This site is intended for healthcare professionals
This email highlights some difficult problems in lipid management including use of "fat soluble versus water soluble statins", management of raised triglycerides and "intermittent statin therapy".
Statin toxicity, as assessed by CK elevations and rhabdomyolysis in randomized trials, also appears to be dose-dependent but not related to the degree to which plasma LDL-C is reduced. There is evidence that statin related myalgia/myositis is less in "water soluble" statins in comparison to "fat soluble" statins. Lipophilic statins also undergo hepatic and enteric metabolism via the cytochrome P450 (CYP450) system; whereas water soluble statins are excreted largely unchanged and do not have significant reaction with the CYP450 pathway.: Water and lipid soluble statins
1) A patient has a history of statin related myalgia (with a normal CK), which statin choice is least likely to cause myalgia?
Simvastatin 40mg per day
Pravastatin 40mg per day
Atorvastain 20mg per day
A 53 year old male T2DM patient has fasting lipids revealing a cholesterol of 6.8 mmol/l and Triglycerides of 10.8 mmol/l. His glycaemic control shows and HbA1c of 68. He drinks alcohol rarely. : Management of raised triglycerides
2) Which statement is true?
Treatment of choice is with a fibrate
Referral for specialist review is not indicated
An increased risk of pancreatitis occurs if a fasting triglyceride is >= 8 mmol/l
A 65 year old chap with a past history of CHD is seen by yourself at surgery because he is "statin intolerant". He has been on simvastatin, atorvastatin, pravastatin and rosuvastatin and noted myalgia after being on these for a few weeks. His CK has been normal. Screening for secondary causes of myalgia has been negative. You have looked up on GPnotebook and decided to give him "intermittent statin therapy" and have started this chap on rosuvastatin 10mg once per week.: Non daily dosing of statins
3) Which statement regarding intermittent statin therapy is true?
There is cardiovascular endpoint data of the effectiveness of intermittent statin theray
There is evidence that 80% of patients who previoulsy had statin related myalgia, can tolerate non-daily statin dosing
Checking lipids after four weeks is indicated to evaluate regime effectiveness
Lipoprotein A (Lpa) is an independent marker of increased cardiovascular risk. Among patients with ACS, raised Lp(a) levels are associated with an increased atherosclerotic burden and it identifies a subset of patients with features of high risk coronary atherosclerosis.: Lipoprotein a (elevated)
4) Which statement regarding raised lipoprotein A (Lpa) is true?
Statins are an effective treatment to reduce Lpa levels
Ezetimibe is an effective treatment to reduce Lpa levels
Lpa levels vary with ethnicity
A 63 year old T2DM with CKD4 and hyperlipidaemia had recent lipid results revealing a cholesterol of 4.8 mmol/l and triglycerides of 6.8mmol/l. He is on maximal statin treatment and, after advice and guidance from his renal specialist, it has been suggested that he should have additional lipid lowering for his raised triglycerides because associated increased cardiovascular risk. : Fibrates and increase in plasma creatinine
5) Which statement regarding this scenario is true?
Adding a fibrate can cause a improvement in eGFR
Fish oils are a useful triglyceride lowering therapy in this scenario
Changing from a water soluble to lipid soluble statin may be helpful
A 58 year old gentleman with history of hypertension had a non-fasting lipids of cholesterol 5.6 mmol/l, HDL 1.2 mmol/l and triglycerides of 1.2 mmol/l. He is on atorvastatin 20mg per day.: Doubling statin dose - approximate increase in cholesterol lowering if double dose of statins
6) What approximate additional lipid lowering would be achieved if the dose of the atorvastatin was doubled to 40mg per day?
20%
12%
6%