Hyperlipidaemia

Question 1

Lipids travels in blood packaged with proteins as lipoproteins.

What are the four classes of lipids?

Answer 1

• Chylomicrons and VLDL (mainly triglyceride)
• LDL (mainly cholesterol)
• HDL (mainly phospholipid)

Question 2

Screening for hyperlipidaemia requires a fasting lipid profile. Who is at risk of hyperlipidaemia?

Answer 2

• FHx of hyperlipidaemia
• Corneal arcus >50 yrs old
• Xanthomata or xanthelasmata

Question 3

Who is at risk of CVD?

Answer 3

• Known CVD
• FHx of CVD < 60 yrs
• DM or impaired glucose tolerance
• HTN
• Smoker
• Increased BMI

Question 4

What are the different types of hyperlipidaemia?

Answer 4

• Common primary hyperlipidaemia → accounts for 70%; increase in LDL only
• Familial primary hyperlipidaemia → multiple phenotypes
• Secondary hyperlipidaemia → causes incl: Cushing’s syndrome, hypothyroidism, nephrotic syndrome or cholestasis; increase LDL, treat the cause first
• Mixed hyperlipidaemia → results in increase in both LDL and triglycerides; caused by T2DM, metabolic syndrome, alcohol abuse + chronic renal failure

Question 5

What is the conservative management of hyperlipidaemia?

Answer 5

• Weight loss
• Aim for BMI → 20-25
• Encourage mediterranean diet → fruit, beg, fish, less red meats

Question 6

What is the medical management of hyperlipidaemia?

Answer 6

• Primary prevention → atorvastatin 20mg PO at night
• Secondary prevention → atorvastatin 80mg PO at night

Question 7

How do statins work?

Answer 7

• Inhibit action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
• Adverse effects → myopathy + liver impairment
• Myopathy = myalgia, myositis, rhabdo, asymptomatic raised CK
• Check LFTs at baseline, 3m + 12m

Question 8

What are types of xanthomata?

Answer 8

• Eruptive → itchy nodules in crops in hypertriglyceridaemia
• Tuberuous → plaques on elbows and knees
• Planar → orange streaks inpalmar creases
• Eyelids → xanthelasma