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Endocrinology Exam 2 > Lipid Disorders and Metabolic Syndrome > Flashcards

Lipid Disorders and Metabolic Syndrome Flashcards

1
Q

What are Lipids?

A

Organic compounds that are not soluble in water

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1
Q

The two main lipids in the blood are

A

○ Cholesterol
○ Triglycerides

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2
Q

Lipids are transported around the body as
part of structures called _____

A

Lipoproteins

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3
Q

Types of lipoproteins

A

○ Chylomicrons
○ Very Low Density Lipoproteins (VLDL)
○ Intermediate Density Lipoproteins (IDL)
○ Low Density Lipoproteins (LDL)
○ High Density Lipoproteins (HDL)

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4
Q

Protein + Lipids = _____

A

Lipoprotein
*Because lipids are insoluble in water, they
can only circulate in the bloodstream with
these water-soluble proteins

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5
Q

Fat digestion process review

A
  • Ingested fats are emulsified by Bile Acids in the small intestine
  • Lipase (Pancreas mostly, also salivary ducts) breaks lipid molecules into free fatty acids, monoglycerides, and cholesterol
  • Bile Acids surround the free fatty acids,
    monoglycerides, and cholesterol.
    ○ This causes formation of a Micelle
  • Micelles are able to diffuse across a layer of
    luminal fluid that covers the villi of the
    small intestine
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6
Q

Once the micelles diffuse across the unstirred layer,
products of fat digestion leave the micelles and enter the ____

A

small intestine epithelium

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7
Q

Within the Golgi Apparatus, globules of triglycerides and cholesterol are coated with proteins to form ____

A

Chylomicrons.

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8
Q

____ transports Chylomicrons away from
the small intestine. Eventually they are dumped into
systemic circulation

A

Lymph in the Lacteal

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9
Q

_____ is an enzyme found on
the surface of capillary epithelium of various
tissues

A

Lipoprotein Lipase

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10
Q

What does lipoprotein lipase do?

A

hydrolyzes triglycerides, forming free fatty acids and glycerol, which are absorbed into the cells and reassemble as triglycerides

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11
Q

Cholesterol is the precursor to various hormones including

A

■ Progesterone
■ Estradiol
■ Cortisol
■ Testosterone
■ Aldosterone
■ And many, many others

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12
Q

The principal constituent of
atherosclerotic plaques

A

Cholesterol

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13
Q

On average, about ____ mg of cholesterol
comes into the “pool” daily

A

1100
○ 800 mg synthesized in the body
○ 300 mg comes from the diet

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14
Q

How is cholesterol excreted in the body?

A

○ Excreted through feces via bile

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15
Q

While the liver can synthesize cholesterol, its other main function with lipids is that of ____

A

cholesterol management

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16
Q

Livers role in managing Cholesterol?

A

○ Processes cholesterol taken up from Chylomicron Remnants.
○ Degrades and excretes cholesterol through the bile
○ Produces Very Low Density Lipoproteins (VLDL).
○ Receptor mediated clearance of LDL from the plasma.

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17
Q

Chylomicron Remnants are endocytosed by _____

A

Hepatocytes

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18
Q

Cholesterol management in the liver ends with

A

The Triglycerides and Cholesterol are integrated into Lipoproteins and released by Hepatocytes into the bloodstream as VLDL

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19
Q

Lipoproteins contains surface
proteins called ____-

A

Apoproteins
These help guide lipid
transport and metabolism

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20
Q

Difference in apoproteins between LDL/VLDL and HDL

A

● LDL and VLDL particles contain the apoprotein Apo B.
○ Seems to promote athersclerotic deposits
● HDL particles contain the apoprotein Apo A-1.
○ Seems to inhibit atherosclerotic deposits

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21
Q

Just smaller than Chylomicrons, these are the largest of the
main Lipoproteins and are made by the liver

A

VLDLs

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22
Q

In fasting serum, ____ are carrying most of the Triglycerides (as there are normally no Chylomicrons in
fasting serum)

A

VLDLs

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23
Q

In fasting serum, most of the Cholesterol is carried by ___ and we refer to this as ____

A

LDLs; LDL-Cholesterol (LDL-C)

24
Q

the lipoprotein that is primarily responsible for the delivery of cholesterol to the tissues for cellular function

A

LDL

25
Q

The most dense (and smallest) of the Lipoproteins

A

HDL

26
Q

Reverse Cholesterol Transport

A

This is the process by which cholesterol within the peripheral tissue (including arterial wall) can be transferred into HDL, allowing HDL to take the cholesterol to the liver for excretion

27
Q

T/F Lipid labs can be drawn in the fasting or non-fasting state

A

T

28
Q

Total Cholesterol (TC) =

A

VLDL + LDL + HDL

29
Q

VLDL = _____

A

TGs divided by 5

30
Q

LDL = _____

A

TC - HDL - TGs/5

31
Q

Dyslipidemia

A

The elevation of plasma cholesterol, triglycerides, or both, or a low HDL level, that contributes to the development of atherosclerosis

32
Q

_____ has been shown to be one
of the main risk factors for heart disease

A

Increased serum LDL-Cholesterol

33
Q

____% of adults in the US have elevated LDL levels

A

34
<50% of those with elevated LDL receive treatment

34
Q

Signs and Sxs of Dyslipidemia

A

Usually asymptomatic until development of coronary artery
disease, stroke, peripheral arterial disease, etc

35
Q

Interestingly, very high levels of Triglycerides (usually greater than 1000 mg/dL) can cause ____

A

Pancreatitis

36
Q

Lipemia Retinalis.

