hyperlipidaemia

Question 1

lipid transport

Answer 1

lipids travel the blood packaged with proteins as lipoproteins
4 classes:
chylomicrons and VLDL (mainly triglyceride)
LDL (mainly cholesterol)
HDL (mainly phospholipid)

Question 2

risk factors

Answer 2

FHx of hyperlipidamia
corneal arcus <50yo
xanthomata or xanthelasma

Question 3

common primary hyperlipidaemia

Answer 3

70% of all

raised LDL

Question 4

familial primary hyperlipidaemias

Answer 4

comprise multiple phenotypes
greatly increase the risk of CVD
evidence suggests that protection gained from statins can be achieved at lower doses than common primary

Question 5

secondary hyperlipidaemia

Answer 5

may be caused by:
cushing's syndrome
hypothyroidism
nephrotic syndrome
cholestasis

high LDL
treat underlying cause first

Question 6

mixed hyperlipidaemia

Answer 6

increase in both LDL and triglycerides

caused by: T2DM, metabolic syndrome, alcohol abuse, chronic renal failure

Question 7

management

Answer 7

lifestyle advice:
BMI 20-25, diet with <10% calories from saturated fats, omega 3, exercise

1st line:
statins eg simvastatin, which decrease cholesterol synthesis in the liver
CI: pregnancy, porphyria, cholestasis
SE: myalgia and mysositis

2nd line:
fibrates eg bezafibrate or cholesterol absorption inhibitors eg ezetimibe