2- clinical aspects of lipids

Question 1

what lipids do we measure?

Answer 1

• total cholesterol
• HDL cholesterol
• triglycerides as requested
  
  • are affected by fasting - will go up if eaten
• We then calculate total/HDL cholesterol ratio
• LDL cholesterol calculated - is possible

Question 2

what does raised triglycerides or chylomicrons affect blood?

Answer 2

milky blood (as so much lipid)

Question 3

when should you measure lipids?

Answer 3

• MI, CVA, other vascular disease
• Acute pancreatitis
• Family history
• Clinical signs

Question 4

what is statins mode of action?

Answer 4

HMG CoA reductase inhibitors (rate limiting enzyme of cholesterol synthesis), cholesterol synthesis inhibited →liver cells expresses more LDL receptors on surface so cholesterol circulating on LDL can be taken into cell to replace what’s not being made

Question 5

what is LDL receptor pathway?

Answer 5

1. synthesis & maturation of LDL receptor in ER
2. LDL receptor recycled to cell surface - carried around by ApoB
3. LDL cholesterol binds to LDL receptors and they are internalised
4. once internalised - it’s then degraded and receptor recycled back to surface

*PCSK 9 controls process so inhibiting PCSK 9 means allowing cell to process LDL more quickly

Question 6

statins do more than just lower cholesterol - what else do they help with?

Answer 6

pretty much all the stuff that makes atheromas:
- smooth muscle migration
- foam cell formation
- T-cell activation
- adherence and aggregation of platelets
- adherence and entry of leukocytes

Question 7

what is familial hypercholesterolaemia?

Answer 7

genetic disorder - autosomal dominant