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Cholesterol – the basics @LWNurses #LWN #LearnWithNurses Michaela Nuttall RGN MSc Founder, Learn With Nurses Director, Smart Health Solutions Associate in Nursing, C3 Collaborating for Health Chair, Health Care Committee HEART UK Member, Nurses Working Party and Guidelines & Information Working Party, British and Irish Hypertension Society Trustee, PoTS UK @thisismichaelaHIGH CVD RISK BHF (2021) • It’s estimated that close to half of adults in the UK are living with cholesterol levels above national guidelines total cholesterol (greater than 5mmol/L) • People living with heart and circulatory diseases may have an even lower target cholesterol level • Around 7-8 million adults in the UK are currently taking lipid-lowering drugs such as statins What is cholesterol? substance which is mainly produced by the body itself - Vital to all cells; – building block in cell membranes – starting material for bile acids – starting material for certain hormones and vitamin D atherosclerotic cardiovascular diseaseisk ofThat’s not easy peasy To fast or not to fast? Random sample • Total cholesterol / serum cholesterol / TC • HDL Fasting sample • LDL • Triglycerides (ideally) Triglycerides Fasting triglyceride (TG) below 1.7mmol/L Non-fasting triglyceride (TG) below 2.3mmol/L • If TG is 4.5 – 9.9mmol/L look at the >7.5mmol/L REFER.on-HDL) if • Isample (one third will return to normal) but if fasted TG>10mmol/L REFER. • If TG >20mmol/L REFER URGENTLY. Consider FH All Individuals whose total cholesterol level is found to be above 7.5mmol/l should be referred to their GP for consideration of Familial Hypercholesterolaemia (FH) and for cascade testing of family members if a FH diagnosis is confirmed Check: Full lipid profile Thyroid, kidneys, liver and for diabetes Ratio Total Chol HDL Ratio 6 / 1 6 6 / 2 3 6 / .8 7.5 Non HDL Total chol HDL 6 - 1 5 6 - 2 4 6 - .8 5.2 Targets…..NICE Measure total cholesterol, HDL cholesterol and non-HDL cholesterol in all people who have been started on high-intensity statin treatment (both primary and secondary prevention, including atorvastatin 20 mg for primary prevention) at 3 months of treatment and aim for a greater than 40% reduction in non-HDL cholesterol. If a greater than 40% reduction in non-HDL cholesterol is not achieved: • discuss adherence and timing of dose • optimise adherence to diet and lifestyle measures • consider increasing the dose if started on less than atorvastatin 80 mg and the person is judged to be at higher risk because of comorbidities, risk score or using clinical judgement. Cholesterol treatments • Atorvastatin • Stanols/sterols • Simvastatin • Soya • Rosuvastatin • Oats & Barleys • Nuts • Ezetimibe • Physical activity • PCSK9 inhibitor In summary • Think cholesterol isn’t bad • Lots of mixed messages • FH radar • New kids on the block