What are the healthy levels in a lipid full profile?
Total cholesterol = 5 or below
HDL (good) = 1 or above
LDL (bad) = 2 or below
Non-HDL = 2.6 or below
Triglycerides = 2.3 or below
What is the criteria to be initiated lipid lowering agents?
- over 85 years with 10 year risk of QRISK3 score greater than 10%
- T2D patient with 10 year risk of QRISK3 score greater than 10%
- ALL T1D patients with:
- who are 40 years or older
- who have had diabetes for over 10 years
- established neuropathy
- patients with chronic kidney disease
-patients with familial hypercholesterolaemia (genetic)
What are the three lipid lowering agents used to treat cholesterol
-statins
-ezetimibe
- fibrates
What the the 5 names of statins
Atorvastatin
Pravastatin
Rosuvastatin
Simvastatin
Fluvastatin
Which two satins are used any time of the day
Atorvastatin and rosuvastatin
Why is 80mg atorvastatin used for
Secondary prevention of heart attacks
What should be managed before starting statins
Hypothyroidism
Patients who have high risk of diabetes should have what done
They should have fasting blood glucose concentration or HbA1c levels checked before starting statins and should be repeated after 3 months
Statins can cause hyperglycaemia
Why is pravastatin, simvastatin and fluvastatin be taken at night
Due to cholesterol being made at night
What monitoring is required when taking statins
- before initiation a full lipid profile, thyroid function and renal function should be assessed
- liver function and liver enzymes should be measured before treatment after 3 months and after 12 months
- discontinue if serum transaminase are raised by more than 3x the upper limit
- creatinine kinase is measured in patients who have previously had persistent muscle aches
If measurement is higher than the 5x upper limit- re measure after 7 days
If still 5x higher than upper limit then don’t start statins
If levels are raised but are lower than 5x upper limit then start at a lower dose
Statins side effects
Myopathy and rhabdomyoisis- muscle toxicity = seek medical advice if experiencing Pain, tenderness or weakness
Interstitial lung disease- seek medical attention if patient develops weight loss, cough or Dyspnoea
Teratogenic - avoid in pregnancy and discontinue 3 months before conceiving
Hyperglycaemia
What are the interactions of statins
CYP450 enzyme inducers- reduces conc of statins
CYP450 enzyme inhibitors- increases the conc of statins and therefore and increased risk of rhabdomyolysis
Patients who are prescribed macrolide should stop taking statins during treatment
Avoid grapefruit juice
Fusidic acid (oral) stop taking statins during treatment and restart after 7 days of the last dose
What are stains maximum dose
Amiodarone + simvastatin 20mg
Amlodipine + simvastatin 20mg
Diltiazem/verapamil + simvastatin 20mg
Elbasvir/ grazoprevir +simvastatin = 20mg
Fibrartes (not fenofibrate) + simvastatin= 10mg
Ticagrelar + simvastatin 40mg
cyclosporine and atorvastatin 10mg
Tipranavir + atorvastatin 10mg
Ezetimibe and stains can cause what?
Increased risk of rhabdomyloysis
What are fibrates
Bezafibrate, fenofibrate and ciprofibrate and gemifibrozil
Myotoxicity in renal impairment
- measure LFTs every 3 months for the first year
Statins and fibrates has an increased risk of muscle related side effects
