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Clin 1 > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

What is the characteristic of apo E-2?

A

does not bind to LDL receptors = increase in VLDL remnants

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2
Q

What are the types of primary hyperlipoproteinemias and the main lipoproteins affected?

A 
I - chylomicrons
IIa - LDL
IIb - LDL - VLDL
III - B-LDL IDL + VLDL + LDL
IV - VLDL
V - VLDL + Chylomicrons
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3
Q

Which types of primary hyperlipoproteinemias have higher CVD risks?

A

IIb + III

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4
Q

What are xanthomas?

A

visible sign of hyperlipoproteinemia

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5
Q

What is the effect of alcohol on lipids profile?

A

it blocks acyl-CoA oxidation so it’s converted to fat

also increases HDL-C

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6
Q

TRUE or FALSE

Lp (a) is very atherogenic

A

true

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7
Q

What affects the variation in serum cholesterol?

A

serum cholesterol = saturated - polyunsaturated + dietary cholesterol
*saturated fats have a bigger impact on serum cholesterol than dietary cholesterol

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8
Q

What are the limitations of the predictive equations for serum cholesterol?

A
  • not all SFA are the same
  • assuming that MUFA and carbohydrates don’t have an effect
  • effect on total cholesterol might not be linear
  • total cholesterol not fractions
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9
Q

What were the findings of the seven countries study?

A

positive linear correlation btwn coronary deaths and serum cholesterol
outliar = crete = mediterranean diet but also other factors
* might have been financed by the sugar industry

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10
Q

TRUE or FALSE

a large decrease in dietary cholesterol (100 mg) results in a significant decrease in serum cholesterol

A

FALSE

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11
Q

What are the effect of dietary cholesterol on lipid metabolism?

A
  • impairs HDL clearance of cholesterol
  • reduce synthesis of LDL receptors
  • increase cholesterol in VLDL, VLDL remnants + chylomicrons
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12
Q

What should be the recommendation to the general population to reduce sat fats?

A

all processed foods, baked goods, pizza and ice cream

not necessarily meat and dairy

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13
Q

What are the medium chain SFAs?

A

caprylic, caproic

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14
Q

What is the intermediate chain SFAs?

A

lauric

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15
Q

What are the long chain SFAs?

A

Myristic
Palmitic
Stearic

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16
Q

Do SFAs from cheese and butter have the same effect?

A

no, cheese less increase in LDL compared to butter

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17
Q

Do SFAs from dairy and meat have the same effects?

A

no dairy products decrease CVD risks

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18
Q

what are dietary sources of linoleic acid?

A

safflower oil, soybean oil, corn oil, sunflower seed oil, walnut

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19
Q

By replacing SFAs with PUFAs what are the effects?

A

reduced CVD risks but not mortality

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20
Q

Is omega-3 supplementation useful to reduce CVD risk?

A

no

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21
Q

What decreases HDL-C?

A
  • high PUFAs intake
  • high sugar intake
  • obesity
  • male sex
  • steroids
  • smoking
  • DM
  • Some anti-hypertensive drugs
  • androgens
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22
Q

What increases HDL-C?

A
  • dietary cholesterol
  • saturated fatty acids
  • moderate alcohol intake
  • female sex
  • estrogens
  • long-term aerobic program
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23
Q

What are the drugs for DLP and CVD prevention?

A
  • HMG-CoA inhibitors
  • Cholesterol absorption inhibitors
  • Bile acid sequestrants
  • PCSK9 inhibitors
  • Fibrates
  • Nicotinic acid slow release
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24
Q

What is ezetimibe?

A

cholesterol absorption inhibitor

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25
Q

What are cholestyramine and colestipol?

A

bile acid sequestrants

promote sterol excretion and increase LDL R

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26
Q

What are statins?

A

HMG-CoA inhibitors
decreased VLDL synthesis and conversion to LDL
increase VLDL clearance by increasing LDL R activity

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27
Q

What are gemifibril + fenofibrate?

A

fibrates
decrease VLDL synthesis
increase LPL activity

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28
Q

What are evolucumab and alirocumab?

A

PCSK9 inhibitors
prevent LDL R catabolism
only for ppl with familial DLP
expensive

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29
Q

Why the Framingham Risk Scores is not available for 80 yo?

A

because there are not many benefits to change lifestyle and nutrition at 80 yo
may lead to malnutrition

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30
Q

What is the link btw estrogen and CVD?

A

estrogen keeps the blood vessels flexible

31
Q

Can estrogen be used as replacement therapy to prevent CVD?

A

NO

32
Q

What are the changes related to lipid profile after menopause?

A

Increase in LDL-C
Decrease or no change in HDL-C
TGs increase
BP increase

33
Q

What are the signs and symptoms of MI?

A
  • Chest pain
  • Dizziness, light-headed
  • Jaw, neck and back pain
  • Arm or shoulder pain
  • Nausea & vomiting
  • Shortness of breath
34
Q

What are the types of ACS?

A

Stable Angina = plaque but no occlusion, vessel unable to dilate enough to allow adequate blood flow to myocardial demand
Unstable Angina = partial occlusion
NSTEMI = results in an injury and infract to the myocardium
STEMI = complete occlusion

35
Q

What are the biomarkers for MI?

A
  • troponin (most specific)
  • CK MB (specific if no skeletal muscle damage)
  • LDH (lactate dehydrogenase)
36
Q

What is a cardiac cath?

A

passing a catheter via arm, groin or neck for visualization, angiogram

37
Q

What is angioplasty?

A

catheter to place a stent or a balloon

38
Q

What is CABG?

A

Coronary Artery Bypass Graft
By passing where artery is blocked
Taking a vessel from leg and inserting to aorta and below the blockage
Blood pass the blockage point
Can have from 1 to 5 depending on the blockage points

39
Q

What is the diet suggested post MI?

