Lecture 4

Question 1

What are dyslipidaemias?

Answer 1

Disorders in abnormal blood lipids, and/or lipoproteins
- Increased cholesterol and/or triglycerides

Question 2

Play a important role in the development of hypercholesterolemia

Answer 2

Genetics

Question 3

Hypercholesterolemia is associated with

Answer 3

gene mutations of proteins involved in cholesterol metabolism

• LDL receptor (LDLr), & proprotein convertase subtilisin-like kexin type 9 (PCSK9)

Question 4

Question 5

Question 6

Basic causes of atherosclerosis

Answer 6

Question 7

The role of lipoproteins:
In atherosclerosis

Answer 7

Question 8

VLDL has

Answer 8

large quantities of TGs, less cholesterol & phospholipids

Question 9

Lipoproteins circulate in blood – lipoprotein lipase walls of tissue capillaries (adipose tissue) – hydrolyses large portion of triglycerides

Question 10

Question 11

Question 12

Control of intracellular [cholesterol]

Answer 12

When [chol] inside cell is great
The cell slows down on its LDL receptor production
Reduce LDL being absorbed

Question 13

Question 14

Question 15

Treating FH

Answer 15

Lifestyle changes, such as exercising & eating a healthy low-fat diet, are the first line of defence against high cholesterol.

Question 16

Treating FH
Specific recommendations include

Answer 16

Reducing the amount of saturated fat in your diet to <30% of daily calories.
Consuming 10-20g of soluble fibre a day (oats, peas, beans, apples, citrus fruits & carrots).
Increasing physical activity.
Maintaining a healthy body weight.
With FH - recommend take medication to help lower your LDL cholesterol levels.
Specific medication depend on various factors, including your risk factors, your age, your current health & possible side effects.

Question 17

Pharmacological Treatment

Answer 17

Statins.
Bile-acid-binding resins.
Cholesterol absorption inhibitors.
Combination cholesterol absorption inhibitor and statin.
Injectable medications.

Question 18

Statins.

Answer 18

Statins — among the most commonly prescribed medications for lowering cholesterol — block a substance the liver needs to make cholesterol. This causes the liver to remove cholesterol from the blood. Statins may also help the body reabsorb cholesterol from built-up deposits on artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) & simvastatin (Zocor).

Question 19

Bile-acid-binding resins.

Answer 19

The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) & colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts the liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in the blood.

Question 20

Cholesterol absorption inhibitors.

Answer 20

The small intestine absorbs the cholesterol from the diet & releases it into the bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.

Question 21

Combination cholesterol absorption inhibitor and statin.

Answer 21

The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in the small intestine and production of cholesterol in the liver. It’s unknown whether Vytorin is more effective in reducing heart disease risk than taking simvastatin by itself.

Question 22

Injectable medications.

Answer 22

A new class of drugs can help the liver absorb more LDL cholesterol — lowers concentration of cholesterol circulating in your blood.
Alirocumab (Praluent) & evolocumab (Repatha) for people who have a genetic condition that causes very high levels of LDL. These drugs may also be used for people who have had heart attacks or strokes & need additional lowering of their LDL levels. These injectable drugs are administered at home one or two times a month.

Question 23

Medications for high triglycerides

Answer 23

Fibrates.
Niacin.
Omega-3 fatty acid supplements.

Question 24

Fibrates.

Answer 24

The medications fenofibrate (Tricor) & gemfibrozil (Lopid) decrease TGs by reducing the liver’s production of very-low-density lipoprotein (VLDL) cholesterol & by speeding up the removal of TGs from the blood. VLDL cholesterol contains mostly TGs.

Question 25

Niacin.

Answer 25

Niacin (Niaspan) decreases TGs by limiting the liver’s ability to produce LDL & VLDL cholesterol. But niacin doesn’t usually provide any additional benefit than using statins alone. Niacin has also been linked to liver damage & stroke, so most doctors now recommend it only for people who can’t take statins.

Question 26

Omega-3 fatty acid supplements.

Answer 26

Omega-3 FA supplements can help lower triglycerides. They are available by prescription or over-the-counter. Omega-3 FA supplements could affect other medications function.

Question 27

Question 28

Question 29

Question 30

Slide 55!