19. Lipid Disorders

Question 1

What are the criteria for metabolic syndrome?

Answer 1

Diagnosis is established when 3 of 5 risk factors are present.

1. Abdominal Obesity (Men over 40 inch, Women over 35 inch)
2. Triglycerides - Greater or equal to 150 mg/dL
3. HDL Cholesterol (Men less than 40 mg/dL, Women less than 50 mg/dL)
4. Blood Pressure - Greater or equal to 130/85 mmHg
5. Fasting Glucose - Greater or equal to 110 mg/dL

Question 2

What are the criteria for Dyslipidemia in insulin resistance syndrome?

Answer 2

1. Elevated total Triglycerides
2. Reduced HDL cholesterol
3. Small, dense LDL cholesterol

Question 3

What are the target levels for lipids in Type 2 Diabetes?

Answer 3

HDL - >40 in Men, >50 in Women

LDL -

Question 4

What is the LDL target for a patient who has had a prior cardiac event?

Answer 4

LDL of less than 70 mg/dl

Question 5

How do you calculate non-HDL cholesterol? Also, what is the goal for non-HDL cholesterol levels?

Answer 5

Non HDL Cholesterol = Total Cholesterol - HDL

Non HDL Goal = LDL Goal + 30 mg/dl

LDL goal is either 100 (in DM2) or 70 (with prior cardiac event)

Question 6

What is small, dense LDL? And how can you tell you have it?

Answer 6

Small, dense LDL particles are more artherogenic than normal LDL. This is because they are more likely to permeate vascular walls and form plaques.

The proportion of small, dense LDL particles is greater in patients with metabolic syndrome or diabetes.

It is more likely that you have small, dense LDL if you have high TGs and low HDL.

Question 7

What is Familial Combined Hyperlipidemia?

Answer 7

Increased LDL and VLDL, Decreased HDL, and Increased TGs.

Increased secretion of ApoB, and pattern of metabolic syndrome.

Question 8

What is Familial Hypercholesterolemia?

Answer 8

Decreased LDL receptor activity in the liver.

Can be homo or heterozygous. Homo means no LDL receptors, Hetero means about half the number of LDL receptors.

Question 9

What is Familial Dysbetalipoproteinemia?

Answer 9

There is an accumulation of remnants of VLDL.Premature Heart Disease.

Question 10

What is Hyperchylomicronemia?

Answer 10

High TGs in clumps (chylomicrons) create a serum that’s white and coats everything.

Question 11

What are the effects of Resins, Niacin, and Statins on lipids?

Answer 11

Resins can complement Statins.

Niacin lowers LDL levels AND density. Also reduces TGs.

Statins decrease the risk of cardiac events the MOST. ~30% decrease.

Question 12

What is Lp(a)?

Answer 12

Lp(a) is a potentially extra thrombogenic type of LDL, which has the addition of apo(a).

Plasma concentration is predictive of artheroschlerotic disease in many epidemiological studies.

Accumulates in plaques and binds to apo B lipoproteins. Also taken up by foam cell precursors. May interfere with thrombolysis.

Question 13

What is Homocysteine?

Answer 13

Linked to artheroschlerosis. Elevated levels linked to genetic defects, exposure to toxins, and diet.

Homomcysteine may cause damage to intimal cells.