FN: Hyperlipidaemia Flashcards Preview

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Flashcards in FN: Hyperlipidaemia Deck (23):
1

Chylomicrons

Mainly TG
Carry dietary TG tissues

2

VLDL

Mainly TG
Take endogenous TG from liver to tissue

3

LDL

Mainly cholesterol
Carry cholesterol form liver to tissues

4

HDL

Mainly phospholipid
Take cholesterol from tissues - liver for excretion

5

Apolipoproteins

Contained in lipiproteins and control transport and uptake
ApoB contained in LDL and binds to cell receptors - uptake

6

Classification types

Common primary hyperlipidaemia
Familial primary hyperlipidaemia
secondary hyperlipidaemia

7

Common primary hyperlipidaemia

70%
Dietary and genetic factors
Raised LDL only

8

Familial primary hyperlipidaemia

Multiple phenotypes
Very high risk of CVD

9

Secondary hyperlipidaemia

Raised LDL
Mixed

10

Raised LDL

Nephrotic syndrome
- Cholestasis: lipoprotein x
- Hypothyroidism
- Cushings
- Drugs: thiazides, steroids

11

Mixed

Raised LDL and raised TG
- T2DM
- EtOH
- CRF

12

Familial primary hyperlipidaemias

1. primary hypercholesterolaemia
2. Combined hyperlipidaemia
3. Lipoprotein lipase deficiency
4. Hypertruglyceridaemia
5. Remnant particle disease

13

Presentation

CVD
Xanthomata
Pancreatitis (Raised TG)

14

Xanthomata

-Eruptive: itchy nodules in crops (raised TG)
- Tuberous: paques on elbows, knees
- Planar: ornage steaks in palmer creases: remnant hyperlipidiaemia
- Xanthelasma: eyelids
- Arcus: cornea

15

Investigations

Plasma cholesterol
Plasma HDL
Fasting TGs
TC: HDL ratio is best predictor of CV risk

16

Management aims

TC

17

Mx lifestyle

Lose wt.
Reduced saturated fat, increased fibre, increased fruit and veg
Increased excercise

18

Mx treatment priorities

Known CVD
Those with DM
Those with 10yr CVD risk >20% - irrespective of baseline lipids

19

1st line Rx

Statins
e.g. simvastatin 40mg PO nocte
--> HMG-CoA reductase inhibitors - reduced cholesterol synthess

20

2nd line Rc

Fibrates:
Ezetimibe
Miacin/nicotinic acid

21

Fibrates

PPARalpha, antagonists, reduces TG

22

Ezetimibe

Inhibits cholesterol absorption

23

Niacin/nicotinic acid

Raised HDL
Reduces LDL

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