Hyperlipidaemia

Dr Ayman Morsy

● Hyperlipidaemia is defined as elevated levels of cholesterol and/or

triglycerides.

Key point
Hyperlipidaemia is defined as elevated levels of cholesterol and/or
triglycerides.

1ry or 2ry ‫اما بتكون‬

dm,hypothyroidism,ch renal ‫النوع االول بيكون خلل جيني و الثاني بيكون ناتج عن‬
,disease,ch liver diseases,steroids

statins and fibrates ‫اهم جروبات األدوية‬

Statins
statins ‫اهم مجموعتين في ال‬
Atorvastatin 20mg,40 mg ,80 mg
Rosuvastatin 10,20 mg

‫ اضعاف الطبيعي‬٣ ‫ لحد‬LFT ‫بترفع وظايف الكبد و مسموح استخدامها حتي لو رفعت‬
hepatic disease ‫ممنوعة في مرضي ال‬

Fibrates
hepatic and renal disease ‫ممنوعة في مرضي ال‬
Used to treat increased TG, hyperchylomicronemia
e.g:Lipanthyl 160 mg,300 mg tab

Niacin

Treat hypertriglyceride is not respond to fenofibrates

‫مالحظات هامة‬
 ● Patients with a high risk of ASCVD (a 10-year risk of at least 7.5%
or 10%, depending on the guideline) should receive statin therapy
for primary prevention.

● Statin therapy should be prescribed for secondary prevention in

patients with known ASCVD, unless contraindicated.

● Niacin, fibrates, and omega-3 fatty acids should not be routinely

prescribed for primary or secondary prevention of ASCVD.
Although these agents lower cholesterol levels, they do not affect
patient-oriented outcomes.
‫ مش بتفرق كتير في ال‬.1ry or 2 nd ‫ سواء لل‬niacin and fibrates ‫ و ال‬٣ ‫االوميجا‬
outcome
‫ هتظل في المقدمة‬statins ‫ علشان كده ال‬aafp ‫طبقا لكالم ال‬
● A moderate-intensity statin plus ezetimibe should be considered as
an alternative in patients with acute coronary syndrome who do not
tolerate high-intensity statin therapy.

‫ و مش بيتحمل جرعات عالية‬statins ‫لو المريض مش مستجيب كويس لجرعة متوسطة من ال‬
)lipidnorm or Ezetrol ‫ (االسم التجاري‬ezetimibe ‫ جرعة‬statins ‫نضيف مع ال‬

Familial hypercholesterolaemia:
a group of single gene disorders affecting the low‐density lipoprotein
(LDL) receptor and causing deficient or absent uptake of LDL particles,
which therefore accumulate in the bloodstream.

Secondary Hyperlipidaemias
Before deciding whether a hyperlipidaemia is primary, diseases
producing secondary hyperlipidaemias should be excluded:
● Diabetes.
● Hypothyroidism.
● Chronic renal failure or nephrotic syndrome.
● Chronic liver disease, especially alcoholic.
● Chronic biliary obstruction.
● Drugs: steroids, oestrogens.
What is the ASCVD risk score?
1. The ASCVD (atherosclerotic cardiovascular disease) risk score is
a national guideline developed by the American College of
Cardiology.
2. It is a calculation of your 10-year risk of having a cardiovascular
problem, such as a heart attack or stroke.
3. This risk estimate considers age, sex, race, cholesterol levels,
blood pressure, medication use, diabetic status, and smoking
status.

What does my risk score mean?

The ASCVD risk score is given as a percentage. This is your chance of

having heart disease or stroke in the next 10 years. There are different
treatment recommendations depending on your risk score.
● A 0 to 4.9 percent risk is considered low. Eating a healthy diet and
exercising will help keep your risk low.
● Medication is not recommended unless your LDL, or “bad”
cholesterol, is greater than or equal to 190.
● A 5 to 7.4 percent risk is considered borderline. Use of a statin
medication may be recommended if you
● have certain conditions, or “risk enhancers.” These conditions may
increase your risk of a heart disease or
● · stroke. Talk with your primary care provider to see if you have any
of the risk enhancers in the list below.
● A 7.5 to 20 percent risk is considered intermediate. It is
recommended that you start with
● · moderate-intensity statin therapy.
● A greater than 20 percent risk is considered high. It is
recommended that you start with high-intensity statin therapy.
 ASCVD 10-Year risk calculator ‫● موقع حساب‬
( atherosclerotic cardiovascular disease)

‫بيعتمد علي‬
● Age
● Male or Femal
● DM
● HTN
● Lipid profile ,
● Smoker?
● on aspirin or not
● On statin or not

http://www.cvriskcalculator.com

‫بيحدد الريسك و الجرعة المطلوبة بناخدها من الجدول‬

‫للقراءة‬
Lipid lowering by diet: reducing fat intake, especially high cholesterol foods (red meat, eggs,
high fat diet, dairy products) lowers cholesterol by 1 mmol/L and reduces body weight.
However, diet alone is insufficient in patients with elevated cholesterol and CAD.

Lipid‐lowering drugs: statins are effective cholesterol‐lowering agents, and should be given
to those with a high (>30% risk over 10 years) or medium (>15%) risk of developing
cardiovascular disease, as assessed from risk prediction charts (e.g. the Joint British
Societies chart found in the British National Formulary), which factor in age, systolic blood
pressure, cholesterol and smoking/diabetes status.

Identify familial or 2° hyperlipidaemias, as ℞ may differ.

Give lifestyle advice; aim for BMI of 20–25; encourage a Mediterranean-style diet—↑fruit,
vegetables, fish, unsaturated fats; and ↓red meat; ↑exercise. Top ℞ priority are those with
known CVD (there is no need to calculate their risk: ipso facto they already have high risk).
Second ℞ priority is primary prevention in patients with chronic kidney disease or type-1
diabetes, and those with a 10-yr risk of CVD >10%, irrespective of baseline lipid levels.