QuestionSBA
QuestionChoice
The QRISK2 is an online calculation to estimate the patient's chance of having a cardiovascular event in the next 10 years. If the risk is 10% or higher then the patient can be offered a statin to decrease the risk, known as primary prevention of cardiovascular events.

The amount the risk would fall by would be dependent on the effectiveness of the statin with the aim being a 40% reduction in non-HDL-C levels. A higher dose statin may be required as well as lifestyle modification to reduce this risk.
62361
d
The patient's risk of having a cardiovascular event can be decreased by 20% by treatment with a statin
QuestionChoice
The QRISK score specifically looks at the risk of cardiovascular events occuring for an individual over 10 years.
62359
b
There is a 20% chance of this patient having a cardiovascular event in the next 20 years
QuestionChoice
The QRISK score is used to predict the likelihood of someone having a cardiovascular event over the next 10 years, it does not predicit morbidity or mortality.
62362
e
The patient an 80% of chance of surviving a cardiovascular event in the next 10 years
QuestionChoice
The QRISK2 is an online calculation to estimate the patient's chance of having a cardiovascular event in the next 10 years. It is used for those under the age of 85 years, and who do not have type 1 diabetes, familial hypercholesterolaemia or chronic kidney disease as these are already considered higher risk for cardiovascular events.
Patients with a QRISK score of 10% or more should be offered lifestyle advice such as weight loss, smoking cessation and increased exercise. A statin (atorvastatin 20mg is first line) should be offered for primary prevention of cardiovascular disease if lifestyle modification is unsuccessful or inappropriate to offer.
62358
a
There is a 20% chance of this patient having a cardiovascular event in the next 10 years
QuestionChoice
The QRISK score is used to predict the likelihood of someone having a cardiovascular event over the next 10 years, it does not predicit morbidity or mortality.
62360
c
There is a 20% chance mortality risk in the next 10 years from a cardiovascular event
Concept
Chapter
# 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
12533
A 52 year old male attends his GP surgery for a general review. As part of this his assessent, his QRISK2 score is calculated which is 20%.

The patient wants to know what this means.

Which of the following is the best description of the patient's QRISK2 score?
a