Management of Hyperlipidaemia

Which of the following statements is INCORRECT with regards to influence of dietary changes towards cholesterol level?

• Reducing saturated fats, dietary cholesterol and polyunsaturated fats have shown to reduce cholesterol levels.

• Plant sterol-enriched dairy and plant foods naturally rich in sterols can reduce LDL-C by 10-15%.

• Patients with elevated lipids should increase intake of fruits, vegetables, wholegrains and a variety of healthy proteins to reduce their risk of cardiovascular event.

• Mediterranean diet was shown to reduce total cholesterol and LDL-C.

Which of the following statements about cholesterol is CORRECT?

• Elevated HDL cholesterol contributes to cardiovascular disease and should always be treated as an individual condition.

• Elevated LDL cholesterol contributes to cardiovascular disease and should always be treated as an individual condition.

• Elevated HDL cholesterol, along with other cardiovascular disease risk factors, contributes to cardiovascular disease, a multi-modal treatment approach is most appropriate.

• Elevated LDL cholesterol, along with other cardiovascular disease risk factors, contributes to cardiovascular disease, a multi-modal treatment approach is most appropriate.

Statins remain first-line in reducing cardiovascular disease risk, which of the following statements on statin is INCORRECT?

• Each doubling of statin dose can produce an additional 6% reduction in LDL-C.

• Stains are generally well tolerated and serious adverse effects are rare but irreversible.

• Statins are associated with an increase in new onset of diabetes mellitus, in patients with risk factors for diabetes (eg. high BMI) and those being treated with high dose statins.

• 90% of statin-intolerant patients are able to tolerate an alternative statin.

Which of the following

statements about the pharmacological management of hyperlipidaemia is CORRECT?

• Ezetimide is suitable to replace statins if patients have not achieved LDL-C targets with the maximal tolerated dose of statin.

• Proprotein convertase subtilisin/kexin type 9 inhibitors can be used in conjunction with the maximum tolerated dose of a statin and/or ezetimibe to manage homozygous familial hypercholesterolaemia.

• Proprotein convertase subtilisin/kexin type 9 inhibitors can be used to manage hypercholesterolaemia in patients who are concerned about rhabdomyolysis.

• Proprotein convertase subtilisin/kexin type 9 inhibitors can only be used when all other agents are contraindicated.

What is the next step when triglyceride target does not achieve with maximally tolerated statin therapy?

• Add fenofibrate

• Add ezetimide

• Add PCSK9 Inhibitor

• Add Fish Oil

Which of the following statements about the non-pharmacological management of hyperlipidaemia

is CORRECT?

• A Mediterranean diet, rich in fish, fruits and vegetables was shown to decrease high density lipoprotein cholesterol by almost a third.

• A Mediterranean diet, rich in fish, fruits and vegetables was shown to decrease low density lipoprotein cholesterol by almost a third.

• A diet consisting of natural plant foods rich in sterols and plant sterol-enriched dairy can reduce high density lipoprotein cholesterol by up to 15%.

• A diet consisting of natural plant foods rich in sterols and plant sterol-enriched dairy can reduce low density lipoprotein cholesterol by up to 15%.

What is the next step if LDL-C target has not been achieved with maximal tolerated dose of statin?

• Replace with Ezetimide

• Add Ezetimide

• Replace with evolocumab Injection

• Add evolocumab Injection

Mr Rahman comes into your pharmacy and asks to speak to a pharmacist. He is very concerned as he has just started on simvastatin 20mg and his arms have started to hurt a little. He is aware of the serious side effect (rhabdomyolysis) caused by statin and he would like to stop taking his simvastatin. Which of the following statements is CORRECT?

• Rhabdomyolysis is common. Given that Mr Rahman arms have started to hurt, he should stop taking his simvastatin and visit his doctor immediately.

• Rhabdomyolysis is a known adverse effect of atorvastatin, Mr Rahman should stop taking his simvastatin and commence on fish oil capsules to manage his triglycerides.

• Rhabdomyolysis is a rare adverse effect of simvastatin, and given that the pain is not intense, you advise that the simvastatin should be continued.

• Rhabdomyolysis is a rare adverse effect of simvastatin, however, given the recent onset of pain in Mr Rahman's arms and his concern, the pharmacist should consider referring him back to his doctor.