A

NPO and progress to clear liquids w/o caffeine

want to maximize blood flow to heart

40
Q

What are the key points for secondary prevention?

A
  • take meds
  • follow up with doctor
  • manage the risks
  • get support
  • participate to cardiac rehab (fitness + improving stress)
41
Q

What is A-fib?

A

Atrial fibrillation = irregular heart beat = disrupts the blood flow to heart
need anti-coagulant (warfarin) = need constant intake of vit K

42
Q

What are the drugs to treat MI?

A
  • Statins
  • Anti-platelets agent (ASA)
  • Beta-blockers, ACE-inhibitors
  • Nitrates - NTG
  • Anti-coagulants
  • Meds to protect stomach
43
Q

What are the precautions to take when high TGs?

A
  • avoid sugar
  • no alcohol
  • healthy weight
  • follow heart healthy guidelines
44
Q

What are the considerations when taking warfarin?

A
  • need consistent vit K intake
  • pay attention to vit A + E that can have an impact on clotting time
  • asians need lower dose
45
Q

What are the complications of a stroke?

A
  • weakness/paralysis
  • limited mobility
  • dysphagia
46
Q

What are the signs of HF?

A
  • coughing
  • ascites
  • edema in lower leg
  • pulmonary edema
  • heart hypertrophy
  • pleural effusion
47
Q

What is the left ventricular ejection fraction?

A

blood pumped out/blood in chamber
50-70% is normal
41-49% is borderline
< 40% is reduced

48
Q

What are the consequences of left-side HF?

A

back up of blood in lungs = increase pressure = edema

49
Q

What are the consequences of right-side HF?

A

back up of blood in vena cava and body = ascites and leg edema

50
Q

Why the BP decrease, Heart Rate increase and respiration also increases when HF?

A

BP decreases bc lower blood volume pumped out so heart pumped more often to deliver the same amount of blood (increased HR) and increase respiration for more O to cells

51
Q

What is BNP?

A

B-type natriuretic peptide used to diagnose HF because it is released when muscle fibers of left ventricle are stretched

52
Q

What are the three main nutritional concerns for patients with HF?

A
  • sodium intake
  • fluid intake
  • nutritional adequacy
53
Q

What are the nutritional recommendations for HF?

A
  • 2,000 mg of sodium
  • fluid restriction
    1-2 L or 1-1.5 for more severe
  • limit alcohol or none if cause of HF
54
Q

What are the effects of fibers on lipid profile?

A

decreased LDL-C and total cholesterol

55
Q

What are the effects of high carbs on lipid profile?

A

decreased HDL-C

increased VLDL-TG (sucrose + fructose)

56
Q

What are the effects of alcohol on lipid profile?

A

increase HDL-C
may inhibit oxidation of lipoproteins
inhibits acyl-CoA oxidation = increase TGs

57
Q

What are the effects of soy prot on lipid profile?

A

no effect on HDL-C

decreased TG, LDL-C, cholesterol

58
Q

What are the effects of antioxidants on lipid profile?

A

may inhibit LDL oxidation

59
Q

What are the effects of phytosterol on lipid profile?

A

decreased LDL-C

increased cholesterol excretion

60
Q

What are the effects of homocysteine on lipid profile?

A

increased CVD risk

linked with B6 and folate deficiency

61
Q

What are the effects of nuts on lipid profile?

A

high intake = decreased CVD risk

moderate intake = decreased LDL-C

62
Q

What are the most prevalent primary hyperlipoproteinemias?

A

IIb + IV

63
Q

Which med is used for second line of treatment?

A

Ezetimibe (Cholesterol absorption inhibitor)

64
Q

When does fibrates are used?

A

For familial hyerTG

Not recommended to add to statins

65
Q

When does PSCK9 are used

A

To treat familial hypercholesterolemia with high LDL-C

66
Q

When does nicotic acid is used?

A

HyperTG, hypercholesterolemia or hypoalphalipoproteinemia

67
Q

What are the consequences of obesity on lipid metabolism?

A
  1. excess flux of FAAs to the liver from excess cal intake + hormone-sensitive lipase activity (from insulin resistance)
  2. decrease HDL from CETP activity (CE to VLDL and LDL) + uptake by the liver and increase clearance of ApoA = HDL catabolism
  3. decrease in LDL receptors
  4. increase in TGs from decrease lipolytic effect = more VLDL also from excess cal
68
Q

What are the normal lipid values?

A

Cholesterol: <5.2 mmol/L
HDL-C: 1.0-1.5 mmol/L (1.0 for men and 1.3 for women)
LDL-C: <2.6 mmol/L
TGs: <1.7 mmol/L

69
Q

Which SFAs increases LDL-C?

A

palmitic, myristic, lauric

70
Q

What is the effect of trans fat on lipid metabolism?

A

decreased HDL and increased LDL-C
increased CETP activity
decreased LDL-R activity
clearance of ApoA and decreased catabolism of ApoB

71
Q

What is the effect of cholesterol on lipid metabolism?

A

increased cholesterol in VLDL remnants and chylo

72
Q

What is the effect of sat fat on lipid metabolism?

A

increase LDL-C and decreased size, increase HDL-C

decreased synthesis and activity of LDL-R

73
Q

what are the effects of polyunsaturated fats on lipid metabolism?

A

linolenic acid:
decreases TG for hyperlipidemic people
decreased risk of mortality for ppl w/ CVD
linoleic acid:
may decrease LDL-C (passive bc replacing sat fats) but oxidative damage to LDL
decreased HDL-C synthesis by the liver
may decrease VLDL-C synthesis thus LDL-C

Clin 1 (4 decks)

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