A

Extremely high levels of Triglycerides
(usually greater than 2000 mg/dL) can
cause retinal vasculature to appear
creamy white

37
Q

visible cholesterol deposits in the body

A

Arcus Senilis (or Corneal Arcus) Tendinous Xanthomas: Most common at Achilles, elbow, or knee
Xanthelasma
Eruptive Xanthomas: Sudden eruption on skin, usually seen in diabetics

38
Q

There are several genetic disorders that can lead to Lipid related disease, two examples are:

A

■ Familial Hypercholesterolemia
■ Familial Hyperchylomicronemia

39
Q

Secondary Causes of Dyslipidemia

A

○ Obesity
○ Sedentary Lifestyle
○ Diabetes Mellitus
○ Alcohol use
○ Hypothyroidism
○ Chronic Kidney Disease
○ Some medications (Diuretics, Beta Blockers, Retinoids, Antipsychotics)

40
Q

T/F Correction of the underlying condition may correct the
lipid abnormality

A

T

41
Q

Before initiating lipid-lowering medication, you should

A

consider secondary causes of dyslipidemia

42
Q

Risk Factors for Dyslipidemia and Atherosclerosis

A

○ Smoking
○ Poor diet
○ Obesity- Higher risk associated with BMI > 30
○ Large waist circumference- Men > 40 inches, women > 35 inches
○ Lack of exercise-
○ Diabetes
○ Hypertension
○ Genetics

43
Q

Metabolic Syndrome

A

Insulin Resistance Syndrome or Syndrome X

44
Q

_____ is another major risk factor for the
development of atherosclerotic disease and dyslipidemia

A

Metabolic Syndrome

45
Q

It is estimated that approximately
____% of American adults have
Metabolic Syndrome

A

25

46
Q

Metabolic Syndrome is Defined as the presence of ANY THREE of the following:

A

○ Abdominal obesity (waist circumference)
■ Men- Greater than 102 cm (40 inches)
■ Women- Greater than 88 cm (35 inches)
○ Triglyceride level of 150 mg/dL or above
■ Or on a medication that treats hypertriglyceridemia
○ Decreased HDL-C level, or on cholesterol medication
■ Men- Less than 40 mg/dL
■ Women- Less than 50 mg/dL
○ Blood pressure greater than 130/85, or on BP medication
○ Fasting glucose 100 mg/dL or greater, or on medication

47
Q

Treatment of Metabolic Syndrome

A

○ Major dietary modifications
○ Intensify weight management
○ Increase physical activity

48
Q

If lipid and non-lipid components do
not improve despite lifestyle
modifications:

A

○ Treat hypertension
○ Consider aspirin therapy**
○ Treat dyslipidemia

49
Q

Atherosclerotic Cardiovascular Disease Defined as history of one or more

A

○ Acute Coronary Syndromes
○ Myocardial Infarction
○ Stable Angina
○ Coronary or other revascularization
○ Stroke
○ Transient Ischemic Attack
○ Peripheral Arterial Disease

50
Q

_____ after an overnight
fast is the best screening tool for dyslipidemia

A

A complete Lipid Profile (AKA Lipid Panel)

51
Q

All patients with known cardiovascular disease and/or diabetes
should have their lipids measured ____

A

regularly/yearly

52
Q

it is reasonable to screen the following individuals (without known risk factors) for dyslipidemia every 3-5 years:

A

● All men over the age of 35 years
● All women over the age of 45 years
● Men aged 20-35 and women aged 20-45 years if at increased risk of coronary heart disease (what kind of risk factors?)
● All children, once between 9 and 11, again between 17 and 21.**

53
Q

For individuals 40-75 YOA with no history
of cardiovascular disease, 1 or more CVD
risk factors, and a calculated 10-year CVD
event risk of 10% or greater

A

Treat with a Statin for primary
prevention (grade B recommendation)

54
Q

Risk categories for ASCVD risk

A

Low Risk <5%
Borderline Risk* 5- 7.5%
Intermediate Risk >7.5- 19.9%
High Risk >20%

55
Q

2018 ACC/AHA Cholesterol Guidelines

A

○ Focus on the treatment of blood cholesterol to reduce the ASCVD risk in adults.
○ Emphasize adherence to a heart healthy lifestyle as the foundation of ASCVD risk reduction.
○ Identify the individuals most likely to benefit from cholesterol-lowering drug therapy

56
Q

heart-healthy lifestyle changes for all patients:

A

○ Dietary changes include:
■ Reduced intake of saturated fats
■ Reduced intake of refined carbohydrates
○ Increased physical activity
■ Such as 30 minutes of moderate
intensity 3-7 days/week
○ Smoking cessation (if applicable)

57
Q

Based on the most recent research, and agreed upon by the newest recommendations, ____ are the
mainstay of dyslipidemia treatment for most

A

Statin medications

Endocrinology Exam 2 (4 decks)

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