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Exercise Prescription > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

0
Q

Name all the lipoprotein classifications?

A

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

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1
Q

What do lipoproteins contain?

A
  • protein

- lipid

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2
Q

What is the function of Chylomicrons?

A

Chylomicrons are lipoprotein particles that contain a large percentage of triglyceride (85-90%) and are involved in the transportation of dietary lipids around the body.

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3
Q

What is known as the “good” and “bad” cholesterol?

A

LDL = Bad cholesterol (strong risk factor for CHD)

HDL= Good cholesterol

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4
Q

What is a triglyceride?

A

A triglyceride is made up of 3 FFA molecules and 1 Glycerol molecule

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5
Q

What is a macrophage?

A

A macrophage is a white blood cell that ingests materials such as lipid.

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6
Q

What are Apolipoproteins?

A

Apolipoproteins is a molecule that has a protein attached to the surface of a lipid molecule e.g. Apo C-II

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7
Q

Name the 3 main pathways responsible for the “generation” and the “transport” of lipids within the body?

A

1) The Exogenous (dietary) lipid pathway
2) The Endogenous pathway
3) The pathway of reverse cholesterol transport

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8
Q

Outline the exogenous (dietary) lipid pathway.

A
  • Following the digestion and absorption of dietary fat, triglycerides (TG) are packaged up to form chylomicrons in epithelial cells of the intestines.
  • Chylomicrons circulate through the intestinal lymphatic system.
  • In the blood, circulating chylomicrons interact at the capillaries of adipose tissue and muscle cells, releasing triglyceride to the adipose tissue to be stored and made available for the body’s energy needs.
  • The enzyme Lipoprotein lipase (LPL) is activated by the apolipoprotein Apo- C-II and LPL hydrolyses the triglyceride and free fatty acids are then subsequently released for energy production, via beta-oxidation.
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9
Q

Outline the Endogenous Pathway.

A

The Endogenous Pathway involves the liver synthesising lipoproteins.

  • Triglyceride and cholesterol esters are generated by the liver and packaged into VLDL particles which are then released into the circulation.
  • VLDL is then processed by the enzyme LPL to release FFA and glycerol. Once VLDL has been processed by LPL it becomes a VLDL remnant.
  • The majority of VLDL remnants are taken up by the liver via the LDL receptor, and the remaining LDL remnant particles become IDL. IDL is a smaller denser lipoprotein that VLDL.
  • The Fate of some of the IDL particles require them to be reabsorbed by the liver; however, other IDL particles are hydrolysed by hepatic-triglyceride lipase to form LDL, a smaller, denser particle that IDL.
  • LDL is the main carrier of circulating cholesterol within the body, and remember high levels of LDL is a potent risk factor for CHD.
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10
Q

Outline Cholesterol Transport.

A

Reverse cholesterol transport refers to the process by which cholesterol is removed from the tissues and returned to the liver

  • HDL is the key lipoprotein involved in reverse cholesterol transport and the transfer of cholesterol esters between lipoproteins.
  • Free Cholesterol is esterified by Lecithin Cholesterol acyltransferase (LCAT).
  • The esters are internalized to HDl via Cholesterol ester transfer protein (CETP)
  • HDL is converted to HDL 3 and then HDL 2
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11
Q

What is primary dyslipidemia?

A

Modifications in the number and function of Apolipoproteins, intra vascular enzymes, lipid transfer proteins and lipoprotein receptors.

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12
Q

What is secondary dyslipidemia?

A

Metabolic disorders, for example: diabetes or medication e.g corticosteroids.

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13
Q

What are corticosteroids?

A

Corticosteroids can influence the way lipoproteins are transported.

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14
Q

Define Dyslipidemias?

A

Dyslipidemias are disorders of lipoprotein metabolism, including lipoprotein overproduction and deficiency.eg

  • elevated total cholesterol
  • high LDL particles
  • high triglyceride particles
  • low levels of HDL
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15
Q

Dyslipidemia is closely associated with atherosclerosis and is a major causal factor for the development of ishcemic diseases. Ishcemic cardiovascular and cerebrovascular events are the leading causes or morbidity and mortality. True or false?

A

True

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16
Q

What happens to the endothelium as a result of repeated exposure to LDL?

A

Repeated exposure to LDL has shown to decrease nitric-oxide bioavailability by:

1) Reducing the concentration of eNOS.
2) Reducing the activation of eNOS.
3) Enhancing NO degradation.

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17
Q

Endothelial dysfunction is characterised by reduced nitric-oxide bioavailability, and this is the preceding step to LDL entry within the arterial intima. True or false?

