Week 5: Dyslipidaemias Flashcards
What is a normal cholesterol level
3.5-5.5 mmol/L
Non-adaptable risk factors for high cholesterol
- Age, sex
- Ethnicity
- Age at menopause
- Family history: CVD, age at first event
- Certain conditions which may secondarily increase cholesterol
Adaptable risk factors for high cholesterol
- Smoking
- Alcohol
- Exercise
- Diet
- Medication
What types of neuro medication can affect lipid levels
- Antiepileptics
* Atypical antipsychotics
What types of cardiac medication can affect lipid levels
Beta blockers
What immunosuppressant drugs can affect lipid levels
- Corticosteroids
- Ciclosporins
What hormonal drugs can affect lipid levels
- Androgens
- Oestrogens
Which are the major lipoproteins involved in creating atherosclerosis
- Chylomicron remnants (RLP)
- IDL
- LPL
- Lipoprotein A
What is a non-cholesterol related reason for high triglycerides
Alcohol
Which lipoprotein measurement is a good marker for risk of pancreatitis
Triglyceride
Why is measuring non-HDL-C more convenient than measuring LDL-C
LDL-C requires fasting (to ensure no chylomicrons/ chylomicron remnants)
Non-HDL-C is not affected by fasting/ eating
What are the 5 components of metabolic syndrome
- Insulin resistance
- Central obesity
- Hypertension
- High triglycerides
- Low HDL
Diagnosis of familial hypercholesterolaemia in a pt
• Total cholesterol conc >7.5 OR • LDL >4.9 AND • Tendon xanthomas in pt/ FDR/SDR OR • Proven mutation in LDLR/ ApoB100/ PCSK9
What QRISK2 score indicates that a pt should be started on statins
> 10% risk
What is the treatment aim when starting a patient on a statin
Reduce non-HDL cholesterol by 40%
List some common sites for deposition of cholesterol
- Around cornea
- Under eyes
- Tendons (usually bilateral deposition)
- Knees, elbows
- Buttocks, calves
- Palms
How does smoking cause high cholesterol
Increases LDL,
Decreases HDL
How does alcohol cause high cholesterol
Increases total cholesterol and triglyceride levels
How do hormone inbalances cause high cholesterol
- thyroid
- growth hormone
- androgens
Low thyroid hormone, low androgens, low growth hormones all lead to high LDL
HPB effects of high cholesterol
- pancreatitis
- gallstones
What does the QRISK2 score calculate
Risk of developing CVD over next 10 years
In which people is it not appropriate to use QRISK2
- inherited lipid metabolism disorders
- Pre-existing CVD
- T1DM
- CKD
- > 85yo
Where are eruptive xanthomas normally located
Elbows
Knee
Buttocks Calves
Tendon xanthomas are associated with what condition
Heterozygous hyperCHOLESTEROLaemia
Eruptive xanthomas on elbows and knees + palmar xanthomas are associated with what condition
Remnant hyperLIPIDaemia
Eruptive xanthomas on buttocks and calves are associated with what 2 conditions
- Familial hyperTRIGLYCERIDaemia
2. Lipoprotein lipase + Apo C2 deficiency
Aortic stenosis is associated with what condition
Homozygous hyperCHOLESTEROLaemia
What does milky plasma mean
A lot of chylomicrons
Genetics of primary hyperCHOLESTEROLaemia
Autosomal codominant
ApoE mutation is associated with what
Remnant hyperLIPIDaemia
ApoB100/ PCSK9/ LDLR mutation is associated with what
Familial hyperCHOLESTEROLaemia
End organ effects of high cholesterol
- HPB
- heart
- brain
- Pancreatitis
- Gallstones (made of cholesterol)
- Angina, MI
- Stroke
- Increased formation of beta-amyloid plaques (increased risk of Alzheimer’s)
