Hyperlipidaemia

Question 1

What are the modifiable and non-modifiable risk factors for cardiovascular disease?

Answer 1

modifiable
- smoking, cholesterol/dyslipidaemia, hypertension, diabetes, obesity, dietary factors, lack of exercise, excessive alcohol consumption thrombogenic factors

non-modifiable
- age, gender (male), ethnicity, family history of CVD

Question 2

What is the primary target to prevent coronary heart disease?

Answer 2

low density lipoprotein (LDL) is the primary target
- normal level is < 4mmol/l
- 10% increase in LDL results in 20% increase in CHD risk

HDL should be >1mmol/l to lower CHD risk
- <1mmol/l of HDL increases risk of CHD

Question 3

What are causes of hyperlipidaemia?

Answer 3

inherited causes
- familial hypercholesterolaemia
= total cholesterol > 7.5mmol/l (5mmol/l is limit), non-HDL > 4.9mmol/l (>4mmol/l is limit)

secondary causes
- hypothyroidism
- diabetes
- renal disease
- liver disease
- alcohol

Question 4

What is the difference between primary and secondary prevention for CVD?

Answer 4

primary prevention
- patient is not known to have had a CV event

secondary prevention
- patient has had a known CV event
= high risk

Question 5

What are the treatment options for hyperlipidaemia?

Answer 5

statins
- atorvastatin, simvastatin
= inhibit cholesterol synthesis by blocking HMG-CoA reductase

fibrates
- fenofibrate, clofibrate
= lowers lipid levels by activating peroxisome proliferator-activated receptor alpha

ezetimibe
= blocks cholesterol absorption at the intestine

Question 6

How can long term risk of cardiovascular disease be calculated for an individual?

Answer 6

tells you whether you are at low, moderate or high risk of developing CVD in the next 10 years

Question 7

What are side effects of statins?

Answer 7

headache
dizziness
nausea
sleep disturbances

myalgia
- can cause myopathy, myositis, rhabdomyolysis
= monitor creatinine kinase, lactic acid/lactate, liver function tests