Dyslipidaemia

Question 1

define Dyslipidaemia?

Answer 1

• Elevation of plasma cholesterol, triglycerides or both

Question 2

what are the 4 classes of lipids?

Answer 2

o	Chylomicrons
o	VLDL (mainly TG)
o	LDL (mainly cholesterol) 
o	HDL (mainly phospholipid)

Question 3

what is the greatest risk for CVD?

Answer 3

cholesterol

Question 4

what are risk factors for hyperlipidaemia?

Answer 4

o Family history of hyperlipidaemia
o Corneal arcus <50 yrs old
o Xanthomata or xanthelesmata

Question 5

what are the types of hyperlipidaemia?

Answer 5

o Common primary hyperlipidaemia: accounts for 70% of hyperlipidaemia
o Familial primary hyperlipidaemia: multiple phenotypes
o Secondary hyperlipidaemia: due to Cushing’s syndrome, hypothyroidism, nephrotic syndrome or cholestasis. Treat cause first.
o Mixed hyperlipidaemia: both LDL and TG high. Due to T2DM, metabolic syndrome, alcohol abuse, chronic renal failure.

Question 6

epidemiology for dyslipidaemia?

Answer 6

very common

Question 7

presenting symptoms?

Answer 7

asymptomatic but leads to conditions ect.

• coronary artery disease
• stroke
• peripheral vascular disease

Question 8

signs of dyslipidaemia?

Answer 8

• Corneal arcus
• Xanthomas
• Xanthelasma – xanthoma of the eyelid
• Milky white appearance of retina

Question 9

which investigations should be carried out for dyslipidaemia?

Answer 9

• FBC:
o serum lipid profile
• Fundoscopy
• Tests for secondary causes of dyslipidaemia:
o fasting glucose, HbA1c, liver enzymes, creatinine, TSH, urinary protein

Question 10

what are normal levels and high levels for dyslipidaemia?

Answer 10

good = 3.9-5.5 
borderline = 5.5-6.5 
high = >6.5

Question 11

what tool should be used to assess if someone needs statins?

Answer 11

• QRISK2

Question 12

who should be offered statins?

Answer 12

o	with a QRISK2 10 year risk of >10%
o	T1DM  
o	CKD with eGFR<60 
o	Ischaemic heart disease 
o	CVD 
o	PAD

Question 13

what lifestyle advice should be given to those with high lipids?

Answer 13

o Aim for BMI 20-25
o Diet with <10% calories from saturated fat, high fibre, fresh fruit and veg, omega-3 fatty acids
o Exercise

Question 14

what is a low and high intensity statin?

Answer 14

• Atorvastatin = high intensity statin

* Simvastatin = low intensity statin

Question 15

what is primary and secondary prevention and how much statin should be given?

Answer 15

primary prevention = 
20mg of atorvastatin 
(preventing a heart event) 
secondary prevention = 
80mg of atorvastatin
(actually has had a heart event)

Question 16

complication sof dyslipidaemia?

Answer 16

• Coronary artery disease
• Stroke
• Peripheral vascular disease
• Very high levels of TGs can cause pancreatitis
• Statin toxicity

Question 17

prognosis?

Answer 17

good if controlled early.