dyslipidemias

Question 1

• List the cardiovascular risk factors used in the NCEP ATPIII risk stratification scheme and describe the point cutoffs.

Answer 1

includes race, gender, age, total chol, HDL, blood pressure, diabetes, smoking

Question 2

• List the secondary causes of dyslipidemia and how they are screened for in clinical practice.

Answer 2

lifestyle, meds, diabetes (glucose, A1C), thyroid dz (TSH), liver dz (LFTs), kidney dz (creatinine, urine protein)

Question 3

familial hypercholesterolemia

Answer 3

defect in LDL receptor results in decreased LDL removal. Autosomal dominant. Results in premature death from atherosclerosis (occurs before age 20 in homozygotes)

Question 4

symptoms of hypercholesterolemia

Answer 4

arcus cornealis (lipid deposits at limbis of cornea), xanthelasmas (lipid deposits in skin of eyelid), tendinous xanthomas (deposits in achilles tnedons and extensor tendons of hands- inidcates familial hypercholesterolemia)

Question 5

broad beta disease

Answer 5

Autosomal recessive, Apo E2 rather than E3 and E4. results in increased triglycerides and/or LDL. Chylomicron remnant and IDL accumulation occurs and increases risk of premature CHD.

Question 6

broad beta disease diagnosis

Answer 6

lipoprotein electrophoresis, genotypings

Question 7

broad beta disease signs/symptoms

Answer 7

Planar, Palmar and Tuboeruptive Xanthomas

Question 8

Hypertriglyceridemia

Answer 8

No single genes but LPL and apo A5 most relevant. May promote clotting, vascular endothelial dysfunction and deliver cholesterol directly to vessel walls. Associated with pancreatitis

Question 9

•NCEP/ATP III Classification of Triglycerides

Answer 9

Normal: < 150 mg/dl. Borderline High: 150-199 mg/dl. High: 200-499 mg/dl. Very High: > 500 mg/dl

Question 10

Severe hypertriglyceridemia clinical features

Answer 10

eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, abd pain +/- acute pancreatitis

Question 11

Tangier disease

Answer 11

ATP binding cassette A1 deficiency- Pts have severe HDL defiency. results in orange tonsils (accumulation of cholesterol)

Question 12

Goals for treatment of low HDL

Answer 12

First reach LDL goal, then increase physical activity and weight management. Consider HDL raising drugs

Question 13

• List the “statin benefit groups” described in the 2013 AHA cholesterol guidelines.

Answer 13

1. Clinical ASCVD. 2. LDL-C >190 mg/dL without secondary cause. 3.Primary prevention: Diabetes, age 40-75 years, LDL-C 70-189 mg/dL. 4. Primary prevention: No diabetes, age 40-75 years, LDL-C 70-189 mg/dL + 7.5% risk of CVD event in the next 10 years.

Question 14

• Describe the Friedwald equation for estimating LDL cholesterol levels and the limitations of this equation.

Answer 14

LDL-C = Total Cholesterol – (HDL-C + TG/5). Can only be used if triglycerides are <400mg/dl (when no chylomicrons are present)

Question 15

average LDL

Answer 15

116mg/dl