Dys Flashcards
What is cholesterol
Structural component of cells
A precursor in hormone synthesis
Used in the production of bile acid by the liver
How does cholesterol exits the body?
As free cholesterol or as bile acid.
Why are bile acids important?
Bile acids are needed in the small intestine to absorb fat.
Bile acids travels from the liver to the bile duct (with free cholesterol and waste product) and into the small intestine.
What is enterohepatic recycling?
The acidic environment in the intestine convert the bile acids into bile salts, which are recycled from the intestine and returned to the liver.
Enteric system - gut
Liver- hepatic
Why is the recycling system important in cholesterol?
It decreases the liver need for new cholesterol by recycling it via bile salt.
What are some drugs target to decrease cholesterol?
Blocking absorption of free cholesterol in the intestine. (i.e. Ezetimibe)
Blocking the enterohepatic recirculation of bile salts. ( i.e. bile acid sequestrants, such as Colesevelam)
What are lipoproteins?
Lipid + protein carrier used to transport cholesterol
Cholesterol cannot dissolve in the blood therefore, it need to be transported via lipoprotein.
What are the three major type of lipoproteins?
LDL - low density lipoproteins
HDL- high-density lipoproteins
VLDL- very low density lipoproteins (serve as a carrier for triglycerides)
Total Cholesterol accounts for cholesterol in all of the different lipoproteins.
Non-HDL = Total Cholesterol - HDL
What is Non-HDL?
It includes atherogenic cholesterol ( increase risk of fatty plaques arteries) such as LDL, intermediate density lipoprotein, VLDL, chylomicron remnants, and lipoproteins.
Non- HDL is a stronger predictor of atherosclerotic cardiovascular disease. (ASCVD) than LDL.
- Atherosclerosis is a condition were fatty deposits accumulate in the arteries.
- Apolipoprotein B (apoB) is a high risk marker and an indicator of a progressive atherosclerosis.
- Atherosclerosis begins when apoB becomes trapped within the vascular wall.
Elevation in these levels increased patient risk of atherogenic disease, coronary cerebrovascular disease, and peripheral artery disease.
Non-HDL
LDL
TG
What is dyslipidemia?
Abnormal protein levels a called dyslipidemia.
Increase: TC, LDL, and TG
Decrease: HDL
What are the classification of Cholesterol and TG levels(mg/dL)?
NON-HDL: < 130 Desire
LDL: < 100 Desire
HDL: >40 for men and > 50 for women
TG: <150 Normal
LDL = TC - HDL - TG/5
What are the types of Dyslipidemia?
Primary or Familial : genetic
Secondary or Acquired: life style, medical conditions and drugs
Defined Primary/Familial Dyslipedemia?
Genetic defect resulting in severe cholesterol elevations and increased risk of premature ASCVD.
- Classified according to Frederickson classification.
- Family History: includes heterozygous and homozygous familial hypercholesterolemia (HeFH and HoFH respectively)
Defined Primary/Familial Dyslipedemia?
Genetic defect resulting in severe cholesterol elevations and increased risk of premature ASCVD.
- Classified according to Frederickson classification.
- Family History: includes heterozygous and homozygous familial hypercholesterolemia (HeFH and HoFH respectively)
Defined. Secondary/Acquired Dyslipedemia?
Severe cholesterol elevation due to other factors that are not genetically related such as, poor diet, lifestyle, medication or medical conditions.
*Includes
LDL greater than or equal to 190 mg/dL
TG gooder than or equal to 500 mg/dL
List drugs that increase LDL and TG?
Protease inhibitors
Steroids
Diuretics
Immunosuppressants ( cyclosporine, tacrolimus)
*Other:
Retinoids
List drugs that increase LDL only ?
Fibrates
SGLT2 inhibitors
*Other:
Anabolic steroids
Progestin
List drugs that increase TG only?
IV lipid emulsions
Propofol
Beta-blockers
Atypical antipsychotics
*Others:
Estrogen
Tamoxifen
Clevidipine
Bile acid sequestrant
List conditions that increase LDL an
d TG?
Obesity
Poor diet
Hypothyroidism
Alcoholism
Smoking
Diabetes
Renal/ Liver disease
Nephrotic syndrome
*Other:
Pregnancy
Polycystic Ovarian Syndrome
Anorexia
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What are non-drug treatments of dyslipidemia?
Diet rich in vegetable, fruits, whole grains and high fiber foods
Consume fish especially fish with high fat content rich in omega-3 fatty acids
Limit intake of saturated fat trans, fat and cholesterol by choosing lean meat non-meat Alternatives and low fat diary product aim for 5 to 6% of calories from saturated fat
