Cholesterol/CVD

• Total cholesterol consists of LDL-C, VLDL-C and HDL-C
• Total cholesterol rage: less or equal to 5 mmol/L
• Total cholesterol to HDL cholesterol ratio range is <6 mmol/L (less than 4 in high risk individuals)
• Familial hypercholesterolaemia is an inherited condition caused by a genetic mutation in the LDLR, Apo B or PCSK9 gene
• Clinical signs of HF:

  Tendon xanthoma- lipid deposits on knuckles, knees or Achilles

  Xanthalasmas- pale yellow lumps around eye and eyelid

  Corneal arcus- pale white ring around iris
• Treatment for HF is high intensity statins. Atorvastatin 20-80mg or Rosuvastatin 10-40mg. Ezetimibe can be used in conjunction.
• The Simon Broome or Dutch Lipid Clinic Network criteria is used for the diagnosis of HF
• High density lipoprotein (HDL) absorbs cholesterol in the blood and transports it back to the liver
• Low density lipoprotein (LDL) transports cholesterol to cells and deposits. Associated with increased risk of CVD.
• Cholesterol is synthesized in the hepatic cells of the liver
• Cardiovascular disease (CVD) risk factors include: previous CVD, smoking, diabetes, hypertension, hyperlipidaemia, chronic inflammatory disorders, family history of early onset CVD and cocaine use
• QRISK3 calculates your risk of a heart attack in the next 10 years by using factors such as age, ethnicity, smoking status, cholesterol and BMI
• Low risk QRISK3 = <10%

  High risk QRISK3= >20%

  Patients with a QRISK 3 >10% should commence lifestyle changes but if ineffective/ inappropriate they should be offered statin treatment
• Primary prevention of CVD= 20mg OD atorvastatin

  Primary prevention is to prevent the atherosclerotic process
• Secondary prevention of CVD= 80mg atorvastatin

  Secondary prevention is the treatment of an already there atherosclerotic process