Dyslipidemia Flashcards
Are lipids soluble in plasma?
No
Lipoproteins’ responsibilities
Carrying lipids to various tissues for energy utilization, lipid deposition, steroid hormone production, and bile acid formation.
Elevations in any lipoprotein species is
hyperlipidemia
Increased levels of triglycerides
hyperlipemia
hyperlipidemia is also known as
hyperlipoproteinemia
What makes up the lipoprotein lipophilic core?
esterified cholesterol and triglycerides.
What is the structure of lipoproteins?
Lipophilic core.
Outer layer.
Apolipoproteins (apoproteins)
What makes up the lipoprotein outer layer?
phospholipids and unesterified cholesterol
What do apolipoproteins do?
Determine lipoprotein function - classifies proteins
5 classifications of lipoproteins
- Chylomicrons
- Very low density lipoprotein (VLDL)
- Intermediate density lipoprotein (IDL)
- Low density lipoprotein (LDL)
- High density lipoprotein (HDL)
very large particles that carry dietary lipids
chylomicrons
carries triglycerides adn to a lesser degree cholesterol
very low density lipoprotein
carries cholesterol esters and triglycerides
intermediate density lipoprotein
carries cholesterol esters
low density lipoprotein
high density lipoprotein
Chylomicrons apoproteins
A-I A-II A-IV B-48 C-I C-II C-II EI
VLDL apoproteins
B-100 C-I C-II C-III E
IDL apoproteins
B-100
C-III
E
LDL apoproteins
B-100
C-III
HDL apoproteins
A-I A-II C-I C-II C-III D E
What are the functions of apoproteins?
B-100 and B48 convey lipids into the tissue and artery wall (VLDL, IDL, LDL, AND CHYLOMICRONS)
Plaque formation leading to atherosclerosis.
functions of HDLs
“scavengers”
acquire and transport cholesterol from atherosclerotic plaques and peripheral tissues to the liver (reverse cholesterol transport).
Elevated HDL reduces the risk of CHD.
What is the leading cause of death in the US?
atherosclerosis
What is considered high cholesterol?
> or equal to 240 mg/dL
What percentage of patients with elevated cholesterol are receiving pharmacotherapy?
<50%
What percent of US adults have high cholesterol?
16.3%
What percent of US adults have TC>200 mg/dL?
50%
How often should a healthy adults over the age of 20 receive lipid panels?
Every 5 years.
When should a lipid panel be obtained?
After a 9-12 hour fast.
What does a lipid panel measure?
Total Cholesterol
Triglycerides
HDL
What cholesterol must be calculated from the lipid panel?
VLDL
LDL
Formula for VLDL
VLDL=Triglycerides/5
Formula for LDL
LDL = TC - (HDL+VLDL)
Primary “familial” hyperlipidemia causes
Lipid metabolism defect Fredrickson Classification (Type I-V)
Secondary “acquired” hyperlipidemia causes
Diabetes Hypothyroidism Renal failure Obstructive liver disease Drug induced
Drugs that induce hyperlipidemia
Anabolic steroids Retinoids Birth control pills and estrogens Corticosteroids Thiazide diuretics Protease inhibitors Beta-blockers
ATP III Classification of LDL
or equal to 190 = very high
ATP III Classification of TC
or equal to 240 = very high
ATP III Classification of HDL
or equal to 60 = high
Identifying CHD risk
Does the patient have: clinical CHD? symptomatic CAD? PAD? abdominal aortic aneurysm? diabetes?
Major risk factors that modify LDL goals
cigarette smoking
HTN (BP > or equal to 140/90 mmHg or an antiHTN medication)
Low HDL (45 men; >55 women)
When do you calculate the Framingham score?
CHD or CHD risk equivalent or 2+ risk factors without CHD risk
What is needed to calculate Framingham risk score?
Age TC Smoking status HDL SBP
Framingham Risk Score calssifications
10- year risk
Low Risk 20%
What do the risk categories indicate?
LDL goal of therapy
Need for therapeutic lifestyle changes (TLC)
Level for drug consideration
How is Non-HDL cholesterol calculated?
Non-HDL cholesterol = TC-HDL
