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Flashcards in Hyperlipidaemia Deck (6):

What is Hyperlipidaemia?

Lipids travel around the body in the form of Lipoproteins
• VLDL – Triglyceride from liver to tissue
• Chylomicrons - Triglyceride from gut to liver
• LDL - Cholesterol from liver to body
• HDL - Phospholipid from body to liver

Hyperlipidaemia is a term used to describe when there is too much total cholesterol, LDL, Triglyceride or a mix of the above. This leads to increased cardiovascular risk due to increased atheroma formation. As such we screen people with signs of Hyperlipidaemia or those with a family/medical history of cardiovascular disease. HDL is not a risk factor and is cardio protective.


What are the causes of Hyperlipidaemia?

Common – Primary Idiopathic Hyperlipidaemia

Others – Diabetes, Pregnancy, Obesity, Alcohol, Cushing’s, Hypothyroidism, CKD (Nephrotic Syndrome), Obstructive Jaundice


What will you ask about/ find on history of a patient with suspected Hyperlipidaemia

Asymptomatic – However there may be physical signs in familial hyperlipidaemia

Risk Factors:
If in teens/20's consider familial Hyperlipidaemia
Cardiovascular risk factors

Specific questions to ask in a history taking:
Ask about diet and exercise - get an idea of how they live (specifically looking for high saturated fats and sedentary lifestyle)
Ask about causes of secondary Hyperlipidaemia
Other associated conditions - High Blood Pressure, Diabetes
If treatment resistant, consider referral for familial hypercholesterolaemia


What will you look for/ find on examination of a patient with suspected Hyperlipidaemia

End of the bed:
Obesity (Risk Factor)
Elbow- tendon xanthomata (Familial)
Corneal Arcus (Familial)
Achilles - tendon xanthomata (Familial)


What investigations will you order in suspected hyperlipidaemia?

Glucose -To assess other cardiovascular risk factors and to rule out secondary hyperlipidaemia due to diabetes

Lipid Profile - Consists of Total Cholesterol, triglycerides, LDL, HDL, and non-HDL-cholesterol. These can also be altered in acute illness so consider patient status
TFT - Hypothyroidism can be a cause of secondary hyperlipidaemia
U&E - Assess renal function as CKD/Nephrotic Syndrome can be a cause of secondary hyperlipidaemia
LFT - Will likely be giving a statin so need to know baseline liver function and also looking for fatty liver which is associated with hyperlipidaemia


What is the treatment of hyperlipidaemia?

Education about the progressive nature of the disease and cardiovascular risk factors that comes with
Optimise BMI 20-25
Mediterranean diet
Increase exercise
Low Sat fat diet, High HDL diet
Reduce cardiac risk factors

Treat if QRisk2 > 10%, CVS Risk Factors, CVS disease or after lifestyle changes have made no effect
1st Line - Atorvastatin, Higher dose in secondary prevention or kidney disease
Target reduction is 40% of lipid levels
2nd Line – Add Ezetimibe
3rd Line -Add Fibrate/Anionic Exchange Resin/Nicotinic Acid/Bile acid sequestrant
In Familial - Refer to specialist e.g. Biochemists
In Secondary – Manage underlying cause as well as giving lipid lowering therapy
Hypertriglyceridemia – Fibrates and Nicotinic Acid First Line, High fish oil diet