Hyperlipidaemia

Question 1

Define it

Answer 1

Elevated blood lipid levels (Total cholesterol, LDL, triglycerides)

Question 2

Causes

Answer 2

• Obesity
• Diabetes
• Physical inactivity
• Hypothyroidism
• Nephrotic syndrome
• Alcohol
• Cholestatic liver disease

Question 3

What does it increase risk of?

Answer 3

Elevated LDL and reduced HDL → promote atherosclerosis → increased risk of cardiovascular events

Question 4

What is familial hypercholesterolaemia (FH)?

Answer 4

• Autosomal dominant inherited disorder
• Caused by a mutation in the gene coding the LDL receptor
• Causes early-onset hypercholesterolaemia and hyperlipidaemia, leading to cardiovascular disease in young patients

Question 5

CF

Answer 5

• Xanthomata → nodular lipid deposits in the skin and tendons
• Xanthelasma → yellow, flat plaques on upper eyelids
• Corneal Arcus → crescentic-shaped opacity at the periphery of the cornea

Question 6

What is the main investigation we do?

Answer 6

Lipid profile - total cholesterol, HDL, LDL, triglycerides

Question 7

What tests for secondary causes are there?

Answer 7

• HbA1c/fasting glucose
• TSH
• LFTs
• Urinalysis

Question 8

What score do we calculate and why?

Answer 8

QRISK2 → screens for risk of cardiovascular disease

Question 9

What do we prescribe if QRISK <10%?

Answer 9

Lifestyle modifications:
- Improve diet
- Physical activity
- Weight management
- Alcohol intake reduction
- Smoking cessation

Question 10

What’s 1st line is QRISK ≥10%?

Answer 10

Trial of lifestyle modification

If ineffective add atorvastatins 20mg (alternative is simvastatin)

Question 11

What does atorvastatins do and who are they contraindicated in

Answer 11

Decreases cholesterol synthesis by inhibiting HMG-CoA reductase
Should be taken last thing at night to improve efficacy

Contraindicated in pregnant women

Question 12

What other medication does atorvastatin have an important interaction with?

Answer 12

Erythromycin/clarithromycin (macrolides)

Can cause myopathy and increase likelihood of rhabdomyolysis

Question 13

When should statin treatment be discontinued?

Answer 13

If serum transaminase concentrations rise to and persist at 3x the upper limit of reference range

Question 14

What’s 2nd line if intolerance to 1st line treatment?

Answer 14

Ezetimibe - cholesterol absorption inhibitor

Question 15

How can we treat the xanthelasma if it’s affecting patient’s AODL?

Answer 15

Laser therapy or surgical excision