Chapter 13 - Hyperlipidemia

Question 1

5 major lipoproteins

Answer 1

1) Chylomicron 2) VLDL 3) IDL 4) LDL 5) HDL

Question 2

Chylomicron distinguinshing particle

Answer 2

one Apo B48

Question 3

VLDL particle distinguishing feature

Answer 3

Apo C and E and Apo B-100

Question 4

Adult treatment panel 3 guidelines on levels of LDL, HDL, TG

Answer 4

TABLE 13.2

Question 5

MARS study on IDL

Answer 5

associated with carotid artery intima-media thickness

Question 6

Another name for IDL

Answer 6

Remnant lipoprotein

Question 7

LDL receptor

Answer 7

Discovered by Nabel and Braunwald (nobel prize 1985) liver has 70% of this higher expression means better = lower circulating LDL level reduces with syndrome X

Question 8

HDL protein and physiology

Answer 8

Liver secrets Apo A-I = no lipid Forms cholesterol ester by lecithin-cholesterol acyltransferase HDL spherical –> return to liver

Question 9

Reverse cholesterol transport

Answer 9

HDL exchange cholesterol for TG from VLDL through cholesterol ester transfer protein (CETP)

Question 10

Atherosclerosis steps

Answer 10

Mononuclear cells in blood –> cholesterol enriched Intracellular droplets of cholesterol accumulate –> foam cells Foam cells adhere and damage endothelium –> migrate to intima layer Foam cells accumulate under endothelium = fatty streak APOPTOSIS lipid spills out = lipid core of atherosclerotic plaque Wall expand = positive remodeling plaque thicken and encroach lumen = negative remodeling cap break = platelet rich clot = thrombosis

Question 11

Most predictive lipoprotein fraction for determining atherosclerotic risk

Answer 11

LDL-C

Question 12

Non-HDL-C =

Answer 12

LDL-C + IDL-C + VLDL-C + lipoprotein A

Question 13

Risk factors for CHD otherthan elevated LDL-C

Answer 13

1) smk 2) HTN > 140/90 3) low HDL < 40 4) FHx 5) age > 45 male; > 55 female

Question 14

Family history that counts towards CHD risk factor

Answer 14

1) CHD in male 1st degree relative < 55 years 2) CHD in female first degree relative < 65 years

Question 15

ATP pannel 1, 2 and 3 recommenadtions

Answer 15

ATP-1 = education and lifestyle intervention ATP-2 = patient with known CHD should have more aggressive LDL-C target ATP-3 = aggressive approach to risk assessment and therapy

Question 16

CHD risk equivalents

Answer 16

1) other clinical forms: PAD, AAA, symp Carotid 2) diabetes 3) multiple risk factors with 10 year risk CHD > 20%

Question 17

Comparison of LDL and non-HDL target by risk ATP-3

Answer 17

TABLE 13.3

Question 18

ACC/AHA guidelines on targets for LDL-C and non-HDL-C at different risks

Answer 18

TABLE 13.4

Question 19

ATP 3 treatment target and when to start TLC and DRUGS

Answer 19

TABLE 13.5

Question 20

PREDIMED study in Spain

Answer 20

7447 patients with CVD risk Mediterranean diet supplemented with olive oil or nuts –> decrease major CV events

Question 21

Essential components of therapeutic lifestyle changes

Answer 21

LDL-RAISING NUTRIENTS 1) sat fat < 7% total calories 2) dietary cholesterol < 200 mg/day LDL lowering 1) plant stanols/sterols 2g/day 2) soluble fiber 10-25g/day 3) total calories to prevent weight gain 4) physical activity to expend 200 kcal/day

Question 22

Statin effect on LDLC HDLC

Answer 22

Lower LDL-C by 18-60% HDLC 5-20% TG 7-30% additional double statin dose = 6% reduction LDLC

Question 23

Side effect of statin

Answer 23

1) transient elevation of transaminase level 2) rhabdo 4/10000

Question 24

Contraindication to statin use

Answer 24

ABSOLUTE 1) active/chronic liver disease RELATIVE 1) cyclosporine, macrolide, antifungal, cytochrome P450 inhibitor (fibrates, nicotinic acid)

Question 25

Starting dose and max dose for different statins

Answer 25

Lovastatin 20 mg - 80 mg Pravastatin 20-80 Simvastatin 20-40 fluvastatin 20-80 atorvastatin 10-80 rosuvastatin 5-40 pitavastatin 2-4

Question 26

Scandinavian simvastatin survival study

Answer 26

lipid lowere therapy reduce mortality

Question 27

HPS study

Answer 27

simvastatin 40 mg/day reduce major vascular event

Question 28

Prospective study of pravastatin in the elderly at risk

Answer 28

PROSPER study reduce LDLC and CHD mortality and major CV events

Question 29

Treating to new targets study

Answer 29

TNT aggressive LDL lowering improves survival

Question 30

Justification for the use of statins in prevention an intervention trial evaluating rosuvastatin

Answer 30

JUPITER rosuvastatin lower CRP and improve CV events and death

Question 31

Niacin effect on HDL, LDL

Answer 31

HDL increase 15-35% LDL down 5-25%

Question 32

Side effect of niacin

Answer 32

hepatotoxicity

Question 33

COMPELL study

Answer 33

niacin + statin has better synergistic effects

Question 34

Fibrates effect on HDL, LDL

Answer 34

TG 25-50% HDL 5-15% LDL 10-20%

Question 35

Bile acid sequestrant types

Answer 35

Colestipol cholestyramine colesevelam

Question 36

Fibrates types

Answer 36

Gemfibrozil Fenofibrate peroxisome proliferator alpha agonist

Question 37

Ezetimibe effect

Answer 37

LDL 15-20%

Question 38

Omega 3 fatty acid types

Answer 38

Eicosapentaenoic acid (EPA) docosahexaenoic acid (DHA)

Question 39

Other agents to lower cholesterol

Answer 39

Cholesterol ester transfer protein inhibitor (CETP) proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9)

Question 40

Care in using gemfibrozil

Answer 40

cannot be used with statin increase toxicity of statins