HYPERLIPIDAEMIA Flashcards
Total cholesterol
5 or below
HDL (good cholesterol)
1 or above
LDL (bad cholesterol)
3 or below
Non-HDL (bad cholesterol)
4 or below
Triglycerides
2.3 or below
Hyperlipidaemia
High blood levels of cholesterol, triglycerides or both
Lipid lowering agents should be offered in
Lipid Lowering agents should be offered in:
Patients under 85 with a 10-year risk of CVD greater than 10%
Patients with type 2 diabetes 10-year risk of CVD greater than 10%
All type 1 diabetic patients with:
* Age over 40
* Diabetes for over 10 years
* Established nephropathy
Patients with chronic kidney disease
Patients with familial hypercholesterolaemia
QRISK2
Assesses cardiovascular risk in those aged 84 or under.
QRISK score > 10% = offer primary prevention.
Unsuitable in those at risk of CVD:
- Type 1 diabetes
- Established CVD
- 85+
- CKD (eGFR <60)
- Familial hypercholesterolemia
Primary prevention
Actions taken to prevent the onset of high cholesterol levels before they occur.
Given to high risk groups:
- Type 1 diabetes
- Type 2 diabetes (if CVD risk >10%)
- QRISK score >10%
- CKD or albuminuria
- Familial hypercholesterolaemia
- 85+ (reduces risk of non-fatal MI)
Secondary prevention
Aimed at individuals who have already been diagnosed with hyperlipidemia or have experienced CVD events:
- CHD (angina, MI)
- Cerebrovascular disease (stroke/TIA)
- Peripheral arterial disease
Statins examples
Atorvastatin Rosuvastatin Simvastatin Fluvastatin Pravastatin
What time of the day should you take statins?
Atorvastatin and Rosuvastatin can be taken any time during the day
Cholesterol synthesis is greater at night, therefore it will be more effective.
Prevention of CVD
High intensity statin.
Atorvastatin:
- Primary prevention = 20 mg
- Secondary prevention = 80mg
Hyperlipidaemia - primary hypercholesterolaemia
High-intensity statin
If statin not tolerated or contra-indicated give ezetimibe.
Hyperlipidaemia - familial hypercholesterolaemia
High-intensity statin
If statin not tolerated or contra-indicated give ezetimibe.
Hyperlipidaemia - moderate hypertriglyceridaemia
If statin not tolerated or contra-indicated give fibrate
Severe hyperlipidaemia
Add on ezetimibe
Resistant hyperlipidaemia
Triglycerides still high after LDL reduced
- Add fibrate or nicotinic acid (also lowers LDL)
atorvastatin 80mg
strongest
used in secondary prevention (heart attack)
Hypothyroidism and statins
Hypothyroidism should be managed before starting statin
Patients at high risk of diabetes mellitus
should have fasting blood-glucose concentration or HbA1C checked before starting statin
Repeat after 3 months
Monitoring
Before initiation
full lipid profile
thyroid function
renal function
liver function
creatine kinase
Monitoring - liver function
Liver enzymes measured: before treatment → 3 months → 12 months
Discontinue if serum transaminases are raised by more than 3 x UL
Monitoring - Creatine kinase
Measured in patients who have previously had persistent muscle aches
If measurement 5 x more than UL - remeasure in 7 days
If still higher than 5 times the limit - do not initiate statins
If levels are raised but under 5 times the limit - start at lower dose
