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SBCP Biochemistry > Lipid Disorders :( > Flashcards

Lipid Disorders :( Flashcards

1
Q

Are lipoproteins hydrophobic or hydorphilic?

A

Hydrophobic

Therefore have apolopoprotein to travel in circulation

Role is lipid transport

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2
Q

Where are apolipoproteins made? What is their role?

A

In liver

They are a component of lipoproteins (which transport lipids):

  • allow transfer of cholesterol between lipoportiens
  • Act as co-factors for enzymes (lipoportein lipase etc)
  • Bind to cells and allow lipid uptake
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3
Q

Are chylomicrons heavy or light? WHat do they transport?

A

Lightest lipoprotein

They transport dietary triglycerides

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4
Q

What do VLDL (very low densitiy lipoproteins) transport?

A

Triglycerides from the liver to other tissues

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5
Q

What does LDL carry?

A

Main carrier of ‘bad’ cholesterol

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6
Q

What does HDL carry?

A

Carries ‘good’ cholesterol from non-hepatic tissues to liver

REVERSE CHOLESTEROL TRANSPORT

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7
Q

What lipoprotein is Apo A (apolipoprotein) linked to?

A

HDL

It has two subtypes

Low levels of Apo A are bad

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8
Q

What lipoprotein is Apo B (apolipoprotein) linked to?

A

LDL (mainly Apo B 100!)

Low amount of apo B receptors can lead to higher LDL in circulation!

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9
Q

What lipoprotein is Apo E (apolipoprotein) linked to?

A

Triglyceride rich fractions eg VDLL and chylomicrons

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10
Q

What is dietary/exogenous lipid transport?

A

Lipids travel from gut to liver using chylomicrons

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11
Q

What is hepatic/endogenous lipid transport?

A

Lipids move from liver to circulation using VLDL

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12
Q

What is reverse cholesterol transport?

A

Tissue to liver

HDL

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13
Q

What can Apo B/Apo A ratio be used to measure?

A

CV risk

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14
Q

What is special about Apo (a)?

A

Levels are genetically linked and inherited.

Higher levels assocaiated with CV risk

Attaches to LDL

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15
Q

What is Apo E2/E2 genotype linked to?

A

Type 3 dyslipidaemia

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16
Q

What is Tangier’s disease of the tonsils?

A

V. low levels of Apo A so no mechanism for clearing cholesterol from circulation

Deposits in tissues and tonsils become large and orange

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17
Q

Who gets screened for their lipid profiles?

A

40-84 yr olds at risk of CV disease

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18
Q

What is measured in lipid profile? (recognise)

A

Total cholesterol
HDL cholesterol
Triglycerides

Calculated non HDL cholesterol
(LDL IS CALCULATED!!!!)

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19
Q

How is LDL cholesterol calculated? (recognise)

A

Friedewald Levy Fredrickson formula

TC- (HDL-C) - (TG/2.2) mmol/L

20
Q

Which is used to determine patient treatment target? Non-HDL-C or Total Cholesterol: HDL-C

A

Non-HDL C

21
Q

Which is used to calculate Q risk? Non-HDL-C or Total Cholesterol: HDL-C

A

Total cholesterol: HDL-C

22
Q

Causes of primary dyslipidaemia? What classification system is used?

A

Monstly mono or polygenic

Fredrickson classification: splits disordes depending on what fraction of lipoprotein in increased

23
Q

Secondary causes of increased LDL cholesterol?

A 
Hypothyroidism
Nephrotic syndrome (in response to protein loss)

Ciclosporin
Cholestatis
Anorexia

24
Q

Secondary casues of decreased LDL C?

A

Severe liver disease
Malabsorption
Malnutrition

25
Q

What increases HDL-C? (good cholesterol)

A

Exercise
Moderate amounts of alcohol
Oestrogen

26
Q

What decreases HDL-C?

A

Smoking
Obesity
Malnutrition
Anabolic steroids

27
Q

What increases VLDL cholesterol? (main method for transporting triglycerides in blood)

A 
Obesity
Diabetes
Hepatitis
Alcohol
Kidney disease
HIV protease inhib.
Retanoic acid
28
Q

What lipoprotein fraction in raised in type 2 dyslipidaemia on Fredrickson scale?

A

LDL and total cholesterol

29
Q

What lipoprotein fraction in raised in type 3 dyslipidaemia on Fredrickson scale?

A

Triglycerides, VDL, and chylomicron

30
Q

How do we classify lipid disorders in clinical practice?

A

Hypercholesterolaemia
Hypertriglyceridaemia
Mixed dyslipidaemia

31
Q

What is the most common lipid disorder?

A

Familial hypercholesterolaemia, present in 1 in 500

32
Q

What problems are there with undiagnosed familial hypercholesterolaemia?

A

50% of men will have heart attack <50 yrs

30% of women will have MI <60 yrs

33
Q

Characterisitc physical feature of FH?

A

Tendon xanthoma

34
Q

What is the underlying disorder in FH? (recognise)

A

Disorder of LDL metabolism

Problem with Apo B or LDL receptor, causing high levels of LDL

35
Q

What Total cholesterol and LDL-C is sus for FH?

A

Total cholesterol > 7.5

LDL-C >4.9

36
Q

What is the criteria for diagnosing definite FH?

A

Simon Broome criteria:
Cholesterol concentrations suggestive of FH and tendon xanthomas, or evidence of these signs in a relative

OR

DNA based evidence of gene mutation

(Be SUSPICIOUS of FH if there is FMHx of MI)

37
Q

What is Familial Dysbetalipoporteinamia?

A

Another name for type 3 dyslipidaemia

Abnormality in apo E receptors resulting in cholesterol not being removed

1 in 170 homozygous for E2/E2

Only 20% have dyslipidaemia

38
Q

Who is at high risk of CV disease? (ie doesnt need QRISK2 score)

A

eGFR <60
CVD
DM type 1
FH

39
Q

Lifestyle interventions for high cholesterol?

A 
Fat <30% calorie intake
Saturated fat 7% or less
Use olive oil
5 portions of f+V
Wholegrain

Exercise: 150 mins a week

40
Q

Drug Rx for high lipids

A

Atorvastain 20mg for primary prevention

80mg for secondary

Aim is 40% reduction in non-HDL cholesterol

41
Q

Are simvastaitn and atorvastatin fat or water soluble?

A

Fat soluble

Rest of statins are water soluble so may be used if patient has side effects from other group

42
Q

What causes hypertriglyceridaemia? (7)

A 
Obesity
DM
Alcohol excess
Renal failure
HIV protease inhibs.
Anti psychotic drugs
Genetic conditions
43
Q

Which lipid disorder increases risk of pancreatitis?

A

Hypertriglyceridaemia

44
Q

Management of hypertriglyceridaemia?

A

10% fat diet (very effective)

DM control
Avoid alcohol
Fribrates and statins

Fish oils

45
Q

Treatment for combined dyslipidaemia? (recognise)

A

First line: Statins

If triglycerides >5.6 then add a FIBRATE

Fish oil (Omacor 4g a day)

46
Q

Investigations for any lipid disorder?

A 
Lipid profile
TFTs
Glucose
Total protein/urine protien
Liver enzymes

FH testing if LDL-C >5 with fmaily MI history

SBCP Biochemistry (9 decks)

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