A

True

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18
Q

High levels of LDL are associated with what in the artery wall?

A

High levels of LDL in the artery are associated with the formation of “foam” cells, that are trapped within the arterial intima by proteoglycans.

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19
Q

Outline the mechanism associated with the formation of foam cells.

A
  • In chronic dyslipidemia, lipoproteins build up within the arterial intima and become oxidised by the action of oxygen free radicals that are generated by either macrophages or endothelial cells.
  • macrophages engulf the oxidised LDL’s by endocytosis via scavenger receptors.
  • the oxidised LDL accumulates in the macrophages and other phagocytes, which are then known as foam cells.
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20
Q

The build up of foam cells causing narrowing of the artery and is the major cause of atherosclerosis. True or False?

A

True

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21
Q

In some instances the foam cells can occlude blood flow and create an area of ishcemia and this can lead to what?

A
  • Stroke (loss of brain function due to reduced blood flow to the brain)
  • Myocardial Infarction (heart attack)

Strokes and myocardial infarction are the two leading causes of cardiovascular-related death.

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22
Q

Provide 2 reasons how can the formation of foam cells be reduced ?

A

1) by consuming foods low in LDL cholesterol

2) increase the levels of HDL via exercise interventions

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23
Q

What is the most important action of HDL cholesterol in the body?

A

HDL provides an atheroprotective mechanism, as HDL uptakes cholesterol from the foam cells (macrophage-lipid laden cells) in the atherosclerosis plaques and returns the cholesterol back to the liver, a process known as “reverse cholesterol transport”

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24
Q

Provide 5 important properties of HDL:

A

1) Cell repair (stimulates endothelial progenitor cells)
2) Anti-inflammatory effects (prevention of monocytes attraction to the vessel wall)
3) Imunomodulatory (innate immunity response)
4) Antithrombotic (prevention of platelet activation by activating NO therefore stimulating Fibrinolysis)
5) Antioxidant effect (Prevention of LDL oxidation).

25
Q

What is fibrinolysis?

A

Fibrinolysis is a process that prevents blood clots from growing and becoming problematic.

26
Q

What class of drugs can be used to Lower levels of LDL cholesterol and what is the mechanism?

A

“Statins” are used to lower LDL cholesterol levels by inhibiting the enzyme HMG-COA Reductase.

27
Q

What is the enzyme HMG-COA Reductase?

A

HMG-COA Reductase is a key enzyme involved in the production of cholesterol in the liver.

28
Q

Statins reduce levels of circulating LDL and have a huge impact on reducing mortality and morbidity. True or false?

A

True

29
Q

What is the national average for cholesterol in the units mmol/L?

A

5.6 - 5.7 mmol/L

30
Q

According to Dyslipidemia targets, it is recommended that all at risk individuals should control their blood cholesterol levels. What are the optimal blood cholesterol levels?

A

TCL = <2.0 mmol/L

31
Q

Although statins have shown to play an important role in reducing LDL and Triglyceride levels they can sometimes case the following side effects:

A

1) upset stomach
2) constipation
3) abdominal pain
4) muscle soreness
5) Pain and weakness

32
Q

In a study conducted by (Kelley et al, 2005) > 8 weeks of aerobic exercise reduced triglyceride levels in obese individuals. True or false?

A

True

33
Q

Diet does not increase HDL alone as an increase in …………. Is also required to see dramatic changes in HDL.

A

VO2 max

34
Q

If you want to reduce LDL levels what strategy would you recommend?

A
  • adjust dietary intake

- increase physical activity levels

35
Q

If we increase our levels of HDL cholesterol by participating in regular exercise, by losing weight etc, it makes the process of “reverse cholesterol transport” much more effective. True or false?

A

True

36
Q

Is exercise intensity or exercise volume more important for reducing and controlling blood lipid levels?

A

Exercise “volume” is more important research has shown that a volume of 1000-2000 kcal/week positively alters HDL and TG.

37
Q

Exercise training has been associated with increased concentrations of HDL, however the amount of exercise required to significantly improve HDL levels has not been identified, therefore research in this area is very much inconsistent. True or false?

A

True

38
Q

Provide 3 important functions or uses of cholesterol in the body?

A

1) build cell membranes
2) production of sex hormones
3) form bile acids required for the digestion of fats

39
Q

What are the ‘desirable’ levels of LDL and HDL for an average adult? Express answer in mg/dL units.

