QuestionSBA
QuestionChoice
The QRISK2 is a score used to estimate the 10-year risk of cardiovascular disease in patients under the age of 85 years who do not have heart disease.
The risk score helps guide **primary prevention** of cardiovascular disease with lifestyle and pharmacological intervention. Patients with a **QRISK2 score of 10% or more** should be **offered a statin** to reduce the risk of cardiovascular disease. First line choice is atorvastatin 20mg.
62423
a
Atorvastatin 20mg
QuestionChoice
The patient shoukd be offered lifestyle advice such as increased exercise, stopping smoking and decreased alcohol intake as part of the primary prevention of cardiovascular disease. However, the patient should also be offered a statin.
62425
c
Recommend an increase in weekly exercise only
QuestionChoice
The QRISK2 is a score used to estimate the 10-year risk of cardiovascular disease in patients under the age of 85 years who do not have heart disease.
The risk score helps guide primary prevention of cardiovascular disease with lifestyle and pharmacological intervention. Patients with a 10% or more QRISK2 score should be offered a statin to reduce the risk of cardiovascular disease. First line choice is atorvastatin 20mg.
If atorvastatin 20mg is commenced and there has not been a 40% or greater reduction in non-HDL cholesterol, then the dose can be increased up to 80mg. For **secondary prevention**, atorvastatin 80mg would be appropriate.
62428
f
Atorvastatin 80mg
QuestionChoice
This patient should be offered a statin and lifestyle advice as part of primary prevention of cardiovascular disease. There is no need to recalculate his QRISK2 score.
62426
d
Recalculate QRISK2 score in 3 months time
QuestionChoice
Whilst a statin is recommended for this patient, atorvastatin is now the first line choice. Atorvastatin is more effective at lowering cholesterol than simvastatin.
62424
b
Simvastatin 40mg
QuestionComment
this question has 6 options :o
27974
QuestionComment
do i get extra points for getting it right
27975
User
subscriber
Complement Kinase
QuestionComment
People at quesmed be trippin
29210
User
subscriber
Respect
User
subscriber
Complement Kinase
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
12546
A 65 year old male presents to his GP for a general health check. As part of this, the GP calculates the patient's QRISK2 score, which is 20%.

He has no past medical history.

Which of the following is the best next step in the management of this patient?
a