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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

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
What increases HDL-C? (good cholesterol)
Exercise Moderate amounts of alcohol Oestrogen
26
What decreases HDL-C?
Smoking Obesity Malnutrition Anabolic steroids
27
What increases VLDL cholesterol? (main method for transporting triglycerides in blood)
``` Obesity Diabetes Hepatitis Alcohol Kidney disease HIV protease inhib. Retanoic acid ```
28
What lipoprotein fraction in raised in type 2 dyslipidaemia on Fredrickson scale?
LDL and total cholesterol
29
What lipoprotein fraction in raised in type 3 dyslipidaemia on Fredrickson scale?
Triglycerides, VDL, and chylomicron
30
How do we classify lipid disorders in clinical practice?
Hypercholesterolaemia Hypertriglyceridaemia Mixed dyslipidaemia
31
What is the most common lipid disorder?
Familial hypercholesterolaemia, present in 1 in 500
32
What problems are there with undiagnosed familial hypercholesterolaemia?
50% of men will have heart attack <50 yrs 30% of women will have MI <60 yrs
33
Characterisitc physical feature of FH?
Tendon xanthoma
34
What is the underlying disorder in FH? (recognise)
Disorder of LDL metabolism Problem with Apo B or LDL receptor, causing high levels of LDL
35
What Total cholesterol and LDL-C is sus for FH?
Total cholesterol > 7.5 LDL-C >4.9
36
What is the criteria for diagnosing definite FH?
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
What is Familial Dysbetalipoporteinamia?
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
Who is at high risk of CV disease? (ie doesnt need QRISK2 score)
eGFR <60 CVD DM type 1 FH
39
Lifestyle interventions for high cholesterol?
``` Fat <30% calorie intake Saturated fat 7% or less Use olive oil 5 portions of f+V Wholegrain ``` Exercise: 150 mins a week
40
Drug Rx for high lipids
Atorvastain 20mg for primary prevention 80mg for secondary Aim is 40% reduction in non-HDL cholesterol
41
Are simvastaitn and atorvastatin fat or water soluble?
Fat soluble Rest of statins are water soluble so may be used if patient has side effects from other group
42
What causes hypertriglyceridaemia? (7)
``` Obesity DM Alcohol excess Renal failure HIV protease inhibs. Anti psychotic drugs Genetic conditions ```
43
Which lipid disorder increases risk of pancreatitis?
Hypertriglyceridaemia
44
Management of hypertriglyceridaemia?
10% fat diet (very effective) DM control Avoid alcohol Fribrates and statins Fish oils
45
Treatment for combined dyslipidaemia? (recognise)
First line: Statins If triglycerides >5.6 then add a FIBRATE Fish oil (Omacor 4g a day)
46
Investigations for any lipid disorder?
``` 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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