T3 - Hyperlipidaemias Flashcards
when was the framingham heart study established and what was the purpose?
established in 1948 with the purpose to identify risk factors that contribute to CVD in those without CVD history
what are the six major risk factors for CVD established from the FHS?
hypertension, smoking, obesity, high blood cholesterol, diabetes and low physical activity
what risk factors does QRISK3 take into account?
age, sex, cholesterol:HDL ratio, BP, diabetes smoking
what QRISK score means a patient should go on primary prevention of lipid lowering therapy?
> 10
what is primary prevention of lipid lowering therapy?
statins
in what situation may the QRISK score not be suitable for assessing risk?
in those with familial hypercholesteroleaemia or other inherited lipid metabolism disorders
does a full lipid profile require a fasting blood sample?
no
what three factors may lead to consideration of familial HCE?
total cholesterol >7.5mmol/L, history of HCE or premature CHD
what is the dose and statin of choice for primary prevention?
20mg of atorvastatin
what is the drug of choice and dose for secondary prevention (ie with previous history of CVD)
80mg atorvastatin
what condition may be caused by lipid disorders and what is this associated with
pancreatitis associated with high serum triglycerides
what ligand does LDL R recognise and where is this found?
ApoB-100 in the plasma membrane of LDL
where are most LDL Rs present?
on hepatocytes in the liver
what drug is used in patients that do not tolerate statins well?
ezetimibe
what is the mechanism of action of ezetimibe and what does it cause?
- potent selective inhibitor of cholesterol absorption in the SI
- decreases cholesterol and Tis
what is the mechanism of action of bile acid sequestrates and what does this cause?
bind bile acids in the intestine and stop recycling by interrupting enterohepatic circulation
- this causes increased conversion of cholesterol to bile acids in the liver
- also increases LDL R expression to remove cholesterols from the blood
what enzyme do fibrate drugs activate and what does this cause?
lipoprotein lipase
- causes increased peripheral lipolysis, decreased hepatic TG production and increased reverse cholesterol transport
- decreases TG and increases HDL
what does omega 3 inhibit and what does it promote?
inhibits lipogenesis and promotes beta oxidation of fatty acids
what is the result of PCSK9 inhibitors and in what circumstance is it given?
increased LDL R on hepatocyte surface therefore increased LDL absorption
- only given to very high risk patients
what are the three main patterns of lipoprotein abnormalities?
1) HCE
2) mixed hyperlipidaemia (dyslipidaemia)
3) hypertriglycerideamiea
how is HCE characterised?
raised total and LDL cholesterol
- familial
which patients is mixed HLE commonly seen in and what influences it?
patients with glucose intolerance and diabetes
- often influenced by lifestyle
what may hypertriglycerideaemia cause?
pancreatitis
what is the inheritance pattern of familial HCE and what is the incidence?
autosomal dominant and 1 in 200-250
