Therapeutics of hyperlipidaemia Flashcards
what are blood clots
- blood clots can form over the fatty, hardened parts of the arteries
- can block arteries completely, cutting off blood flow
- bits of the blood clot can break away and become lodged in an artery or vein in another part of the body, which can cause a heart attack or stroke
what are the signs and symptoms of high cholesterol
- often asymptomatic
- xanthomas
- corneal arcus
- pancreatitis
what are the advantages of measuring non HDL c lipids
- there is no need for a fasting sample
2. it represents the TC circulating in both LDL c and other apolipoprotein containing triglyceride rich particles
what is familial hypercholesterolaemia
- an inherited condition- where an altered gene causes high blood cholesterol
- runs in families
give examples of lipid lowering agents
- statins
- ezetimibe
- PCSK9 inhibitors
- inclisaran
- bempedoic acid
- fibrates
- bile acid sequestrants
- omega 3 fatty acids
- nicotinic acids
what is the mechanism of action of ezetimibe
- inhibits sterol transporter at brush border and consequently intestinal absorption of cholesterol
in turn decreases delivery of cholesterol to liver and reduce hepatic cholesterol stores
what is the mechanism of action of PCSK9 inhibitor
- mAB binds to circulating PCSK9 and prevents degradation of LDL R
- increases LDL R, so they can clear blood LDL C
- 50-70% LDL reduction as monotherapy
summarise the major findings of the heart protection study
- cholesterol lowering with statin treatment reduced the risk of heart attacks and strokes by at least 1 third
- continued treatment with a statin prevented further major vascular events and deaths in people who had already had a heart attack or stroke
- the benefits of treatment increased throughout the 5 year study treatment period, so more prolonged use of a statin would be expected to produce even bigger benefits
describe when lipid modification is used
- measure total cholesterol, HDL cholesterol and non HDL cholesterol in all people who have been started on high intensity statin treatment at 3 months of treatment
- aim for a greater than 40% reduction in non HDL cholesterol
- if greater than 40% reduction is not achieved:
- discuss adherence and timing of dose
- optimise adherence to diet and lifestyle measures
- consider increasing dose if started on less than atorvastatin 80mg and person is judged to be at higher risk
What is the primary prevention risk assesment
QRISK2/QRISK 3
describe lipid lowering therapy in primary prevention
- ensure have completed lipid profile
- calculate CV risk
- check current drug therapy
- check renal function, LFTs, TFTs
- if diabetic, optimise control
- exclude pregnancy
- check co morbidities
- select drug therapy- aiming for >40% reduction in non HDL C
- patient centred discussion
describe the monitoring of statins
- baseline- lipid profile, LFT and TFT
- repeat lipid profile and LFT at 3/12
- repeat 3/12 after dose titrations
- LFT at 1 year
- CK if muscle pain
- avoid grapefruit juice with simvastatin and limit with atorvastatin
- simvastatin and pravastatin- take at bedtime
what are the adverse effects of statins
- headache, altered liver function, new onset diabetes, paraesthesia, GI effects, rash and hypersensitivity, muscle effects
how are PCSK9 inhibitors administered
eg. alirocumab and evolocumab
- administed S/C every 2-4 weeks
- added if LDL C not at target
when you suspect familial hypercholesterolaemia
suspect FH as a possible diagnosis in adults with:
- a total cholesterol level greater than 7.5mmol/l or LDL>4.9mmol/l
- a personal or family history of coronary heart disease
- refer to lipid clinic: genetic testing and high CV risk
