Dyslipidemias

Question 1

1. Review lipid/lipoprotein metabolism and the relationship to atherosclerosis

Answer 1

overproduction or decreased removal

Question 2

2. Describe how LDL cholesterol (LDL-C) levels are determined

Answer 2

total cholesterol= LDL+ HDL, VLDL
VLDL= TAG/5, when TG’s are under 400
LDL= Total-Tag/5-HDL

Question 3

3. Describe how to assess risk for atherosclerotic events.

Answer 3

male>female
african american> caucasian
cigarrete smoking- current
HTN
High total cholesterol
Low HDL
Diabetes

Question 4

4. Identify the acquired and genetic causes of dyslipidemia and their associated physical findings.

Answer 4

acquired
-diet, etoh, inactivity
-meds (steroids, diuretics, b blockers, HIV meds, cyclosporine, retinoids)
Thyroid disease- TSH
Diabetes- glucose, HBA1C
Liver disease- liver function tests
Kidney disease- creartinine, urine protein, BUN

Question 5

statin benefit groups

Answer 5

CVD
LDL >=190 w/o secondary cause (familial cholesterolemia)
diabetes age 40-75 LDL 70-189
no diabetes age 40-75 LDL 70-189 + 7.5% risk of cvd event in the next ten years

Question 6

what is a normal LDL?

Answer 6

avg. 116

Question 7

Familial HYpercholesterolemia

Answer 7

almost always due to LDL receptor issue
AD 1-250, 1-300
premature death from atherosclerosis

Question 8

PCSK9 (GOF)

Answer 8

gene that causes increased destruction of LDL receptor, less recycling–> higher PCSK9

Question 9

Arcus cornealis
xanthelasmas
tendinous xanthomas

Answer 9

common eye concentration of cholesterol
eye lid cholesterol
cholesterol deposits

Question 10

Hypertriglyceridemia

Answer 10

normal-

Question 11

severe hypertriglyceridemia clinical features

Answer 11

eruptive xanthomas
lipemia retinalis
hepatosplenomegaly
abdominal pain+/- acute pancreatitis

Genetics!!!
LDL receptor def
c2 def
GPIHBP1 def

Question 12

Familial Dysbetalipoproteinemia

Answer 12

issue with APO E subtypes/
AR
E2 is the bad one
IDL accumulation–> increase CVD risk

palmar xanthomas

Question 13

HDL

Answer 13

Having low HDL and high LDL is the worst

Question 14

Tangier disease

Answer 14

orange tonsils, issue with HDL

Question 15

treatment of low HDL

Answer 15

get LDL goal
weight management
lower TAG’s below 200
HDL raising drugs are not beneficial