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Flashcards in Dyslipidemia 2 Deck (21):


Abnormal lipid profile in serum



Predominant hyperTAG Predominant hypercholesterolemia Mixed


What level of hyperTAG + risk pancreatitis

When level >10mmol/l


What reduction in total cholesterol reduced CAD risk by 20% after 3 years

A 10% reduction


Causes of secondary

Neprhotic Anorexia Hypothyroid T2DM Cholestasis Obesity Kidney impairment Alcohol abuse Smoking


Confirmation of diagnosis

Confirm a positive result with a repeat test in 6-8 weeks.


Treatment goals

TC <4
LDL <2.5 (<2 in high risk)
HDL >1
TG <2


Patients requiring treatment: at what levels

1. CAD->Cholesterol >4 2. High risk->DM, FH, FHx CAD Cholesterol >6.5 or >5.5 + HDL cholesterol >6.5 4. Patients not for above: men 35-75, PM women->Cholesterol >7.5, TAG >4 5. Others->Cholesterol >9, TAG >8


Non-pharmacological measure

1. Diet 2. Exercise 3. Smoking 4. Alcohol 5. Cooperation of family 6. Exclude secondary causes Diet therapy reduction in TG and LDL within 6-8 weeks. Continue for at least 6 months before medication, unless high risk


Diet measures

Ideal weight Reduce fats Avoid fast food Replace to mono-unsaturated Approved cooking method Avoid busicuts/sweets between meals High fibre fruit and vegetables Complex carbohydrates Drink more water Reduce alcohol Fish oil


Pharmacological management of hypercholesterolemia

1. Atorvastatin 10mg nocte (max 80mg) 2. Ezetemibe if statin intolerant (arthralgia, myalgia, liver) 3. Combination ezetemibe + statin 4. Bile acid sequestrating: cholestyramin 4g daily in fruit juice->GIT SE 5. Fibrates->if others not tolerated Second line: Nicotinic acid Probucol


Adverse effects of statins and monitoring

Muscle pains Raised liver enzymes GIT Monitor LFTs and CK as baseline Repeat LFTs after 4-8 weeks, then every 6 weeks for 6 months


Pharmacological management of mod-severe TG

Gemfibrozil BD or fenofibrate Slow response, monitor LFTs, predisposes to gall stones and myopathy Second line: Nicotinic acid If +++TG Fibrate + fish oil


Treatment when mixed

If TG 4: fibrate Consider statin + fish oil, fibrate + resin


Should a statin + fibrate be used

Increased risk of myopathy, need specialist supervision for use


Follow up investigations

Serum lipids LFTs CK


Heirachy of concern when raised CK and raised ALT

1. CK: statin > fibrate > nicotinic acid or ezetimibe 2. ALT: nicotinic acid > ezetimibe > fibrate > statin


Baseline elevation in ALT, creatinine

3X ULN ALT and 5X ULN Creatinine--> incidental? (alcohol and exercise-->avoid for few days and retest) Consider delay treatment until normal +Not to 3/5 X normal--> incidental? If starting therapy--> heirachy of concern


Reassessment elevation of LFTs

ALT 3XULN, CK 10X ULN or 5X with muscle symptoms--> STop therapy, retest in a month If persistent elevation: consider harm benefit, consider alternative: retest at 1, 6, 12 months, then when symptoms


How to manage when elevated not to 3X or 10 X (ALT and CK)

If no muscle: retest 6, 12 months or when symptoms, continue therapy W persistent muscle->encourage ongoing therapy and retest if symptoms ++ Consider heirachy of concern Continue unless muscle symptoms Retest in 6 months


Components of CVD risk calculator

Sex Age SBP Smoking TC HDL Diabetes ECG LVH