Claire Davies Profile picture
Nov 16 19 tweets 7 min read
Lots and lots of #lipids today @diabetespc this time with @PNewlandJones covering the fundamentals we all need to know for #PLWD

Once again standing room only!
And managed to catch his eye to say 😀 for the camera 📸 Image
Phil explaining how lipids have become unnecessarily complicated

We have gone from one medicine and one back up to multiple options for lipid management

Today going to take things back to fundamentals
How complicated lipids can be in one diagram 🖼️

Take away point: multiple mechanisms to lower lipids, work on different parts of the pathway Image
Lipoproteins broken down by size

- LDL will move cholesterol around the body
- Chylomicrons - smaller, risk of causing pancreatitis ImageImage
What’s in a blood? What’s in a lipid profile? Image
So what tests do we need?

Initial sample does NOT need to be fasting. Make the most of every visit. Test if able. Image
Primary Prevention:

- don’t use QRISK for T1DM

- for males, T2DM over 51 QRISK will be over 10%
- for females, T2DM over 58 QRISK will be over 10% Image
Titrate up doses until getting a reduction of 40% of baseline Image
Causes of raised cholesterol

Important to take full history Image
Managing dyslipidaemia in DM Image
Secondary prevention:

Work backwards, start high and reduce as able ImageImage
Ezetimibe:
- far lower CV benefits than a statin - particularly CV end points/events Image
PCSK9:
- rapidly recycle and clear lipid receptors

- imagine a snooker 🎱 table, more pockets
- increase uptake and recycling process

- tight criteria
- potent medicines - can see big drops

Negatives:
- cost and access ImageImage
Bempedoic acid:
- work similarly to statins
- good for true statin intolerance patients Image
Inclisiran:
- works similarly to PCSK9 inhibitors
- limited outcome data Image
Statins:

- if you reduce LDL by 1mmol/L with statins you reduce CV risk by 20%

Is intolerance a no-cebo effect? As myopathy figures in RCTs are a lot less than reported in practice Image
Statin intolerance:
- simplified pathway
- washout period (longer washout if high CK)
- then re challenge
- if symptoms persist before rechallenge unlikely the cause was the statin

Consider potent statins once or twice a week E.g rosuvastatin Image
Lipid medicines compared by potency: Image
Summary slides: ImageImage

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More from @claireyrivs

Nov 16
Catching @drsarahjdavies and @drnkan in the heart🫀and kidney clinic letting us know about reducing CV events

🧵 ⬇️ @UKCPADiabetes @UKCPACardiac @diabetespc #DPC22
CVD remains responsible for 24% of deaths in the UK

1 death every 3 minutes ⏱️
Range of modifiable and non-modifiable factors which can be discussed in clinic appointments

Individualised advice is 🔑

Biggest risk of having a CV event is having already had one!
Read 12 tweets
Aug 28
A 🧵for anyone prescribing, monitoring or seeing people on drug Tx for HF from @escardio #esc2022

"The practicalities of drug treatment in HF" 💔💊 with lots and lots of top tips⤵️

Great advice from conference that you can apply day to day! @GoggleDocs @UKCPACardiac @UKCPA
ESC Guidelines for HFrEF treatment:

Look at the quality of that evidence and recommendations for drug Tx! 😃💊 Image
Beta-blockers:
- start low, go slow
- ALWAYS titrate 📈for maximum benefit
- intolerance likely to resolve with time ⏲️ ImageImage
Read 13 tweets
Aug 28
Getting my #flozin fix on a Sunday catching up on #ESC2022 #ESCCongress2022 some thoughts in a thread 🧵 @UKCPACardiac @UKCPA @UKCPADiabetes
@escardio @hFRenDsUK

Let's start with the headline, drum roll please 🥁... Dapagliflozin in HFmrEF and HFpEF DELIVER Trial results
1. Background💔
HFpEF pts represent approx 50% of all people with HF
Currently limited Tx options in this group
Uncertainty remains re:
- People in highest part of EF range, ?attenuation of Tx effect
- People initiated on Tx during/soon after hospitalisation
- EF improved to >40%
2. Trial design, Endpoints and Flow
Note: either ambulatory or hospitalised patients
6236 patients. 3131 received dapagliflozin. Across 20 countries 🗺️
Follow up - 2.3 years
Equal drop out and incomplete follow up in Tx and in placebo arms ImageImageImage
Read 12 tweets

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