Hyperlipidaemia

Question 1

What did NICE update in 2014 regarding hyperlipidaemia management?

Answer 1

NICE updated their guidelines on lipid modification, recommending statins for a significant proportion of the population over 60 years.

Question 2

What is the 10-year risk percentage for assessing high risk of cardiovascular disease (CVD)?

Answer 2

A QRISK 10-year risk of 10% or greater.

Question 3

Which tool does NICE recommend for CVD risk assessment in patients aged <= 84 years?

Answer 3

The QRISK2 CVD risk assessment tool.

Question 4

In which situations should QRISK2 not be used?

Answer 4

1. Type 1 diabetics
2. Patients with eGFR < 60 ml/min and/or albuminuria
3. Patients with a history of familial hyperlipidaemia.

Question 5

Which populations may QRISK2 underestimate CVD risk?

Answer 5

1. People treated for HIV
2. People with serious mental health problems
3. People taking dyslipidaemia-causing medications
4. People with autoimmune/systemic inflammatory disorders.

Question 6

What lipid levels should be measured before starting a statin?

Answer 6

Total cholesterol, HDL, and a full lipid profile including triglycerides.

Question 7

What cholesterol level indicates a need to consider familial hyperlipidaemia?

Answer 7

Total cholesterol level greater than 7.5 mmol/L or a personal/family history of premature coronary heart disease.

Question 8

What is the new cut-off for 10-year CVD risk according to the 2014 guidelines?

Answer 8

10%.

Question 9

What should be offered to people with a QRISK2 10-year risk of >= 10%?

Answer 9

A statin.

Question 10

What is the first-line statin recommended by NICE?

Answer 10

Atorvastatin 20mg.

Question 11

What does NICE recommend for adults with type 1 diabetes regarding statin treatment?

Answer 11

Consider statin treatment for primary prevention of CVD.

Question 12

What should be offered to patients with chronic kidney disease (CKD)?

Answer 12

Atorvastatin 20mg.

Question 13

What is the first-line statin for secondary prevention in patients with CVD?

Answer 13

Atorvastatin 80mg.

Question 14

When should patients started on statins be followed up?

Answer 14

At 3 months.

Question 15

What should be repeated during the follow-up of patients on statins?

Answer 15

A full lipid profile.

Question 16

What lifestyle modifications does NICE recommend for patients?

Answer 16

1. Cardioprotective diet
2. Physical activity
3. Weight management
4. Alcohol intake
5. Smoking cessation.

Question 17

What are the dietary recommendations for a cardioprotective diet?

Answer 17

1. Total fat intake <= 30% of total energy
2. Saturated fats <= 7% of total energy
3. Dietary cholesterol < 300 mg/day
4. Replace saturated fats with monounsaturated/polyunsaturated fats.

Question 18

What is the recommended physical activity for adults?

Answer 18

At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week.

Question 19

What is the alcohol intake recommendation for adults?

Answer 19

Men and women are advised not to drink more than 14 units a week on a regular basis.

Question 20

What should smokers be encouraged to do?

Answer 20

Quit smoking.

Question 21

What is hyperlipidaemia?

Answer 21

A condition characterized by elevated levels of lipids in the blood, which can lead to the formation of xanthomata.

Question 22

What are palmar xanthomas?

Answer 22

Xanthomata that may be seen in remnant hyperlipidaemia and less commonly in familial hypercholesterolaemia.

Question 23

What are eruptive xanthomas?

Answer 23

Multiple red/yellow vesicles on extensor surfaces (e.g. elbows, knees) due to high triglyceride levels.

Question 24

What causes eruptive xanthomas?

Answer 24

Familial hypertriglyceridaemia and lipoprotein lipase deficiency.

Question 25

What are tendon xanthomas, tuberous xanthomas, and xanthelasma associated with?

Answer 25

Familial hypercholesterolaemia and remnant hyperlipidaemia.

Question 26

What are xanthelasma?

Answer 26

Yellowish papules and plaques caused by localized accumulation of lipid deposits, commonly seen on the eyelid.

Question 27

Can xanthelasma occur in patients without lipid abnormalities?

Answer 27

Yes, they can be seen in patients without lipid abnormalities.

Question 28

What are the management options for xanthelasma?

Answer 28

Surgical excision, topical trichloroacetic acid, laser therapy, and electrodesiccation.

Question 29

What do statins inhibit?

Answer 29

Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.

Question 30

What are the adverse effects of statins?

Answer 30

Adverse effects include myopathy, liver impairment, and potential increased risk of intracerebral haemorrhage.

Question 31

What is myopathy in relation to statins?

Answer 31

Myopathy includes myalgia, myositis, rhabdomyolysis, and asymptomatic raised creatine kinase. Risk factors include advanced age, female sex, low body mass index, and multisystem disease like diabetes mellitus.

Question 32

Which statins are more likely to cause myopathy?

Answer 32

Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than in relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin).

Question 33

What does NICE recommend for liver impairment monitoring?

Answer 33

NICE recommends checking LFTs at baseline, 3 months, and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.

Question 34

What is the recommendation regarding statins and intracerebral haemorrhage?

Answer 34

Statins may increase the risk of intracerebral haemorrhage in patients with a history of stroke, and should be avoided in such patients.

Question 35

What are the contraindications for statins?

Answer 35

Contraindications include macrolides (e.g., erythromycin, clarithromycin) and pregnancy.

Question 36

Who should receive a statin?

Answer 36

All people with established cardiovascular disease, those with a 10-year cardiovascular risk >= 10%, patients with type 2 diabetes mellitus, and certain patients with type 1 diabetes mellitus.

Question 37

When should statins be taken?

Answer 37

Statins should be taken at night, especially simvastatin, as this is when the majority of cholesterol synthesis occurs.

Question 38

What does NICE recommend for atorvastatin dosage?

Answer 38

NICE recommends atorvastatin 20mg for primary prevention, increasing the dose if non-HDL has not reduced for >= 40%, and atorvastatin 80mg for secondary prevention.