Dyslipidemia

Question 1

Define:

Answer 1

elevation of plasma cholesterol, triglycerides or both

Normal cholesterol <200mg/dL

Normal TG <150 mg/dL

Question 2

Aetiology:

Answer 2

Lipids travel in the blood bound to a protein to form a lipoprotein. There are 4 classes : cyclomicrons, VLDL, HDL and LDL

There is an increased risk of CVD with increased cholesterol except HDL

Types:
-primary = 70% (LDL high)
Familial
Secondary (Cushing’s, hypothyroidism, nephrotic syndrome and cholestasis)
-Mixed (high LDL and TG) due to T2DM, alcohol abuse, chronic renal failure, metabolic syndrome.

Question 3

Risk factors:

Answer 3

family history

corneal arcus <50 yrs

xanthoma/ xanthelasma

Question 4

Symptoms:

Answer 4

usually asymp unless there are symptoms of vascular disease

Question 5

Signs:

Answer 5

Corneal arcus (this is normal in the elderly)
xanthoma
xanthelasma
milky white retina (in very high TG)

Familial:

• planar (orange streaks in the palmar creases)
• tuberous (plaques on elbows and knees)
• Xanthomas

Question 6

Investigations:

Answer 6

FBC

Serum lipid profile - total cholesterol, TG, HDL, calculated LDL and VLDL

Fundoscopy

To investigate secondary cause: fasting glucose, HBA1c, liver enzymes, creatinine, TSH and urinary protein

fasting lipid profile

Question 7

Management:

Answer 7

Lifestyle modifications:

• exercise
• BMI from 20-25
• Diet (<10% of calories from saturated fats)

Medications:
1st line = satins (simvastatin)
2nd = fibrates (bezafibrate) or cholesterol absorption inhibitors (ezetimbe)

Question 8

Complications:

Answer 8

PVD
coronary artery disease
stroke 
if very high TG = pancreatitis 
statin toxicity

Question 9

prognosis:

Answer 9

Good if controlled early