Hyperlipidemia

Question 1

What organ produces most of the body’s cholesterol (where does the rest come from)

Answer 1

The Liver (75-80%), the rest from the diet

Question 2

Stats about Hyperlipidemia

Answer 2

1:6 Americans have high cholesterol
1:3 of those are treated and in good control
Less than have of those diagnosed with high cholesterol are receiving treatment

Question 3

What is dyslipidemia?

Answer 3

The elevation of plasma cholesterol, triglycerides or both or an elevation of a low density lipoprotein level (LDL)

Question 4

3 Types of triglycerides

Answer 4

1) Saturated - Has greatest impact on increasing LDL (all carbons fully saturated with hydrogens). (from Meat, dairy, and exotic oils
2) Monosaturated - OK in moderation from vegetable oils, peanuts and avocados.
3) Polyunsaturated - Best for you, only essential fats.. from Sunflower, safflower oils and cold water fish

Question 5

_______ carries 60-70% of total serum cholesterol

Answer 5

LDL

Question 6

Mono and Polyunsaturated triglycerides are only good for you in what conditions

Answer 6

Liquid form and at room temperature

Question 7

The higher the density of cholesterols______

Answer 7

The lower the lipid content

Question 8

What is a lipoprotein comprised of?

Answer 8

A lipid and an apoprotein

Question 9

What is the rate limiting step in the cholesterol synthesis process

Answer 9

The enzyme HMG CoA reductase

Question 10

Classifications of Hyperlipidemia/Dyslipidemia

Answer 10

Primary and Secondary

Increase in cholesterol, Triglycerides or both

Question 11

What is Primary Hyperlipidemia?

Answer 11

A single or multiple genetic mutation that results in the overproduction or defective clearance of cholesterol usually due to a defect in an apoprotein

Question 12

3 types of Primary Hyperlipidemia

Answer 12

1) Familial hypercholesterolemia - An increase in LDL
2) Familial combined hyperlipidemia - An increase in both LDL and VLDL
3) Familial hypertriglyceridemia - An increase in triglycerides (usually autosomal dominant)

Question 13

What is the big dangers of familial hypertriglyceridemia?

Answer 13

50% of these patients have an MI under age 60

More at risk for pancreatitis

Question 14

What to do if diagnosed with primary hyperlipidemia

Answer 14

Test all family members

Question 15

What are the lab findings of Type IIa Hypercholesteromia?

Answer 15

TG normal, Increase LDL and cholesteroal

Question 16

What is the defect found in Type IIa Hypercholesteromia?

Answer 16

An LDL recepotor defect

Question 17

What are the clinical features of Type IIa Hypercholesteromia?

Answer 17

Premature vascular disease, xanthomas. Onset found at all ages. Untreated life expectancy = 20 years.

Question 18

What is the therapy of Type IIa Hypercholesteromia?

Answer 18

Low fat/low cholesterol diet, MEDS, intestinal bypass

Question 19

What is secondary hyperlipidemia?

Answer 19

High cholesterol due to a significant secondary cause because patients tend to have an athrogenic combination of high TG, high LDL fractions or low HDL

Question 20

Environmental/medical risk factors for secondary hyperlipidemia?

Answer 20

Sedentary lifestyle
Excessive intact of bad fats and cholesterol
DM or Metabolic syndrome
ETOH or tobacco use
Chronic Kidney disease/nephrosis
Hypothyroidism
Cholestatic liver disease
Medications

Question 21

What medications can contribute to secondary hyperlipidemia?

Answer 21

Thiazides/beta blockers
Cyclosporine
Retinoids
Estrogens and progesterone
Anabolic and corticosteroids
Carbamazepine
Protease inhibitors

Question 22

Risk factors of secondary hyperlipidemia for people with Type 2 DM. (how does it happen?)

Answer 22

Combo of obesity, poor control or both resulting in an increase FFA.
An increase in FFA leads to an increase liver VLDL production. TG rich VLDL then transfers TG and cholesterol to LDL and HDL. That promotes formation of TG rich, small dense LDL and clearance of TG rich HDL

Question 23

What is the pathology of hyperlipidemia?

Answer 23

Deposits of cholesterol in vascular walls creates Fatty streaks that become fibrous plaques. This creates less elasticity of the walls and a narrowing of the vessels (stenosis). Inflammation causes plaque instability leading to plaque rupture that can lead to MI, TIA and CVA.

Question 24

Factors to consider with hyperlipidemia when taking a patient’s history?

Answer 24

CV disease, Liver problems, thyroid problems, a review of medications, family history.

Question 25

Factors to consider with hyperlipidemia when taking the patient’s physical exam?

Answer 25

Patient’s BMA, Xanthelasma’s on eyelids, Xanthomas (AT, patella, back of hand, buttocks), cream color in blood, signs of ETOH abuse, DM or Metabolic syndrome

Question 26

Current labs for hyperlipidemia workup

Answer 26

Fasting glucose, LFT’s, Chem panel, TSH and Urine protein