased CRP risk?
3
what lifestyle advice can be given for hyperlipidaemia?
- eat a cardioprotective diet
- physical activity
- weight management
- alcohol
- smoking cessatation
how does ezetimibe work?
Inhibits gut absorption of cholesterol and inhibits VPCILI a lipid transporter
what is the criteria for diagnosing an acute MI?
Two of:
- clinical features like chest pain
- ECG changes
- cardiac enzyme changes
Other than a heart attack what else can cause raised troponin?
- Primary ischaemic cardiac injury due to an acute coronary syndrome mainly a ruptured plaque
Secondary ischaemic cardiac injury
Non ischaemic cardiac injury
what are causes of non ischaemic cardiac injury?
- myocarditis causes such as viral
- cardiac trauma
- inflammation
- auto immune
- drugs
