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Hyperlipidaemia Mx
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> 2014 NICE - controversial ''Primary prevention'' >40yr with 10yr risk of CVD >10% use QRISK2 unless >85yr, T1DM, eGFR<60 or albuminuria, FH hyperlipid note QRISK2 underestimates risk in those with HIV, mental health problem, on antipsychotics,steroids or immunosuppressants, with autoimmune/inflammatory disorders eg SLE Atorvastatin 20mg - 1st line ''Measuring lipid levels'' do both //total cholesterol and HDL// Full profile (including TG) needed pre-statin (not fasting sample) If total chol >7.5 with FH premature CVD - consider familial hypercholest - needs referral If total chol >9.0 or LDL-chol (ie nonHDL) >7.5 without FH premature CVD - consider familial hyperchol - needs referral ''Interpreting QRISK2'' from 2014 use cut off of 10yr risk of 10% and offer statin Can do lifestyle first and repeat chol pre statin ''Special situations'' ''Type 1 diabetes mellitus'' consider atorvastatin 20mg in all >40yr, DM>10yr, nephropathy or other CVD risk factor ''CKD'' atorvastatin 20mg to all increase dose if <40% reduction in non-HDL cholesterol and eGFR > 30 If eGFR < 30 to renal specialist ''Secondary prevention'' All with CVD should be taking a statin unless CI - 1st line - Atorvastatin 80mg (?Mark - for 3/12 then reduce and give as per level - stabilizes plaque in initial 3/12 post MI) ''Follow-up'' of all starting on statins at 3/12 ... repeat profile and do LFTs and inc dose up to Atorva 80 if nonHDLchol hasn't dec by 40% underline lifestyle change ''Lifestyle modifications'' ''Cardio-protective diet'' total fat <30% total energy intake (sat fat <7%) chol intake <300mg/day replace sat fat with monunsat or polyunsat fat replace sat and momunsat with olive or rapeseed oil (or spread from these) wholegrain starch reduce sugar and food containing fructose 5 F&V/day 2 fish /week - 1 oily 4-5 nuts/seeds/legumes/wk ''Physical activity'' 150 mins moderate intensity or 75 mins vigorous aerobic activity / wk muscle strengthening activity 2+ days /wk for all major muscle groups ''Weight management'' Aim for normal ''Alcohol intake'' 3-4u/day men, 2-3u/d women ''Smoking cessation'' quit
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LipidsAndStatins