GEM - lipid lowering treatment educational module part one

Lipid Lowering Educational Module

Scenario 1:

• 46 year old man with a history of type 2 diabetes. Glycaemic control revealed an HBA1c of 7.2%. Lipid profile revealed a total cholesterol of 6.5 mmol/l, LDL of 3.4 mmol/l, HDL 1.1 mmol/l and fasting triglycerides of 3.4 mmol/l
  • should a cardiovascular risk equation be used in this situation? GPnotebook reference...click here
  • if lipid lowering treatment was to be used, then what base-line investigations would be considered before starting statin therapy? GPnotebook reference...click here
  • this gentleman had his lipids monitored four weeks after initiating a statin. Is this period of time too soon? GPnotebook reference...click here
  • which two important trials are concerned with the use of statins in patients with diabetes?
    • trial 1: GPnotebook reference...click here
    • trial 2: GPnotebook reference...click here

Scenario 2:

• 55 year old lady with a history of manic depression. She is on treatment with olanzapine and it has been noted that her weight has increased since initiation of her olanzapine treatment. Recent blood tests revealed a fasting glucose of 6.2 mmol/l. Her fasting lipids revealed a cholesterol of 7.7 mmol per litre and triglycerides of 4.4 mmol/l. Other secondary causes of hyperlipidaemia were excluded.
  • what is significant about her fasting glucose level? GPnotebook reference...click here
  • is olanzapine associated with possible development of diabetes? GPnotebook reference...click here
  • how might olanzapine affect this lady's lipid levels?GPnotebook reference...click here
  • this lady was put on simvastatin 40mg per day and her cholesterol was 5.4 mmol/l. What reference is useful in deciding what the next step in statin treatment might be? GPnotebook reference...click here

Examples of other causes of raised lipids:

• how does abnormal thyroid funtion affect lipid levels? GPnotebook reference...click here
• how does HRT affect lipid levels? GPnotebook reference...click here

Myalgia and statin treatment

• how common is myalgia associated with statin treatment? GPnotebook reference...click here

Statins and warfarin

• does pravastatin interact with warfarin? GPnotebook reference..click here

NICE

• what does NICE say about the use of statins in prevention of cardiovascular disease? GPnotebook reference..click here

Drugs used in hypertriglyceridaemia include:

• fibrates GPnotebook reference...click here
• fish oils GPnotebook reference...click here

What conditions are associated with a low HDL? GPnotebook reference...click here

Other lipid lowering agents include:

• ezetimibe, a cholesterol absorption inhibitor GPnotebook reference...click here
• bile sequestrants GPnotebook reference...click here