Flashcards in Hyperlipidaemia. Deck (39):
How do lipids travel in the blood?
Packaged with proteins, as lipoproteins.
What do lipoproteins contain?
Free cholesterol, phospholipid, triglycerides, apolipoprotein and cholesterol esters.
What are the 4 classes of lipoprotein?
Cholymicrons, very low density lipoproteins, low density lipoproteins and high density lipoproteins.
Lectures also say intermediate density lipoproteins.
What are cholymicrons made of?
Made of proteins but mainly triglycerides.
What are very low density lipoproteins made of?
What are low density lipoproteins made of?
What are high density lipoproteins made of?
What is LDL associated with?
Atherosclerosis and CHD. 10% extra LDL, gives a 20% increased risk of CHD.
What other risk factors is LDL modified by?
Low HDL, smoking, hypertension and diabetes.
What are triglycerides associated with?
Increased risk of CHD - may be due to low HDL or highly atherogenic forms of LDL. May have accompanying dislipidaemias.
What is the normal level of triglycerides?
What is a very high level of triglycerides and what is it associated with?
11.3 mol/L. Gives an increased risk of pancreatitis.
What lowers HDL?
Smoking, obesity and physical inactivity.
What is HDL associated with?
Protective effect - correlates inversely with CHD and atherosclerosis.
What level of HDL is desirable?
What is the link between HDL and triglycerides?
HDL tends to be low when triglycerides are high.
How much of the UK has a significant risk of CHD due to their serum cholesterol levels?
What must a full screening include?
Fasting lipid profile.
Who should be screened for hyperlipidaemia?
Those at risk of it, those at risk of CVD, low socioeconomic patients and Indian/Asian background.
Who is considered at risk of hyperlipidaemia and should be screened?
Family history, corneal arcus under the age of 50. Xanathomata or xanathelasma.
What are the different types of hyperlipidaemia?
Common primary, familia primary, secondary and mixed.
What are the features of common primary hyperlipidaemia?
Is 70% of all hypers, shows increased LDL only.
What are the features of familial primary hyperlipidaemia?
Multiple phenotypes, greatly increased risk of CVD. Lower levels of statins may be required to protect from cardiac risk than primary hyper.
What are the features of secondary hyperlipidaemia?
Increased LDL. We have to treat the cause first.
What are some examples of causes of secondary hyperlipidaemia?
Cushings, thiazides, hyperthyroidism, nephrotic syndrome and cholestasis.
What are the features of mixed hyperlipidaemia?
Results in increased LDL and triglycerides.
What are some causes of mixed hyperlipidaemia?
Type 2 DM, metabolic syndrome, alcohol abuse and chronic renal failure.
What are some clinical markers of hyperlipidaemia?
Corneal arcus, xanathelasma and xanathomas.
What is xanathoma and the different types?
Yellow lipid deposits. May be: erruptive, tuberous, planar/palmar or tendon.
What is erruptive xanathoma?
Itchy crops of nodules on the buttocks, posterior thighs and skin folds, usually from hypertriglyceridaemia.
What is tuberous xanathoma?
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.
What is planar/palmar xanathoma?
Orange streaks in palmar creases. Diagnostic of remnant hyperlipidaemia.
What is tendon xanathoma?
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.
What are the management stages if hyperlipidaemia?
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.
What are the treatment priorities of hyperlipidaemia?
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.
What is the first line treatment of hyperlipidaemia?
Statins. 40mg PO at night.
What is the second line treatment of hyperlipidaemia?
Fibrates or cholesterol absorption inhibitors. Anion exchange resins and nicotinic acid.
What does hypertriglyceridaemia respond best to?
Fibrates, nicotinic acid or fish oils.