Hyperlipidaemia

Question 1

What is hyperlipidaemia?

Answer 1

Elevated levels of lipids (cholesterol and triglycerides) in the blood

Question 2

Why are lipids necessary?

Answer 2

They are essential for cell membranes, hormone production, and energy storage.

Question 3

What is the main risk of hyperlipidaemia?

Answer 3

Development of atherosclerosis → fatty plaque build-up → cardiovascular disease (MI, stroke, PAD)

Question 4

What is the role of LDL?

Answer 4

“Bad cholesterol” – delivers cholesterol to tissues, contributes to plaque formation

Question 5

What is the role of HDL?

Answer 5

“Good cholesterol” – removes cholesterol from tissues, transports it to the liver for excretion

Question 6

What is the role of VLDL?

Answer 6

Transports triglycerides and some cholesterol from the liver to tissues

Question 7

What is the role of chylomicrons?

Answer 7

Transport dietary triglycerides from intestines to tissues

Question 8

What imbalance is common in hyperlipidaemia?

Answer 8

↑ LDL and triglycerides, ↓ HDL

Question 9

What happens to dietary lipids in the intestine?

Answer 9

Fatty acids + glycerol → triglycerides → packaged into chylomicrons

Question 10

What enzyme breaks down triglycerides in chylomicrons?

Answer 10

Lipoprotein Lipase (LPL) → releases free fatty acids for storage or energy

Question 11

What are chylomicron remnants?

Answer 11

Cholesterol-rich particles left after triglyceride removal, processed by the liver

Question 12

What does the liver secrete after processing remnants?

Answer 12

VLDLs (containing triglycerides and cholesterol)

Question 13

What happens to VLDLs in circulation?

Answer 13

LPL removes triglycerides → VLDLs become IDLs

Question 14

What is the fate of IDLs?

Answer 14

Taken up by the liver or converted into LDLs

Question 15

What is the role of LDLs in metabolism?

Answer 15

Deliver cholesterol to cells for membranes and hormone synthesis

Question 16

What are the two broad categories of hyperlipidaemia?

Answer 16

Primary (familial/genetic) and secondary (acquired)

Question 17

What are examples of primary hyperlipidaemia?

Answer 17

Familial hypercholesterolaemia, familial combined hyperlipidaemia, familial hypertriglyceridaemia, familial dysbetalipoproteinaemia

Question 18

What are common causes of secondary hyperlipidaemia?

Answer 18

Diet (high fat), obesity, diabetes, hypothyroidism, alcohol, certain drugs

Question 19

Why is hyperlipidaemia clinically important?

Answer 19

It is a major modifiable risk factor for cardiovascular disease

Question 20

What causes Type 1 Familial Hyperlipidaemia?

Answer 20

Lipoprotein Lipase or ApoC2 deficiency → impaired triglyceride breakdown → ↑ chylomicrons

Question 21

What characterises Type 2A Familial Hypercholesterolemia?

Answer 21

↑ LDL due to LDL receptor mutations → high “bad cholesterol.”

Question 22

What characterises Type 2B Familial Hypercholesterolemia?

Answer 22

↑ LDL + ↑ VLDL due to defective lipoprotein regulation

Question 23

What causes Type 3 Dysbetalipoproteinemia?

Answer 23

Defective ApoE → impaired clearance of VLDL & chylomicron remnants → ↑ risk of atherosclerosis

Question 24

What causes Type 4 Familial Hypertriglyceridaemia?

Answer 24

↑ VLDL production in the liver → ↑ triglycerides

Question 25

How does diabetes cause hyperlipidaemia?

Answer 25

Insulin resistance → ↑ VLDL production + ↓ HDL

Question 26

How does hypothyroidism cause hyperlipidaemia?

Answer 26

↓ thyroid hormones → reduced lipid metabolism → ↑ LDL

Question 27

Which medications can cause hyperlipidaemia?

Answer 27

Thiazide diuretics and others that alter fat metabolism

Question 28

What are the treatment goals in hyperlipidaemia?

Answer 28

↓ LDL-C, ↑ HDL-C, ↓ triglycerides → prevent atherosclerosis & CV events

Question 29

What is the mechanism of statins?

Answer 29

Inhibit HMG-CoA reductase → ↓ cholesterol synthesis → ↑ LDL receptor expression → ↑ LDL clearance

Question 30

What are pleiotropic effects of statins?

Answer 30

Improve endothelial function, reduce oxidative stress, stabilise plaques

Question 31

When are statins used?

Answer 31

First-line therapy for primary & secondary prevention of CVD

Question 32

Examples of statins?

