Wk 13: Lipids

Question 1

What is cholesterol?

Answer 1

• Make up cell membrane - stabilise cell
• Precursor for prod of steroid hormones + bile acids

Question 2

What is triglyceride?

Answer 2

• Made up of glycerol + FA
• Main store of energy esp in adipose tissue
• Causes damage to arteries

Question 3

What are low density lipoproteins?

Answer 3

• Major transporter of cholesterol
• Encourage deposit of cholesterol in arteries

Question 4

What are high density lipoproteins?

Answer 4

Carry cholesterol from cells back to liver

Question 5

What are the guidelines to lipids?

Answer 5

• Non HDL used to measure
• Statin therapy when 10 yr CV risk >10%
• QRISK2 used

Question 6

What is used as primary prevention?

Answer 6

Atorvastatin 20mg

Question 7

When is QRISK2 used?

Answer 7

• Primary prevention (upto 84)
• Type 2 diabetes

Question 8

When do you not use QRISK2?

Answer 8

• Type 1 diabetes
• eGFR: <60 + albuminuria
• Established CVD
• Inherited lipid conditions

Question 9

Which people will have risks that will be underestimated in their CVD score?

Answer 9

• HIV
• Mental health
• Meds that cause dyslipidemia: antipsychotic, corticosteroid or immunosuppressant
• Autoimmune disorders: systemic lupus erythematosus
• Recently stopped smoking
• Antihypertensives or lipid mods

Question 10

What are the lifestyle modifications given to people w/ high risk or CVD?

Answer 10

• Red sat fat intake
• Inc mono sat fat intake
• Choose wholegrain
• Red intake
• 5 portions of fruit + veg per day
• 2 portions of fish per week
• 4-5 portions of nuts/seeds/legumes per week

Question 11

What are the lipid measurements taken?

Answer 11

• Full lipid profile (total cholesterol, HDL, non-HDL + triglycerides)
• Non-HDL (predicts CVD)

Question 12

When would you consider familial hypercholesterolaemia?

Answer 12

• Total cholesterol conc >7.5mmol/l
• Fx premature coronary heart disease

Question 13

When would you refer when interpreting results?

Answer 13

• Total cholesterol: >9mmol/L
• Non-HDL: >7.5mmol/L
• Triglycerides: >20mmol/L

Question 14

What happens if a patient has unexplained muscle pain before starting a statin?

Answer 14

• Measure CK levels
• > 5x ULN, retest after 7 days, if high don’t start statin
• Raised <5x ULN, start at low dose + monitor

Question 15

What doses are used for high intensity treatment?

Answer 15

• Atorvastatin: 20–80 mg
• Rosuvastatin: 10–40 mg
• Simvastatin: 80 mg

Question 16

When would you offer atorvastatin 20mg for primary prevention?

Answer 16

• 10% risk of CVD
• > 85 yrs old to red MI
• Type 1 diabetes
• Type 2 w/ 10% risk of CVD
• CKD

Question 17

What is the dose used for secondary prevention?

Answer 17

Atorvastatin 80mg OD

Question 18

When would you offer primary prevention in type 1 diabetes?

Answer 18

• Older than 40
• Diabetes for > 10 yrs
• Established nephropathy
• CVD risk factors

Question 19

What dose do you give for primary prevention in a patient with CKD?

Answer 19

Inc if greater than 40% red in non HDL cholesterol not achieved + eGFR 30

Question 20

What are the monitoring requirements after starting statin therapy?

Answer 20

High intensity statin for 3 months: aim 40% red

• Total cholesterol
• HDL cholesterol
• non-HDL cholesterol

Question 21

Which drugs interact w/ simvastatin?

Answer 21

• Erythromycin + clarithromycin
• Ciclosporin
• Amiodarone
• Diltiazem
• Amlodipine

Question 22

Can pregnant women or childbearing potential take statins?

Answer 22

• No teratogenic
• Planning: stop 3 months before attempting + restart after breastfeeding