Hyperlipidemia: Lecture 1

Question 1

Normal Cholesterol Homeostasis

Answer 1

Dietary cholesterol goes from GI tract and brought to liver by Chylomicrons

Get packaged into VLDL, and travels through blood stream to other tissues. Along the way it gets turned into LDL due to muscles and organs taking TG.

LDL taken up into cells, and then excess cholesterol is put into HDL and sent back to liver in process called Reverse Cholesterol Transport

Cholesterol used to make bile to break down fats

Question 2

Role of Lipoproteins

Answer 2

transport TGs and Cholesterol from liver to tissues and back

Question 3

Chylomicrons have…

Answer 3

lowest density but must TGs

Question 4

TG/Chol/Protein of Chylomicrons

Answer 4

90/5/5

Question 5

TG/Chol/Protein VLDL

Answer 5

60/30/10

Question 6

TG/Chol/Protein LDL

Answer 6

10/60/30

Question 7

TG/Chol/Protein HDL

Answer 7

10/30/60

Question 8

What APO protein thought to play role in Anti-Atherosclerotic properties of HDL?

Answer 8

APO A-1

Found on HDL

Question 9

Which APO protein is thought to be Atherogenic

Answer 9

APO B

Found on Chylomicrons, VLDL, LDL

Question 10

General CV Risk Factors

Answer 10

Hypertension
Hyperlipidemia
Diabetes
Smoking
Obesity
Physical Inactivity

Question 11

Examples of ASCVD/CHD/CAD

Answer 11

MI
ACS
Stable/Unstable Angina
CVA (stroke) or TIA
CABG
PTCA

Question 12

ASCVD more prevalent in….

Answer 12

nonhispanic black males and females

Question 13

average life loss to patient after having Heart attack?

Answer 13

11.5 years

Question 14

How does too much Cholesterol leads to ASCVD

Answer 14

Too much cholesterol start to deposit between layers of artery walls, forming fatty streak.

Body sends macrophages, ingest cholesterol but they turn into foam cells.

This causes fatty streak to become bigger and form into plaque. Body then forms a fibrous cap which is thin nd not very strong.

When cap breaks, a blood clot forms and blocks the artery. Depending where artery is, determines what kind of ASCVD event occurs.

Question 15

Size of LDL effect on ASCVD

Answer 15

Small dense = more likely to cause ASCVD

Larger, less dense = less likely to cause ASCVD

Question 16

Effect of decreasing LDL, increasing HDL on ASCVD risk?

Answer 16

1% decrease risk for every 1mg/dL LDL decrease

2% decrease risk for every 1mg/dL HDL increase

Question 17

Alcohol effect on Lipids

Answer 17

Increase TG

Question 18

Thiazide Diuretics effect on Lipids

Answer 18

Increase LDL and TC

Question 19

B Blocker effect on Lipids

Answer 19

Increase TG, decrease HDL

Question 20

Glucocorticoids effect on Lipids

Answer 20

Increase VLDL,LDL, TC

Question 21

Olanzapine effect on lipids

Answer 21

Increase LDL, TC

Question 22

Bile acid specific DI

Answer 22

Don’t take drugs 2hrs before or 4hrs after taking them

Question 23

Diet changes for Hyperlipidemia

Answer 23

Eat: Veggies, Fruits, Whole Grains, Low-fat Dairy, Poultry/fish, nuts, nontropical veg oil

Limit: Sweet, Sugar sweetened Bev, red meats

Question 24

Herbal/OTC products that might have some efficacy on Cholesterol

Answer 24

Fish Oil
Soy
Cholestin (Red Yeast)
Plant Stanols

Question 25

Good fatty acid

Answer 25

Omega -3

flaxseed, Canola, Soybean oil
Oily fish, Fish oil capsules

Question 26

Bad fatty acid

Answer 26

Omega 6

Corn, safflower, sunflower oil

Question 27

Omega-3 Recommended intake

Answer 27

w/o ASCVD = fish 2/week, use good oils
w/ ASCVD = ~1g EPA/DHA per day
Need to lower TG = 2-4g EPA/DHA per day

Question 28

Lovasa

Answer 28

decrease TG synthesis in liver (inhibit acylCOA)

Decrease TG, Increase HDL, and LDL

Increases the large/fluffy LDL, so not as bad

Well tolerated