Answer 32

Atorvastatin, Simvastatin, Rosuvastatin

Question 33

How are statins dosed?

Answer 33

Once daily; simvastatin at night, atorvastatin/rosuvastatin any time

Question 34

What monitoring is needed with statins?

Answer 34

LFTs before and after 3 months; lipid profile every 3 months

Question 35

Common side effects of statins?

Answer 35

Myopathy, rare rhabdomyolysis, ↑ liver enzymes, GI disturbances

Question 36

Key counselling for statins?

Answer 36

Take consistently; report muscle pain; avoid grapefruit juice (esp. simvastatin)

Question 37

What is the mechanism of ezetimibe?

Answer 37

Inhibits NPC1L1 transporter in intestine → ↓ cholesterol absorption → ↑ LDL receptor expression → ↓ LDL

Question 38

When is ezetimibe used?

Answer 38

Add-on to statins if LDL remains high or in statin intolerance

Question 39

Example of ezetimibe?

Answer 39

Ezetimibe (Ezetrol)

Question 40

How is ezetimibe dosed?

Answer 40

Once daily, with or without food; often combined with statins.

Question 41

What monitoring is needed with ezetimibe?

Answer 41

Lipid profile; LFTs if combined with statins

Question 42

Common side effects of ezetimibe?

Answer 42

Diarrhoea, abdominal pain, fatigue, arthralgia (usually mild)

Question 43

Key counselling for ezetimibe?

Answer 43

Maintain healthy diet; remind patients of monitoring if combined with statins

Question 44

Why is pharmacological management of hyperlipidaemia important?

Answer 44

Reduces risk of atherosclerosis, heart attacks, strokes, and cardiovascular mortality

Question 45

What is the mechanism of fibrates?

Answer 45

PPAR-α agonists → ↑ lipoprotein lipase expression → ↓ triglycerides, ↑ HDL, ↓ VLDL production

Question 46

What is the rationale for using fibrates?

Answer 46

Effective in hypertriglyceridaemia; moderately increase HDL; sometimes combined with statins in mixed dyslipidaemia

Question 47

Examples of fibrates?

Answer 47

Fenofibrate, Gemfibrozi

Question 48

How are fibrates dosed?

Answer 48

Once or twice daily, usually with meals

Question 49

What monitoring is required with fibrates?

Answer 49

Lipid profiles, liver function tests, renal function tests

Question 50

Common side effects of fibrates?

Answer 50

GI disturbances, gallstones, myopathy (especially with statins)

Question 51

Key counselling for fibrates?

Answer 51

Report muscle pain/weakness; combine with diet/exercise for best effect.

Question 52

What is the mechanism of PCSK9 inhibitors?

Answer 52

Monoclonal antibodies block PCSK9 → ↑ LDL receptors on hepatocytes → ↑ LDL clearance

Question 53

What is the rationale for using PCSK9 inhibitors?

Answer 53

For familial hypercholesterolaemia or high CV risk patients not controlled with statins/ezetimibe

Question 54

Examples of PCSK9 inhibitors?

Answer 54

Alirocumab, Evolocumab

Question 55

How are PCSK9 inhibitors dosed?

Answer 55

Subcutaneous injection every 2–4 weeks.

Question 56

What monitoring is required with PCSK9 inhibitors?

Answer 56

Regular lipid profiles

Question 57

Common side effects of PCSK9 inhibitors?

Answer 57

Injection site reactions, flu-like symptoms, fatigue

Question 58

Key counselling for PCSK9 inhibitors?

Answer 58

Teach injection technique; stress adherence; report persistent flu-like symptoms or injection site issues

Question 59

What dietary changes help manage hyperlipidaemia?

Answer 59

↓ saturated/trans fats; ↑ soluble fibre (oats, beans, lentils); plant sterols/stanols

Question 60

How does exercise help?

Answer 60

Regular aerobic activity (≥150 min/week) → ↑ HDL, ↓ triglycerides

Question 61

How does weight loss help?

Answer 61

Losing 5–10% body weight → ↓ LDL/triglycerides, ↑ HDL

Question 62

Why is smoking cessation important?

Answer 62

Smoking ↓ HDL and damages vessels → quitting improves lipid profile and CV risk

Question 63

How does alcohol intake affect lipids?

Answer 63

Excess alcohol ↑ triglycerides; moderation reduces risk

Question 64

Why combine lifestyle changes with drug therapy in hyperlipidaemia?

Answer 64

Lifestyle modifications enhance drug efficacy, reduce LDL/triglycerides, raise HDL, and improve CV outcomes