Hyperlipidaemia.

Question 0

What do lipoproteins contain?

Answer 0

Free cholesterol, phospholipid, triglycerides, apolipoprotein and cholesterol esters.

Question 1

How do lipids travel in the blood?

Answer 1

Packaged with proteins, as lipoproteins.

Question 2

What are the 4 classes of lipoprotein?

Answer 2

Cholymicrons, very low density lipoproteins, low density lipoproteins and high density lipoproteins.

Lectures also say intermediate density lipoproteins.

Question 3

What are cholymicrons made of?

Answer 3

Made of proteins but mainly triglycerides.

Question 4

What are very low density lipoproteins made of?

Answer 4

Mainly triglycerides.

Question 5

What are low density lipoproteins made of?

Answer 5

Mainly cholesterol.

Question 6

What are high density lipoproteins made of?

Answer 6

Mainly phospholipids.

Question 7

What is LDL associated with?

Answer 7

Atherosclerosis and CHD. 10% extra LDL, gives a 20% increased risk of CHD.

Question 8

What other risk factors is LDL modified by?

Answer 8

Low HDL, smoking, hypertension and diabetes.

Question 9

What are triglycerides associated with?

Answer 9

Increased risk of CHD - may be due to low HDL or highly atherogenic forms of LDL. May have accompanying dislipidaemias.

Question 10

What is the normal level of triglycerides?

Answer 10

2.3 mol/L.

Question 11

What is a very high level of triglycerides and what is it associated with?

Answer 11

11.3 mol/L. Gives an increased risk of pancreatitis.

Question 12

What lowers HDL?

Answer 12

Smoking, obesity and physical inactivity.

Question 13

What is HDL associated with?

Answer 13

Protective effect - correlates inversely with CHD and atherosclerosis.

Question 14

What level of HDL is desirable?

Answer 14

Over 1mmol/L.

Question 15

What is the link between HDL and triglycerides?

Answer 15

HDL tends to be low when triglycerides are high.

Question 16

How much of the UK has a significant risk of CHD due to their serum cholesterol levels?

Answer 16

50%

Question 17

What must a full screening include?

Answer 17

Fasting lipid profile.

Question 18

Who should be screened for hyperlipidaemia?

Answer 18

Those at risk of it, those at risk of CVD, low socioeconomic patients and Indian/Asian background.

Question 19

Who is considered at risk of hyperlipidaemia and should be screened?

Answer 19

Family history, corneal arcus under the age of 50. Xanathomata or xanathelasma.

Question 20

What are the different types of hyperlipidaemia?

Answer 20

Common primary, familia primary, secondary and mixed.

Question 21

What are the features of common primary hyperlipidaemia?

Answer 21

Is 70% of all hypers, shows increased LDL only.

Question 22

What are the features of familial primary hyperlipidaemia?

Answer 22

Multiple phenotypes, greatly increased risk of CVD. Lower levels of statins may be required to protect from cardiac risk than primary hyper.

Question 23

What are the features of secondary hyperlipidaemia?

Answer 23

Increased LDL. We have to treat the cause first.

Question 24

What are some examples of causes of secondary hyperlipidaemia?

Answer 24

Cushings, thiazides, hyperthyroidism, nephrotic syndrome and cholestasis.

Question 25

What are the features of mixed hyperlipidaemia?

Answer 25

Results in increased LDL and triglycerides.

Question 26

What are some causes of mixed hyperlipidaemia?

Answer 26

Type 2 DM, metabolic syndrome, alcohol abuse and chronic renal failure.

Question 27

What are some clinical markers of hyperlipidaemia?

Answer 27

Corneal arcus, xanathelasma and xanathomas.

Question 28

What is xanathoma and the different types?

Answer 28

Yellow lipid deposits. May be: erruptive, tuberous, planar/palmar or tendon.

Question 29

What is erruptive xanathoma?

Answer 29

Itchy crops of nodules on the buttocks, posterior thighs and skin folds, usually from hypertriglyceridaemia.

Question 30

What is tuberous xanathoma?

Answer 30

Lipid deposits in the dermis and subcutis. Either nodular, papular or plaques on the extensor surfaces of the large joints e.g. The hands, buttocks, heels and knees. Unusually from familial or acquired hypertriglyceridaemias or biliary cirrhosis.

Question 31

What is planar/palmar xanathoma?

Answer 31

Orange streaks in palmar creases. Diagnostic of remnant hyperlipidaemia.

Question 32

What is tendon xanathoma?

Answer 32

Most common in the Achilles' tendon. Also in the extensor tendons of the fingers, patella and elbows etc. caused by diffuse lipid infiltration of the tendon. Caused by type 2 and 3 hyperlipidaemia.

Question 33

What are the management stages if hyperlipidaemia?

Answer 33

Lifestyle advice, 1st and second line therapies and others such as: improving endothelial dysfunction, increase NO availability, antioxidants, inhibition of inflammation and atherosclerotic plaque stabilisation.

Question 34

What are the treatment priorities of hyperlipidaemia?

Answer 34

Identify familial and secondary types. 1. Treatment for those with CVD. 2. Treat those with DM, especially if they have a cardiac risk of over 2% a year. 3. Treat those with a 10 year risk of CVD over 20% regardless of baseline lipid levels.

Question 35

What is the first line treatment of hyperlipidaemia?

Answer 35

Statins. 40mg PO at night.

Question 36

What is the second line treatment of hyperlipidaemia?

Answer 36

Fibrates or cholesterol absorption inhibitors. Anion exchange resins and nicotinic acid.

Question 37

What does hypertriglyceridaemia respond best to?

Answer 37

Fibrates, nicotinic acid or fish oils.

Question 38

What are normal serum lipid levels?

Answer 38

Total cholesterol under 5. LDL under 3. Fasting triglycerides under 2 and non fasting under 4. (All mol/L).