QuestionSBA
QuestionChoice
Statins inhibit of HMG-CoA reductase, the enzyme responsible for cholesterol synthesis as well as lipid and low density lipoprotein (LDL) metabolism and transport.
62365
c
Activation of HMG-CoA reductase
QuestionChoice
HMG-CoA reductase is the key enzyme in cholesterol production in the liver, as well as lipid and low density lipoprotein (LDL) metabolism and transport.
Hyperlipidaemia is associated with increased risk of cardiovasculardisease.
62363
a
Inhibition of HMG-CoA reductase
QuestionChoice
A statin lowers cholesterol by inhibiting HMG-CoA reductase, the key enzyme in cholesterol production in the liver, as well as lipid and low density lipoprotein (LDL) metabolism and transport.
Lipase inhibitors such as Orlistat can be used in weight loss management. It is an inhibitor of gastrointestinal lipase, therefore inhibiting the hydrolysis of triglycerides, therefore prevening their absorption and helping weight loss.
62367
e
Lipase inhibitor
QuestionChoice
A statin lowers cholesterol by inhibiting HMG-CoA reductase, the key enzyme in cholesterol production in the liver, as well as lipid and low density lipoprotein (LDL) metabolism and transport.
62366
d
Binds to cholesterol
QuestionChoice
ACE inhibitors such as ramipril are used in the treatment of hypertension.
Statins are HMG-CoA reductase inhibitors.
62364
b
Competitive inhibition of ACE
QuestionComment
who cares man
23847
User
subscriber
Sydney Sweeney
Concept
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# Definition

Hypercholesterolaemia is the term used to denote raised serum levels of one or more of total cholesterol.

# Causes

Causes can primary or secondary.

Secondary causes include:

- Familial dyslipidaemias
- Familial hypercholesterolaemia
- Apoprotein disorders
- Medical conditions
	- Hypothyroidism
	- Obstructive jaundice
	- Cushings syndrome
	- Nephrotic syndrome
	- Chronic Kidney Disease
- Drugs e.g. thiazide diuretics, glucocorticoids, ciclosporin
- Pregnancy
- Obesity 
- Alcohol abuse


# Physicial signs

Diagnosis is usually biochemical. 

There are two key physical signs which may indicate familial hypercholesterolaemia

 - Premature arcus senilis
 - Tendon xanthomata

# Investigations

- Lipid profile 
- Fasting blood glucose
- Renal function
- Liver function tests
- Thyroid function tests

# Management


## Statins

- Statins are the first line treatment of high cholesterol. 
- They are HMG-CoA reductase inhibitors. 
- This enzyme plays a key role in the production of cholesterol, so inhibiting it reduces the cholesterol in the body.
- In patients with high cholesterol, the QRISK score is used to see if they would benefit from statins as primary prevention against cardiovascular disease. 
- If an adult is under 80 years old and their QRISK is greater than 10% then a statin should be offered. 
- For primary prevention of CVD aim for a greater than 40% reduction in non-HDL cholesterol
- For secondary prevention of CVD, aim for low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol per litre or less, or non-HDL cholesterol levels of 2.6 mmol per litre or less.

## Doses

- Atorvastatin 20mg is the usual starting dose for primary prevention.
- For patients who need a statin as secondary prevention, e.g following a stroke, heart attack, peripheral arterial disease or angina, atorvastatin at 80mg starting dose should be used.

## Side effects of statins


Common side effects of statins include muscle pain, abdominal pain, constipation and headache.

If a patient is struggling with significant myalgia, this may indeed indicate a myositis. Creatinine Kinase can be measured and  if it is 5-10 times the upper limit of normal, the statin should be stopped. 

Statins can also cause abnormal liver function so this should be monitored with a repeat blood test in 4-6 weeks time. If the transaminases (ALT, AST) are 3 times the upper limit the statin should be stopped.

Offer ezetimibe instead of a statin to people for whom statins are contraindicated/cause abnormal blood test results.

# NICE Guidelines

[NICE Guidelines - Cardiovascular disease: risk assessment and reduction, including lipid modification ](https://www.nice.org.uk/guidance/ng238/chapter/Recommendations)
1799
1994
Hypercholesterolaemia
Topic
60
General Practice
12534
A 62 year old female is prescribed a statin for primary prevention of cardiovascular disease.

Which of the following describes the main mechanism of action of statins?
a