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Who should take lipid-lowering drugs?
At risk groups for cardiovascular disease, e.g. familial hypercholesterolaemia, diabetics over 40, HTN.
For primary and secondary prevention of cardiovascular disease
What conservative measures should be advised when trying to lower lipid levels?
Diet, exercise, smoking cessation, reduced alcohol consumption and weight management
What other drugs should be considered when prescribing lipid-lowering drugs?
Low dose aspirin
What options are there for lowering lipid levels?
- Bile acid sequestrant
- Nicotinic acid
What are the cholesterol targets when prescribing lipid-lowering drugs?
Total cholesterol <4mmol/l
LDL cholesterol <2mmol/l
How do statins work?
Competitively inhibits HMG CoA in the liver (cholesterol synthesis pathway)
When should you be cautious when prescribing statins?
Ensure hypothyroidism is well-managed
History of liver disease or alcoholism (measure LFTs at 3/12 and 12/12)
Risj of myopathy or rhabdomyolysis
Pregnancy and breast-feeding
What are the side effects of statins?
Myalgia, Myopathy, Myositis, Rhabdomyolysis
Rarely: hepatitis, jaundice, pancreatitis and liver failure
GI disturbance, Sleep affected, headaches, dizziness
What counsel should you give a patient before they start statins?
To report unexplained muscle pain, tenderness or weakness promptly
Give examples of statins