Makindo Medical Notes

🩸 Hyperlipidaemia = abnormal elevation of lipids in the blood (cholesterol and/or triglycerides). ⚠️ It is a major modifiable risk factor for cardiovascular disease (CVD), including MI and stroke. 🎯 NICE guidelines (UK) focus on LDL-C reduction to cut cardiovascular risk, especially in high-risk groups (e.g., diabetes, CKD, familial hypercholesterolaemia).

🔍 Step 1: Initial Assessment & Risk Stratification

• 🧪 Lipid Profile: Total cholesterol, LDL-C, HDL-C, triglycerides.
• 📊 QRISK3 tool: Estimate 10-yr CVD risk in adults 40–84 yrs.
• 🧠 Secondary Causes: Hypothyroidism, diabetes, nephrotic syndrome, liver disease, alcohol excess, obesity.
• 🧬 Familial Hypercholesterolaemia: Suspect if TC > 7.5 mmol/L or FHx of premature CVD → consider Simon Broome criteria / genetic testing.

🥦 Step 2: Lifestyle Interventions (First-line for All)

• 🥗 Diet: ↑ fruit/veg/wholegrains/oily fish. ↓ saturated fat. Use plant sterols/stanols.
• 🏃 Exercise: ≥150 min/week moderate intensity.
• ⚖️ Weight: Aim BMI 20–25 kg/m².
• 🚭 Smoking: Cessation reduces CVD risk more than any drug.
• 🍷 Alcohol: Keep within UK safe limits (≤14 units/week).

💊 Step 3: Pharmacological Therapy

• 🌟 Statins = First-line
  • Offer atorvastatin 20 mg OD if QRISK3 ≥10%, T2DM, CKD, or FH.
  • Use high-intensity statins (atorvastatin 40–80 mg) if established CVD.
  • 🧪 Monitor: Lipids + LFTs baseline, 3m, 12m.
• ➕ Ezetimibe: Add if LDL target not reached, or use alone if statin-intolerant.
• 💉 PCSK9 inhibitors (alirocumab, evolocumab): Severe/refractory hyperlipidaemia despite max therapy.
• 🟢 Bempedoic acid: Alternative for statin-intolerant patients.
• 🧪 Fibrates: Mainly for triglycerides >5.6 mmol/L (prevent pancreatitis).

📈 Step 4: Monitoring & Adjustment

• 📉 Annual lipids to check control and adherence.
• 🔎 Ask about side effects (myalgia with statins, LFT derangements).
• 📊 Reassess CVD risk periodically → consider intensifying therapy if risk rises.

👩‍⚕️ Step 5: Referral

• 🏠 Familial Hypercholesterolaemia: Refer to lipid clinic.
• ❗ Complex cases: Refractory hyperlipidaemia or statin intolerance → specialist input.

🎯 Target LDL-C Levels (UK context)

Patient Group	Target LDL-C (mmol/L)	Target LDL-C (mg/dL)	Notes
🧍 General population	<3.0	<115	No major risk factors
⚠️ High risk (QRISK3 ≥10%, DM)	<2.0	<77	Start atorvastatin 20 mg
❤️ Very high risk (CVD)	<1.8	<70	Secondary prevention
🧬 Familial hypercholesterolaemia	<1.8	<70	Genetic or strong family history
🩺 CKD	<2.0	<77	eGFR <60
🍬 Diabetes	<2.0	<77	Offer statin regardless of QRISK

📚 Exam Pearls & Teaching Commentary

💡 Remember: In UK exams, always mention QRISK3 + statin therapy when asked about hyperlipidaemia. 🔑 Familial hypercholesterolaemia = tendon xanthomata + FHx of early MI → refer to lipid clinic. 🧠 Statin side effect buzzwords: “muscle pain”, “LFT derangement”, “new onset diabetes risk (small)”. ⚠️ For OSCEs: show awareness of lifestyle + drug + monitoring, not just prescribing statins.

✅ Conclusion

Management of hyperlipidaemia requires a combined lifestyle + pharmacological approach, guided by cardiovascular risk. Regular monitoring, patient education, and early referral in suspected familial cases are essential. In clinical practice, lowering LDL-C translates directly into fewer heart attacks and strokes — making this a cornerstone of preventive medicine. ❤️