A

LDL = below 130mg/dL

HDL= above 60mg/dL

40
Q

Why is exercise good at improving levels of HDL and improving the efficiency of the “reverse collateral transport system”?

A

Exercise stimulates several key enzymes involved in the reverse cholesterol transport system.

41
Q

Although volume is believed to be more important than intensity at improving blood lipid levels, Stein et al. (1990) reported significant improvements in HDL when men exercised above …………. HRmax for 3 times a week, for 12 weeks.

A

Above 75% HRmax

42
Q

Most study suggests that in endurance exercise is positively associated with increases in HDL cholesterol amongst men. True or false?

A

True

43
Q

Changes in HDL levels in response to exercise are very much dependant on:

A

1) Intensity
2) Duration
3) Frequency

44
Q

A cardio protective diet includes:

A

1) total fat intake < 300mg/day
4) saturated fats replaced by monounsaturated or polyunsaturated fats
5) Eat 5potions of fruit and veg per day
6) consume 3 portions of fish per week.

45
Q

According to Martin et al. (2001) exercise volume shows the largest significant differences in the management of dyslipidemia. True or false?

A

True

46
Q

Improvements in LDL and TC levels are associated with improvements in body composition. Therefore exercise has an indirect effect on LDL and TC. However exercise has a direct effect on HDL levels. True or false?

A

True

47
Q

What type of training is better for improving levels of HDL cholesterol?

A

Aerobic training is better than resistance training for improving HDL. 8 weeks of aerobic training induced a net increase in HDL of 2.53 mg/dL.

48
Q

Every 1mg/dL increment in HDL is reported to be associated with a 2% and 3% reduction in CVD risk in men and women, respectively. True or false?

A

True

49
Q

A small increase in HDL concentration can have a large influence in reducing the risk of cardiovascular disease because of the “Reverse cholesterol transport” mechanism. True or false?

A

True

50
Q

According to Kodama et al. (2007) each 10 minute increase in exercise duration conferred a ………… mmol/L increase in HDL.

A

0.036 mmol/L in HDL

51
Q

A weekly energy expenditure of 900kcal/week is required to demonstrate improvements in what?

A

HDL cholesterol

52
Q

For obese individuals what is the best strategy to improve their levels of HDL?

A
  • exercise intervention
  • pharmacological intervention
  • dietary intervention
53
Q

Outline the key findings of the study by Kokkinos et al (1995).

A
  • TC:HDL ratio improved incrementally with exercise training volume
  • HDL improved by 0.2 mg/dL/km
  • significant improvements in HDL were observed amongst individuals running between 7-14 miles per week.
54
Q

Outline the key findings of the study conducted by Drygas et al (1988).

A
  • significant improvements were archived when energy expenditure was 1500-3000 kcal/week
  • further increases in HDL were archived when exercise volume increased.
  • > 3000kcal = 3.5mg/dL improvement in HDL
55
Q

It is believed that changes in TC and LDL are due to changes in body composition. True or false?

A

True

56
Q

What mechanisms of change occur in response to exercise training?

A
  • Reduced adiposity reduces the concentration and flux of circulating non-esterified fatty acids (NEFA) to the liver, attenuating lipogenesis response and reduced hepatic production of lipoproteins.
  • Increased metabolism of VLDL in muscle, fatty acids are oxidised in the mitochondria via beta oxidation and therefore less triglyceride is stored.
  • Changes in HDL are linked with an increased oxidative capacity e.g increased activity of citrate synthase and cytochrome c oxidase. Also linked with increased LPL activity in the muscles and hepatic lipase in the liver.
57
Q

Why is “moderate intensity” “high volume” exercise good at improving blood lipids?

A

Because this type of exercise relies on more lipid as a fuel to produce ATP, and therefore has a longer lasting effect on LPL in the muscle and hepatic lipase in the liver, leading to an increased lipid uptake and an increased lipid oxidation in the skeletal muscle.

58
Q

A combination of bth exercise and dietary modifications have shown to be an effective strategy for lowering cholesterol levels (Varady and Jones, 2005). True or false?

A

True

59
Q

Outline the study by Varady and Jones (2005).

A

Varady and Jones (2005) examined the effect of limiting fat intake (20-30%) combined with moderate intensity exercise (30-60mins per session 7 days per week) on reducing cholesterol levels.

Results lowered:

  • TC by 7-18%
  • LDL by 7-15%
  • TG by 5-14%

And increased HDL by 5-14%

60
Q

In women for each 1 hour increase in TV viewing per day it increases the risk of metabolic syndrome be 26%. True or false?

A

True

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