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Cardio Exam 2 > lecture 2 > Flashcards

lecture 2 Flashcards

1
Q

lipoproteins

A

large macromolecular complexes that transport hydrophobic lipids: TGs, cholesterol, & fat-soluble vitamins (plasma, interstitial fluid & lymph)

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2
Q

function of lipoproteins

A
  • the absorption of dietary cholesterol, long-chain fatty acids & fat-soluble vitamins
  • transport TGs, cholesterol, & fat-soluble vitamins from the liver to peripheral tissues & the transport of cholesterol from peripheral tissues to the liver
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3
Q

apolipoproteins

A
  • activate enzymes important in lipoprotein metabolism

- ligands for cell surface receptors

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4
Q

ApoA-I, ApoA-II

A

HDL

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5
Q

ApoB-48

A

chylomicrons

intestine

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6
Q

ApoB-100

A

VLDL, IDL, LDL

liver

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7
Q

ApoE, ApoC

A

chylomicrons, VLDL, IDL

metabolism & clearance

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8
Q

ApoB does not

A

transfer between lipoproteins

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9
Q

primary disorders of lipoprotein metabolism

A

genetic

familial hypercholesterolemia

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10
Q

secondary disorders of lipoprotein metabolism

A 
obesity
DM (esp T2)
thyroid diseases
renal diseases
liver diseases
alcohol
estrogen
lysomal storage disease
cushing's syndrome
drugs
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11
Q

familial hypercholesterolemia

A

an autosomal codominant disorder characterized by elevated plasma levels of LDL-C with normal TGs, tendon xanthomas & premature coronary atherosclerosis
- large # of LDL receptor mutations

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12
Q

elevated LDL-C in FH are due to

A

an increase in the production of LDL from IDL& delayed removal of LDL from the blood

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13
Q

TC levels in FH

A

> 500mg/dL & can be higher than 1000mg/dL in homozygotes

200-400mg/dL in hetero

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14
Q

FH can lead to

A
  • accelerated atherosclerosis, which can result in disability & death in childhood
  • symptomatic coronary atherosclerosis before puberty (homo)
  • symptoms can be atypical & sudden death is NOT uncommon
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15
Q

FH homozygous diagnosis

A
  • family history
  • skin biopsy measuring LDL receptor activity in cultured skin fibroblasts
  • flow cytometry analysis of LDL receptor density on lymphocytes
  • DNA sequencing to find mutations in LDL receptor gene
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16
Q

obesity

A
  • increased adipose tissue mass
  • insulin resistance
  • increased FFAs are delivered to the liver from adipose tissue- VLDLs
  • high insulin promotes FA synthesis in the liver
  • Low HDL-C
17
Q

secondary alterations in lipid metabolism examples

A 
obesity 
DM
hypothyroidism
renal disorders
liver disorders
alcohol
18
Q

T1DM

A
  • type 1 usually w/out hyperlipidemia if glycemia is under control
  • ketoacidosis–hyperTGs due to increased hepatic FFA influx from adipose tissue
19
Q

T2DM

A
  • decreased LPL activity
  • increased release of FFA from adipose
  • increased synthesis of FA in the liver
  • increased hepatic production of VLDLs
  • elevated levels of TGs from VLDL
  • increased LDL
  • decreased HDL-C
20
Q

hypothyroidism

A
  • elevated LDL-C due to a reduction in hepatic LDL receptor function, delaued clearance of LDL
  • increased circulating IDL
  • some times- mild hyperTG
  • all pts presenting with incr. plasma LDL-C, IDL or TGs should be screened for hypothyroidism
21
Q

nephrotic syndrome

A
  • characterized by significant proteinuria (3.5g/day/1.73m^3BSA)
  • hypercholesterolemia or hyperTG; a combination of increased hepatic production & decreased clearance of VLDLs with increased LDL production
22
Q

end stage renal disease (ESRD)

A

mild hyperTG (<300mg/dL) due to accumulation of VLDLs and remnant lipoproteins in the circulation

23
Q

renal transplants

A

usually have increased lipid levels due to the effect of the drugs required for immunosuppression (cyclosporine & glucocorticoids) & present a difficult management problem since HMG-CoA reductase inhibitors must be used cautiously in these pts

24
Q

hepatitits

A

increased VLDLs & mild-moderate hyperTG

- severe hepatitis & liver failure- reduced plasma cholesterol & TGs

25
Q

choestasis

A
  • hypercholesterolemia- free cholesterol, coupled with phospholipids, is secreted into the plasma as a constituent of a lamellar particle called LP-X. the particles can deposit in skin folds, producing lesions resembling those seen in patients with FDBL. Planar and reuptice xanthomas can also be seen in pts with cholestasis
26
Q

alcohol

A
  • increased plasma TG levels
    increased hepatic secretion of VLDL
  • regular consumption- HDL-C up
27
Q

screening

A

all adults older than 20 should have plasma levels of cholesterol, TG, LDL-C, and HDL-C measured after 12-hour overnight fast

28
Q

diagnosis

A
  • determine the class of altered lipoproteins

- rule out secondary causes of hyperlipidemia

Cardio Exam 2 (12 decks)

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