Lipid Disorders and Metabolic Syndrome

Question 1

What are Lipids?

Answer 1

Organic compounds that are not soluble in water

Question 1

The two main lipids in the blood are

Answer 1

○ Cholesterol
○ Triglycerides

Question 2

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

Answer 2

Lipoproteins

Question 3

Types of lipoproteins

Answer 3

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

Question 4

Protein + Lipids = _____

Answer 4

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

Question 5

Fat digestion process review

Answer 5

• 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

Question 6

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

Answer 6

small intestine epithelium

Question 7

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

Answer 7

Chylomicrons.

Question 8

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

Answer 8

Lymph in the Lacteal

Question 9

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

Answer 9

Lipoprotein Lipase

Question 10

What does lipoprotein lipase do?

Answer 10

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

Question 11

Cholesterol is the precursor to various hormones including

Answer 11

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

Question 12

The principal constituent of
atherosclerotic plaques

Answer 12

Cholesterol

Question 13

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

Answer 13

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

Question 14

How is cholesterol excreted in the body?

Answer 14

○ Excreted through feces via bile

Question 15

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

Answer 15

cholesterol management

Question 16

Livers role in managing Cholesterol?

Answer 16

○ 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.

Question 17

Chylomicron Remnants are endocytosed by _____

Answer 17

Hepatocytes

Question 18

Cholesterol management in the liver ends with

Answer 18

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

Question 19

Lipoproteins contains surface
proteins called ____-

Answer 19

Apoproteins
These help guide lipid
transport and metabolism

Question 20

Difference in apoproteins between LDL/VLDL and HDL

Answer 20

● 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

Question 21

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

Answer 21

VLDLs

Question 22

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

Answer 22

VLDLs

Question 23

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

Answer 23

LDLs; LDL-Cholesterol (LDL-C)

Question 24

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

Answer 24

LDL

Question 25

The most dense (and smallest) of the Lipoproteins

Answer 25

HDL

Question 26

Reverse Cholesterol Transport

Answer 26

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

Question 27

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

Answer 27

T

Question 28

Total Cholesterol (TC) =

Answer 28

VLDL + LDL + HDL

Question 29

VLDL = _____

Answer 29

TGs divided by 5

Question 30

LDL = _____

Answer 30

TC - HDL - TGs/5

Question 31

Dyslipidemia

Answer 31

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

Question 32

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

Answer 32

Increased serum LDL-Cholesterol

Question 33

____% of adults in the US have elevated LDL levels

Answer 33

34 <50% of those with elevated LDL receive treatment

Question 34

Signs and Sxs of Dyslipidemia

Answer 34

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

Question 35

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

Answer 35

Pancreatitis

Question 36

Lipemia Retinalis.

Answer 36

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

Question 37

visible cholesterol deposits in the body

Answer 37

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

Question 38

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

Answer 38

■ Familial Hypercholesterolemia ■ Familial Hyperchylomicronemia

Question 39

Secondary Causes of Dyslipidemia

Answer 39

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

Question 40

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

Answer 40

T

Question 41

Before initiating lipid-lowering medication, you should

Answer 41

consider secondary causes of dyslipidemia

Question 42

Risk Factors for Dyslipidemia and Atherosclerosis

Answer 42

○ 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

Question 43

Metabolic Syndrome

Answer 43

Insulin Resistance Syndrome or Syndrome X

Question 44

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

Answer 44

Metabolic Syndrome

Question 45

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

Answer 45

25

Question 46

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

Answer 46

○ 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

Question 47

Treatment of Metabolic Syndrome

Answer 47

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

Question 48

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

Answer 48

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

Question 49

Atherosclerotic Cardiovascular Disease Defined as history of one or more

Answer 49

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

Question 50

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

Answer 50

A complete Lipid Profile (AKA Lipid Panel)

Question 51

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

Answer 51

regularly/yearly

Question 52

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

Answer 52

● 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.**

Question 53

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

Answer 53

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

Question 54

Risk categories for ASCVD risk

Answer 54

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

Question 55

2018 ACC/AHA Cholesterol Guidelines

Answer 55

○ 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

Question 56

heart-healthy lifestyle changes for all patients:

Answer 56

○ 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)

Question 57

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

Answer 57

Statin medications