Treatment of Hyperlipidaemia Flashcards
What is atherosclerosis?
response to injury - as you accumulate risk factors you damage your vascular internal and inevitably you end up with some form of atherosclerosis -
risk factors:
smoking, diabetes etc
what are some modifiable risk factors for cardiovascular disease?
•Modifiable
–Smoking
–Dyslipidaemia
- raised LDL cholesterol
- low HDL cholesterol
- raised triglycerides
–Raised blood pressure
–Diabetes mellitus
–Obesity
–Dietary factors
–Lack of exercise
–Excess alcohol consumption
what is the single greatest predictor of cardiovscular disease?
family history
what are the good/bad types of lipids?
low density lipoprotein = bad
high density lipoprotein?= good
describe the process of atherosclerosis and it’s association with hyperlipidemia
As you damage the endothelium – monocytes attack to the endothelium = oxidized LDLs are taken up by monocytes which then migrate into the subendothelium and then plaque developments form
how are lipoproteins classified?
by density
Based on density:
- Chylomicrons (non-atherogenic)
- Very low-density lipoprotein (VLDL)
•
•Intermediate-density lipoprotein (IDL)
•
•Low-density lipoprotein (LDL)
•
•High-density lipoprotein (HDL).
how do you raise your good cholesterol?
you raise your HDL cholesterol - by consistently exercising - it’s one of the reasons that exercise works
Why is HDL good for you?
Mechanism may be
due to reverse cholesterol
transport (Probably other mechanisms e.g. antiinflammatory, antioxidative.)
what is the difference between primary prevention and secondary prevention in CVD?
primary = stop heart attack from occuring in the first place
secondary = stop heart attack from occuring again with drug therapy
the more risk factors….?
the more aggressive the treatment
obesity raises the risk of morbidity from… ?
- Hypertension
- Dyslipidemia
- Type II diabetes mellitus
- Coronary heart disease
- Stroke
- Gallbladder disease
- Osteoarthritis
- Sleep apnea
- Cancer
are triglycerides bad for you?
yes. rarely you’ll find isolated raised triglycerides - it’s usually involved with other condiitons
a 65 year old diabetic, hypothyroidetic, obese, boozy, and he is on the pill, presents to the clinic with a raised cholesterol… what do you do?
if you have a primary reason for high cholesterol - treat it - find the cause and stomp on it
how do statins work?
- The statins are the most effective and best-tolerated agents for treating dyslipidemia.
- These drugs are competitive inhibitors of HMG-CoA reductase
what do you use to lower triglycerides?
with a fibrate
what is the effect of statins?
lower LDL
raise HDL
lower Triglycerides
why might you use a different statin?
people have differences in metabolism - so if you have side effects on one, use a different one
what are some proven adverse effects of statins?
•Myopathy
- defined as muscle pain or weakness combined with large increases in blood concentrations of creatinine kinase
- Diabetes you will cause in some people
- It is likely that the risk of haemorrhagic stroke is increased
- the net benefit of the drug far outweighs the side effects
what are some myths about statins ?
nocebo - if you tell someone about the side effects, they’ll start to feel like they have them- it’s the opposite of the placebo
muscle pain?- muscle pain on a placebo is the same as muscle pain on statins
memory loss?- nope
cataracts? nope
erectile dysfunciton? Nope
Will you find evidece of this in literature? Yes. Do the statins cuase this? No.
risk of myopathy with statins increases with what?
increases with concentration
what factors may increase statin risk?
drugs that effect the catabolism of statins - increase risk of myopathy
measure a CK before prescribing a Statin in the following situations.
- Renal impairment
- Hypothyroidism
- Personal or family history of hereditary muscular disorders
- Previous history of muscular toxicity with a statin or fibrate
- Alcohol abuse
- Elderly patient
- Clinical monitoring is essential in these patients
- If CK levels are significantly elevated do not use a Statin
how do fibrates work?
we don’re really know - invovles interaction with the nuclear transcription factor PPAR that regulates several genes invovled in lipid metabolism
What are Bile-Acid binding sequestrants?
bile-acid binding resins stop absorption of bile - they are very effective drugs - they are not absorbed by the body so they are super safe!
the benefits of statin therapy depends on what?
depends on the individuals absolute risk
- Lowering LDL by 2 mmol/L for 5 years in 10,000 patients would typically prevent major vascular events from occurring in about 1000 patients (10% absolute benefit) with pre-existing occlusive vascular disease (secondary prevention).
- And in 500 patients (5% absolute benefit) who are at increased risk but have not yet had a vascular event (primary prevention)
What is the biggest concern with statins? What increases this risk?
myopathy = biggest risk
- increase risk of this with concentration of statins or drugs that effect statin catabolism
is it true to say that statins are extremely beneficial for a small subgroup of the population and not effective for a larger group?
that’s a fair statement - you cannot measure individual risk. You cannot prove that someone ‘would have’ had a heart attack if not on statins
