Etiology of Atherosclerosis

Question 1

3 stages

Answer 1

fatty streak formation, plaque formation, plaque disruption

Question 2

fatty streak formation

Answer 2

fatty yellow discolorations on the arterial inner surface that neither protrude into the lumen nor disrupt blood flow

Question 3

plaque formation

Answer 3

arterial fatty streaks increase in size due to the inflammatory response as the lipid deposits accumulate

Question 4

plaque disruption

Answer 4

as plaques grow in size their lipid cores become large which causes foam cell death, which leads to plaque necrosis, instability and increased potential for thrombogenesis.

Question 5

modifiable risk factors for hyperlipidemia

Answer 5

obesity, hypertension, diabetes, smoking, and physical inactivity

Question 6

biomarkers

Answer 6

C-reactive protein, hyperhomocysteinemia, and lipoprotein(a)

Question 7

Risk enhancing factors

Answer 7

Family hx of premature ASCVD; primary hypercholesterolemia; metabolic syndrome; chronic kidney disease; chronic inflammatory conditions; history of POI, high risk race/ethnicity; persistently elevated primary hypertriglyceridemia and/or other biomarkers associated with increased risk

Question 8

elevated hcCRP

Answer 8

2.0 and above

Question 9

elevated Lp(a)

Answer 9

50mg/dL and above or 125 nmol/L and above (order for fam hx premature ASCVD)

Question 10

elevated Apo B

Answer 10

130 mg/dL (order if triglyceride is 200 or more)

Question 11

Stratification of hsCRP for ASCVD risk

Answer 11

Low risk: < 1 mg/L
Moderate risk: 1–3 mg/L
High risk: > 3 mg/L
An hsCRP level >10 mg/L has been observed in acute plaque rupture, which may lead
to thrombosis

Question 12

Homocysteine levels

Answer 12

High homocysteine blood levels (greater than 15
mcmol/L) are associated with increased oxidative
stress and secretion of proinflammatory factors.
Both mechanisms stimulate smooth cell proliferation and accelerate atherosclerosis.

Question 13

Importance of lipoprotein(a)

Answer 13

a subtype of LDL that
includes apoprotein A (Apo A) in its structure.

Question 14

Role of lipoprotein(a) in atherosclerosis

Answer 14

(1) inhibition
of fibrinolysis (2) enhanced capacity to traverse the arterial endothelium (3) low affinity
for the LDL-receptor mediated clearance from circulation

Question 15

Using lipoprotein(a) in treatment decisions

Answer 15

If > than 30 mg/dL in patients with an elevated total cholesterol:HDL ratio (> 5.5) or other major RFs risk indicates the need for a more aggressive therapy to further lower LDL

Question 16

Lipids

Answer 16

play a crucial role in living organisms as a source of energy and as structural constituents of cell membranes and complex molecules such
as steroids and eicosanoids (e.g., prostaglandins,
thromboxane A2, leukotrienes) and lipid-soluble
vitamins

Question 17

Phospholipids

Answer 17

are structural components of cell membranes, myelin, lipoproteins, and blood clotting factors.

Question 18

Cholesterol

Answer 18

Cholesterol is a structural component of cell membranes and a precursor of other steroids, namely steroid hormones, bile acids, and signaling molecules. It is mainly synthesized in the liver but is also absorbed in the intestine from dietary sources and enterohepatic circulation

Question 19

Fatty acids

Answer 19

are a source of energy and > 100 fatty acids have been identified. Unsaturated fatty acids (monounsaturated or
polyunsaturated) vs Saturated fatty acids. The former are
waxy solids at room temperature, while unsaturated
fatty acids are liquids.

Question 20

Triglycerides

Answer 20

The main source of dietary fat and can also be synthesized in the liver from intermediary metabolites of excess carbohydrates. (2) They accumulate in adipose tissue and muscle cells and can later
be mobilized as free fatty acids as a source of energy when dietary sources are not
readily available

Question 21

Transfatty acids

Answer 21

Some edible fats, including hydrogenated vegetable products (oils, margarines, and
shortenings) are rich in trans fatty acids which are solid at room temperature

Question 22

Dangers of transfat

Answer 22

They are inexpensive to produce, give foods a desirable texture and taste, have a long shelf-life, and can be reused
to deep-fry foods. However, their increased dietary intake is associated with increased ASCVD.

Question 23

Lipoproteins

Answer 23

responsible for transporting cholesterol and triglycerides in the plasma

Question 24

Apoproteins

Answer 24

Apoproteins are a famly of surface proteins that have various metabolic functions (Apo A, APo B, Apo C, and Apo E)

Question 25

Chylomicrons

Answer 25

are large lipoproteins that carry mostly triglycerides and cholesterol. can only be reduced by reducing dietary fat consumption

Question 26

VLDL

Answer 26

are smaller than chylomicrons but carry a significant portion of triglycerides and cholesterol

Question 27

IDL

Answer 27

are created when VDLD is depleted

Question 28

LDL

Answer 28

the most cholesterol rich lipoprotein; can be increased due to genetic mutations of either the LDL receptor or Apo B-100, thyroid or estrogen deficiencies; lowering LDL is the primary goal of treatment and prevention of ASCVD

Question 29

HDL

Answer 29

the smallest but densest lipoproteins (protein content of 33%); removes cholesterol from the periphery and transports it to the liver, and is excreted in bile; moderate to high levels may help prevent ASCVD