Lipid Disorders - waldron Flashcards
what are the subclasses of lipids
fatty acids
triglycerides
cholesterol
phospholipids
what is the importance of lipids
storing energy
signaling
structural components of cell membranes
provide insulation
source of fat-soluble vitamins (A,D, E, K)
protection
what does cholesterol in circulation originate from
either endogenous of exogenous pathway
what must lipids attach to to be soluble
lipoproteins
what is atherosclerosis
chronic inflammatory disease characterized by buildup of lipids in/on artery walls
what is the underlying process responsible for the majority of cardiovascular events
atherosclerosis
what make a atherosclerotic plaque vulnerable
thinning of the fibrous cap
what occurs with plaque rupture
formation of thrombus
what is the framingham heart study
identified risk factors:
blood cholesterol levels as predictive
C-reactive proteins as predictive in higher risk patients
equivocal on homocysteine as a predictor
what are non-modifiable risk factors of atherosclerosis
age
sex
family history
what are modifiable risk factors for atherosclerosis
smoking
High BP
High blood cholesterol levels
inflammatory and hyper-coagulable states
DM
overweight/obesity
sedentary lifestyle
high stress
unhealthy diet
what are considerations for risk calculations for atherosclerosis
age
sex
race
cholesterol levels
BP
Meds
Diabetes status
smoking status
over what percentage is considered high risk for ASCVD
> 20%
what are risk enhancers for ASCVD
family hx of early onset ASCVD
continually elevated LDL
chronic kidney disease
metabolic syndrome
preeclampsia or premature menopause
inflammatory disease (RA, psoriasis, HIV/AIDS)
south asian ancestry
continually elevated triglycerides
elevated biomarkers
what are the types of lipid disorders
Primary (familial/hereditary) hyperlipidemia
secondary (acquired) hyperlipidemia: hypercholesterolemia and hypertriglyceridemia
what are the typically causes of hypercholesterolemia/hyperlipidemia
high fat diets
sedentary lifestyle
obesity
DM
Genetic causesL: familial hypercholesterolemia
what is familiar hypercholesterolemia
genetic disorder
causes significant elevation of LDL-C levels
leads to early cardiovascular disease (CVD)
What is the friedewald equation
Total cholesterol = LDL + HDL + (TG x 20%)
what can affect total cholesterol
can vary due to stress, minor illness
what is LDL (low-density lipoprotein)
primary measure for cardiovascular disease risk assessment and treatment guidance
made up mostly of cholesterol
high levels increases risk for heart disease and stroke
what is HDL (high-density lipoproteins)
inversely associated with adverse cardiac outcomes
absorbed cholesterol and takes it back to the liver
what are triglycerides
store unused calories and provide body with energy
What are the different LDL particles and what do each contain more or less of
Small LDL particles - less cholesterol
Large LDL particles - more cholesterol
What is ApoB
primary apolipoprotein attached to atherogenic particles
involved in metabolism and transport of lipids
high # indicative for increased risk for Heart dx
what is lipoprotein A
genetically determined
increased may indicate increased risk for MI, stroke or aortic stenosis in the future
what are cholesterol treatments
dietary changes
weight loss
aerobic exercise
tobacco cessation
pharmacotherapy: statins, bile acid sequestrants, fibrates
what are the considerations when choosing treatment options
overall cardiovascular disease risk factor
cost of treatment
patient preferences
what is considered first line therapy for lipids
statins
what are statin intolerance
muscle symptoms
rhabdomyolysis
ALT rise >3x normal
serious liver disease
what is personal hx that increases risk for statin intolerance
age (>80)
sex (f)
ethnicity (asian)
neuromuscular, kidney, or liver conditions
hypothyroidism
new intensive exercise
what should be monitored when using long term statin
check lipid panel
LFTs
CK level
how do BAS work
sequestering bile acid in the GI tract, prevents being absorbed into bloodstream
- liver removes cholesterol from blood to make more bile acid, thus reducing cholesterol levels
what is the primary indication for fish oils
hypertriglyceridemia
what is the use of fibrates
reduces liver production of VLDL and speeds up removal of TG from blood
consider with high triglycerides
what is Ezetimbie (zetia)
hyperlipidemia medication that inhibits absorption of cholesterol from small intestine
decreases amount of cholesterol normally available to liver cells
reduces CV events, reduces LDL-c
what is Niacin
hyperlipidemia medication that reduces TC, LCL-C, TG and increases HDL-C
What are PCSK9 Inhibitors
monoclonal antibodies that block PCSK9 protein from working - LDL receptors increase and LDL-c decreases
may be used with or separate from statin medications
what can high triglycerides be a sign of
type 2 diabetes or prediabetes
metabolic syndrome
hypothyroidism
certain rare genetic conditions that affect how the body converts fat to energy
what medications can have a side effect of high triglycerides
diuretics
estrogen and progestin
retinoids
steroids
BB
some immunosuppressants
some HIV meds
what are the initial management choices for triglycerides
healthy lifestyle
exercise
avoid sugar/refined carbs
lose weight
choose healthier fats
limit alchohol intake
what is the medication management for triglycerides
statins
fibrates
fish oil
niacin
what are metabolic syndromes associated wtih
insulin resistance
prothrombotic and pro-inflammatory states
risk of DM, MI and CVA
what are risk factors for metabolic syndrome
obesity
sedentary lifestyle
family hx
hyperlipidemia
HTN
how often should screenings be done for metabolic syndromes
repeat every 3 years
how are metabolic syndromes diagnosed
impaired glucose metabolism
lipid profile
insulin resistance
what is the management of metabolic syndrome
key is to prevent progression of diabetes
weight reduction/loss
aerobic exercise
decreased caloric intake
pharmacologic tx for glucose control and cardiac risk management
