Hyperlipidaemia treatment guideline

Introduction

Hyperlipidemia can be defined as elevation of serum total cholesterol (TC) and/or triglyceride (TG) or reduced high-density lipoprotein (HDL) cholesterol that predisposes to the development of atherosclerosis.
Hyperlipidaemia is a major risk factor for ischemia heart disease

Clinical features

  • Patients present with ischaemic heart disease or the underlying cause hyperlipideaemia
  • Signs include xanthomata, xanthelasmata, and corneal arcus

Differential diagnoses

  • Primary hyperlipidaemia
  • Secondary hyperlipidaemia: diabetes mellitus,
  • Nephrotic syndrome

Complications

  • Ischaemic heart disease
  • Peripheral vascular disease
  • Stroke,
  • Hypertension

Investigations

  • Lipid profile
  • Urea, Electrolytes and Creatinine
  • Fasting blood glucose
  • Urine proteins
  • Serum proteins (total and differential)

Treatment objectives

  • Lower lipid levels
  • Prevent or treat complications
  • Treat underlying causes

Non-drug treatment

  • Stop smoking
  • Reduce weight
  • Exercise moderately and regularly
  • Water soluble fibre: oat, bran

Drug treatment

  • Atovastatin

Notable adverse drug reactions, caution and contraindications

  • Caution in patients with history of liver disease, high alcohol intake
  • Hypothyroidism should be adequately managed before starting treatment with a statin
  • Liver function tests mandatory before and within 1 months of starting treatment; thereafter at intervals of 6 months for 1 year
  • Statins may cause reversible myositis, headache, diarrhoea, nausea, vomiting, constipation, flatulence, abdominal pain;
    insomnia

Prevention

  • Dietary manipulation
  • Early identification of individuals at risk

 

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