Lipid Disorders

Question 1

What is the screening test for dyslipidaemia?

Answer 1

Fasting lipids

Question 2

What tools can be used to calculate CV risk?

Answer 2

Fremington risk calculator

CVDcheck.org.au

Question 3

Drugs to reduce cholesterol

Answer 3

Statins
Ezetimibe
Fibrates (PPAR-a agonists)

Question 4

Mechanism of action of statins

Answer 4

HMG-CoA reductase inhibitor (inhibits hepatic cholesterol synthesis, increasing LDL clearance from blood)

Question 5

Risks of combined statin and fibrate regime

Answer 5

Increased risk of myopathy (5-10% of people on statins alone will have symptomatic myopathy at some point, up to 50% have findings on autopsy)

Question 6

Increased risk of myopathy

Answer 6

Simvastatin (esp with added fibrate e.g. gemfibrozil!)

Question 7

What investigations can be performed looking for myopathy?

Answer 7

CK

Question 8

If LDL-C goals are not achieved?

Answer 8

Increase statin dose
Switch to a more potent statin (Lipitor or Crestor)
Combination therapy may be required

Question 9

Mechanism of action of ezetimibe

Answer 9

Inhibition of cholesterol absorption by intestine (cholesterol receptor blocker??)

Question 10

Mechanism of action of fibrates

Answer 10

Activates the nuclear TF PPAR-a, modifying the expression of multiple genes involved in lipoprotein production

Question 11

Effect of statin on lipid profile

Answer 11

Greatest reduction in LDL
??
(for others?)

Question 12

Side effects of statins

Answer 12

Myositis/myopathy

Raised liver enzymes (1-3% of pts; baseline screening no longer recommended)

Question 13

How is statin-induced myopathy managed?

Answer 13

Drug holiday
Start back at lower dose (and/or change to lower risk statin)
Check for other causes of symptoms (e.g. TSH, vit D)

Question 14

Causes of isolated high TGs

Answer 14

Nephrotic syndrome
Uncontrolled DM
Pancreatitis

Question 15

How should recurrent (chronic?) pancreatitis be managed?

Answer 15

Lifestyle - ?

Question 16

Effect of fibrates on lipid profile

Answer 16

Reduced TGs

Increased HDL

Question 17

Drugs to come?

Answer 17

PCSK9 inhibitor (or drugs targeting other points in the pathway)
But all SC injections

Question 18

High dose statins

Answer 18

Crestor (rosuvastatin) or lipitor (atorvastatin) 40-80mg

Simvastatin falling out of favour due to increased risk of myopathy

Question 19

How much can diet affect LDL cholesterol?

Answer 19

Lowering saturated fat from usual 15% to

Question 20

Non-pharmacological management of hyperlipidaemia

Answer 20

Replace saturated fat with poly-unsaturated fatty acids in diet
Vegetarian or Mediterranean diet
?