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Medicine II > Hyperlipidemia, Metabolic Syndrome, & Obesity > Flashcards

Hyperlipidemia, Metabolic Syndrome, & Obesity Flashcards

1
Q

What is hyperlipidemia/dyslipidemia?

A

umbrella term for lipid abnormalities in Total cholesterol, LDL-C, TG, or HDL

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2
Q

What is hypercholesterolemia?

A

increase in total cholesterol and LDL-C or low HDL

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3
Q

What is triglyceridemia?

A

increase solely in TG

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4
Q

What is the leading cause of death for men, women, and people of most racial and ethnic groups?

A

heart disease

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5
Q

What is a major CV risk factor in the development of ASCVD?

A

hyperlipidemia

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6
Q

Approx ___% of adults have ________ levels.

A

50, elevated LDL-C

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7
Q

What are the 3 main lipids in the body?

A

-cholesterol
-triglycerides
-phospholipids

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8
Q

What is cholesterol?

A

fat-like waxy substance composed of long-chain hydrocarbon fatty acid compounds
insoluble in water
has an essential role in body functions

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9
Q

In excess, cholesterol causes ______ ______ in vessels and ______.

A

plaque formation, ASCVD

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10
Q

What are the essential roles of good cholesterol?

A

bile acid synthesis
-digestion of fats
-stored in the gallbladder
-some eliminated in feces

hormone synthesis
-cortisol, aldosterone, testosterone, estradiol, and progesterone

vitamin D3 synthesis

cell membrane structure

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11
Q

Why can excess cholesterol be bad?

A

excess cholesterol accumulates in arterial walls forming plaques obstructing blood flow
inc risk of MI, stroke, and PVD

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12
Q

Where does cholesterol come from?

A

hepatocytes- endogenous (primary source)- approx 80% from own body
diet- exogenous (remaining source)

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13
Q

How is cholesterol produced?

A

-endogenous production
-exogenous production
-reverse cholesterol transport

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14
Q

Where does endogenous cholesterol synthesis occur?

A

endoplasmic reticulum of hepatocytes

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15
Q

What is the mevalonate pathway for endogenous cholesterol synthesis?

A

hydrocarbon molecules are broken down through a series of enzymatic reactions
Enzyme HMG-CoA reductase- rate-limiting step
regulated by binding protein SREBPs
low cholesterol levels –> triggers SREBPs to break from its molecule –> binds to HMG-CoA gene –> results in inc HMG-CoA reductase activity –>activates mevalonate –> cholesterol inc

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16
Q

What inhibits HMG- CoA reductase?

A

statins

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17
Q

What is the exogenous cholesterol pathway?

A

dietary fat
protein NPC1L1 helps absorb cholesterol from intestinal lumen into cells > bile breaks down fats into triglycerides > chylomicrons transport triglycerides thru circulation > enzyme lipoprotein lipase (LPL) breaks chylomicrons down into fatty acids and glycerol “remnants” > remnants go into muscle and adipose tissue, transported to the liver for storage, or excreted in feces with the help of HDL-C

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18
Q

What protein removes cholesterol from peripheral tissues and arteries?

A

ABCA1

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19
Q

What enzyme breaks down cholesterol into cholesterol esters?

A

LCAT

20
Q

What is on the surface of the HDL lipoprotein that facilitates transportation to the liver for excretion?

A

Apolipoprotein A1

21
Q

What is involved in the reverse cholesterol transport pathway for cholesterol excretion?

A

ABCA1, LCAT, Apolipoprotein A1

22
Q

How does cholesterol move through the body?

A

cholesterol and triglycerides require the help of lipoproteins to move through our circulation

23
Q

What is the structure of the lipoprotein?

A

lipid core- contains hydrophobic molecules of triglycerides and cholesterol
surface layer- contains phospholipids, free cholesterol, variety of apolipoproteins

24
Q

What is found on the surface of lipoprotein?

A

amino acids

25
Q

What role do amino acids play?

A

regulate cholesterol excretion by binding to specific chol receptors
metabolism of cholesterol by regulating various enzymes (lipoprotein lipase (LPL) and lecithin cholesterol acyltransferase (LCAT)

26
Q

Many types of _____ are found on the surface of a lipoprotein.

A

apolipoproteins

27
Q

What are the 4 main types of lipoproteins?

A

chylomicrons, VLDL, LDL, and HDL

28
Q

Classes differ by

A

size
lipid composition/function
types and # of apolipoproteins on their surfaces

29
Q

What are the largest of the lipoproteins with lowest density?

A

chylomicrons

30
Q

Where are chylomicrons synthesized?

A

in the wall of small intestine

31
Q

What is the function of chylomicrons?

A

transports dietary lipids, mainly triglycerides through circulation to the skeletal and adipose tissue and liver

32
Q

Chylomicrons are dependent on ____ ____ to break down triglycerides down for utilization by the body.

A

lipoprotein lipase (LPL)

33
Q

Where are VLDL, HDL, and LDL synthesized?

A

in the liver

34
Q

VLDL and LDL are a type of ____ cholesterol.

A

bad

35
Q

VLDL carries predominately ____ ___ ____ to peripheral skeletal and adipose tissue and some excess is recycled back to the liver.

A

triglycerides from liver

36
Q

____ is the main carrier of cholesterol.

A

LDL

37
Q

What cholesterol is most closely associated with cardiovascular disease?

A

LDL

38
Q

HDL is mainly composed of _____.

A

proteins

39
Q

The good cholesterol removes ____ and _____ for excretion.

A

cholesterol, adipose cells

40
Q

Heterozygous familial hypercholesterolemia

A

2-3x normal
LDL-C
more common

41
Q

Homozygous familial hypercholesteremia

A

rare
up to 8x normal and premature ASCVD
markedly high LDL-C
tx may require liver transplant and/or plasmapheresis

42
Q

Familial chylomicronemia

A

very high triglycerides (>1000 mg/dL)
inc risk of recurrent pancreatitis and hepatosplenomegaly in childhood

43
Q

What is an example of a genetic defect?

A

Marked inc in LDL
-absent/defective LDL receptors m/c
-apolipoprotein B defect (unable to bring LDL-C into lipoprotein
-inc activity of enzyme PCSK9: inc in LDL receptor breakdown

Marked inc in TG
-lipoprotein lipase defect (enzyme unable to breakdown TG)
-additional comp: recurrent pancreatitis and hepatosplenomegaly in childhood

44
Q

What is an acquired cause of lipid disorders related to lifestyle?

A

high fat diet, sedentary lifestyle, EtOH

45
Q

What is an acquired cause of lipid disorders related to meds?

A

OCP, diuretics, B-blocker, steroids

46
Q

What is an acquired cause of lipid disorders related to an underlying etiology?

A

uncontrolled DM, hypothyroidism, nephrotic, CKD, cirrhosis, obstructive liver dz, malignancy, cushing’s syndrome, PCOS

47
Q
A

Medicine II (5 decks)

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