Hyperlipidaemia

Question 1

Which type of hyperlipidaemia is more common primary or secondary, and what causes it?

Answer 1

1. Secondary more common than primary.

2. Hypothyroidism, diabetes, renal disease, liver disease, alcohol.

Question 2

How is hyperlipidaemia investigated?

Answer 2

1. Lipid profile - TC, HDL, LDL, non-HDL, TG
2. U&Es
3. LFTs and GGT (alcohol)
4. HbA1c
5. TFTs
6. Urine dip

Question 3

What primary hyperlipidaemia should be considered in raised total cholesterol and family history of premature heart disease (<60 years)?

Answer 3

Familial hypercholesterolaemia

Question 4

Which type of familial hypercholesterolaemia is the most common and second most common, and what are the results of TC and TG?

Answer 4

1. Type IIA - high TC, low TG

2. Familial combined hyperlipidaemia - high TC, high TG

Question 5

How do you establish whether treatment is required in hyperlipidaemia?

Answer 5

QRISK3 score:

1. All patients with established CVD for secondary prevention.
2. Familial hypercholesterolaemia
3. Primary prevention in DM, CKD 3

Question 6

What is the management of hyperlipidaemia?

Answer 6

1. Cardioprotective Mediterranean diet, exercise, weight management, reduce alcohol, smoking cessation.
2. Statins 1st line, cholesterol absorption inhibitor 2nd line (ezetimibe), PCSK9i 3rd line (alirocumab)