Cholesterol and Triglycerides Flashcards
Cholesterol
-Component of all cell membranes and membranes of intracellular organelles.
-Required for synthesis of certain hormones (e.g.- estrogen, progesterone, testosterone.)
-Required for synthesis of bile salts, which are needed to absorb and digest dietary fats.
-Comes from dietary sources
-Manufactured by cells, primarily in the liver.
3 classes of plasma lipoproteins relevant to coronary atherosclerosis
- Very-low-density lipoproteins (VLDL)
-triglycerides
-role is to deliver triglycerides from the liver to muscles and adipose tissue for fuel - Low-density lipoproteins (LDL)
-Cholesterol primary core lipid
-Greatest contributor to coronary heart disease - High-density cholesterol (HDL)
-Good cholesterol
-Carry cholesterol to liver
Exogenous cholesterol
-Cholesterol that comes from dietary sources.
Endogenous cholesterol
-Cholesterol that comes from cells, primarily in the liver.
3-hydroxy-3-methylglutaryl coenzyme A
-An enzyme that is the catalyst for hepatic cholesterol synthesis.
Cholesterol screening
-Every 5 years for adults older than 20
Total cholesterol:
-HDL greater than or equal to 45 mg/dL: low to undesirable
-LDL < 100 mg/dL: desirable
-Triglycerides < 90 mg/dL
Treatment for high LDL
-Therapeutic lifestyle changes
-smoking cessation
-diet
-exercise
-Drugs should only be used if lifestyle changes fail
Metabolic Syndrome
-Group of metabolic abnormalities associated with an increased risk for ASCVD and type 2 diabetes.
Metabolic abnormalities
-High blood glucose
-High triglycerides
-High apolipoprotein B
-Low high-density lipoprotein
-Small LDL particles
-Prothrombotic state
-Proinflammatory state
-Hypertension
Metabolic Syndrome
-High triglyceride levels-150 mg/dL or higher
-Low HDL cholesterol-below 40 mg/dL for men or below 50 mg/dL for women
-Hyperglycemia- fasting blood glucose 100 mg/dL or higher
-High blood pressure- systolic 130 or higher and/or diastolic 85 or higher
-Waist circumference 40 inches or more for most men or 35 inches or more for most women
Treatment goals for metabolic syndrome
-Reduce the risk for atherosclerotic disease.
-Reduce the risk for Type 2 diabetes
-Increase physical activity
HMG-CoA reductase inhibitors
(Statins)
Lovastatin (Altoprev)
-Most effective drugs for lowering LDL
-Take these drugs in the evening
-Cholesterol is synthesized more at night
-Lowers LDL cholesterol
-Increases HDL cholesterol
-Decreases triglyceride levels
Statin therapeutic use
-Hypercholesterolemia
-Primary and secondary prevention of CV agents
-Post MI therapy
-Diabetes
Statin adverse effects
-Common-
-Headache
-Rash
-GI disturbances
-Rare-
-Myopathy/rhabdomyolysis- muscle aches, tenderness. Breakdown of muscle tissue.
-Hepatotoxicity- Jaundice, feeling bad. Draw liver enzymes
Statin drug interactions
-Most other lipid-lowering drugs
-Drugs that inhibit CYP3A4
-Use in pregnancy is contraindicated
Statin administration
-Given PO
-Dosing should be once daily in the evening.
Bile-Acid Sequestrants
-Reduces LDL-bad lipids
Colesevelam (Welchol) uses
-Reduces LDL cholesterol with modified diet and exercise.
Colesevelam (Welchol) adverse effects
-Constipation
Fibric acid derivatives (Fibrates)
-Lowers triglyceride levels
Gemfibrozil (Lopid) uses
-Reduces high levels of plasma triglycerides
-Can raise HDL
Gemfibrozil (Lopid) adverse effects
-Rashes
-GI disturbances
-Gallstones
-Myopathy
-Liver injury
Gemfibrozil (Lopid) drug interactions
-Displaces warfarin from plasma albumin
-INR needs to be measured frequently
