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Clinical Pathology II > Lipids > Flashcards

Lipids Flashcards

1
Q

Functions of Triglycerides

A

• Energy storage*
• Insulating and protecting organs
• Cellular membrane fluidity
• Fat soluble vitamin transport

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2
Q

Cholesterol is a component of: (5)

A

-Bile acids
-Progesterone
-Vitamin D
-Glucocorticoids
-Minerocorticoids

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3
Q

Function of cholesterol

A

Cell membrane fluidity

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4
Q

Sources of cholesterol

A

• De novo: endogenous (70-80%)-liver
• Diet

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5
Q

Cholesterol is eliminated through conversion by:

A

The liver to salts of bile acids

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6
Q

ApoB

A

Atherogenic: Chylomicrons, VLDL, IDL, LDL (“Bad”), Lp (A)

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7
Q

ApoA

A

Cardioprotective-HDL (“good”)

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8
Q

Main component of chylomicrons

A

Triglycerides

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9
Q

Chylomicrons are:

A

Exogenous: 12 hours to clear circulation

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10
Q

VLDL are the predominant carrier of:

A

Blood triglycerides

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11
Q

VLDLs are:

A

Endogenous*

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12
Q

IDLs are formed after:

A

Removal of some triglycerides from VLDL

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13
Q

LDLS are formed after:

A

Removal of triglycerides from IDL

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14
Q

LDLs carry:

A

Cholesterol to be deposited into tissues

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15
Q

Lp(a)

A

• LDL particle with additional lipoprotein attachment
• Highly heritable*, tend to be stable over time

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16
Q

Components of LDL

A

-45% cholesterol, 10% triglycerides, 20% phosphates, 25% protein

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17
Q

HDL is synthesized by:

A

Liver and small intestines

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18
Q

HDLs carry a higher percentage of:

A

Protein

(50% protein, 1-5% triglycerides, 15% cholesterol, 30% phospholipid)

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19
Q

Total Cholesterol: Desirable Level

A

125-200 mg/dL

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20
Q

LDLc Levels

A

<100: Optimal*
100-129: Near Optimal*
130-159: Borderline high*
160-189: high
>190: Very High

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21
Q

HDLc: Desirable Levels

A

• Men: >40 mg/dL
• Women: >46 mg/dL

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22
Q

HDLc tends to have an inverse relationship with:

A

Triglycerides

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23
Q

TC: HDL Ratio provides insight into balance between:

A

Atherogenic and cardioprotective lipoproteins

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24
Q

TC:HDL Radio: Average Risk

A

• 5:1 (males)
• 4.5:1 (females)
-3:1 (Ideal Ratio)

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25
Q

Non-HDL Cholesterol =

A

TC-HDLc

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26
Q

Non-HDL Cholesterol includes cholesterol carried by: (4)

A

VLDL, IDL, LDL, Lp(a)

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27
Q

Non-HDL Cholesterol: Desirable Level

A

LDL target + 30 mg/dL

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28
Q

Triglycerides: Desirable Level

A

Desirable: <150 mg/dL

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29
Q

HLP IIa: Description

A

Excessive LDL-c in circulation and excessive deposition in peripheral tissue

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30
Q

HLP IIa: Serum Cholesterol

A

500-1200mg/dL

31
Q

HLP IIa: Signs/Symptoms

A

• Xanthelasmas
• Tendon and tuberous xanthomas*
• Arcus juvenilis
• Arterial bruit
• Claudication
• Accelerated atherosclerosis

32
Q

HLPIIa: Lab Findings

A

**Serum cholesterol increased
• Homozygous – 500-1200 mg/dL
• Heterozygous – 250-500 mg/dL

• Triglycerides normal
• **Increased LDL (>190mg/dL)

33
Q

HLP IV: Description

A

• Genetic problem causing decreased elimination of VLDL

34
Q

HLP IV: Signs/Symptoms

A

-Obesity
-Lipemia retinalis
-Atherosclerosis
-Hepatosplenomegaly
-Possible pancreatitis* (esp if notable increase in triglycerides (>500))

35
Q

HLP IV: Lab Findings

A

• **Increased triglycerides: 250-500mg/dL
• Normal cholesterol
• Normal LDL
• *Decreased HD

36
Q

Hyperelphalipoproteinemia

A

• Elevated HDL cholesterol (80-100+)

37
Q

Secondary Causes of Dyslipidemia

A
38
Q

Diabetes Mellitus

A

Increased production of VLDL->Increased TGs/Decreased HDL
-Increased LDLc
-Increased TC

39
Q

Hypothyroidism

A

-Increased LDL
-Increased TC
-Increased TGs
-Decreased HDLs

40
Q

Chronic Liver Disease (2)

A

-Increased TGs
-Decreased HDL

41
Q

Obstructive Liver Disease

A

-Cholelithiasis (gallstone-colicky pain)
-Increased LDL
-Increased TC: 400-500 (acute)/700-800 (chronic)
-Increased TGs
-Decreased HDL

42
Q

Pregnancy

A

-Increased TGs (3rd trimester)
-Increased LDL
-Increased TC
-Decreased HDL

43
Q

PCOS

A

-Increased TG
-Decreased HDL
-Increased LDL
-Increased TC

44
Q

Certain Medications

A

-Oral contraceptives
-Corticosteroids
-Diuretics

45
Q

• Lipid panel abnormalities tend to be _____ than those seen with genetic abnormalities

A

Milder

46
Q

Ranges indicative of lifestyle factors

A

• Total cholesterol: 200-250
• LDLc: 100-190;
• Triglycerides: 150-250\
-HDL: Exercise, inverse of TGs

47
Q

Causes of Hypocholesterolemia

A

-Chronic liver disease,
-Hyperthyroidism,
-Anemia
-MMMs (Malignancy, malnutrition, malabsorption)

48
Q

Cardiac Risk Assessment: Pathophysiology

A
  1. Endothelial cell damage (HTN, smoking, hyperglycemia, increased homocystemia..)
  2. LDL deposition in tunica intima
  3. WBCs enter, release free radicals*
  4. LDL oxidized*
  5. Positive feedback loop
  6. Lipid plaque formed from dead WBCs and smooth mucles that engulfed LDL
  7. Lipid plaques become fibrous*
  8. Inflammation>plaque instability>plaque rupture*
49
Q

Major Risk Factors

A

• Smoking
• High blood pressure
• High LDL cholesterol
• Low HDL cholesterol
• Diabetes
• Age: Male (45+)/Female (55+/menopause)
• Premature family history of cardiovascular disease (1st degree): Male (<55)/Female (<65)

50
Q

Risk Enhancing Factors

A

-Based on 10 year risk profile
• Obesity
• Sedentary
• Diet
• Alcohol
• Stress and psychosocial factors
• Elevated triglycerides
• Metabolic syndrome

51
Q

Risk Enhancing Factors: Other Abnormalities

A

• Lp(a)
• Hyperhomocystinemia
• Prothrombotic factors (fibrinogen)*
• hsCRP (inflammation)
-Sleep apnea

52
Q

Cluster of metabolic abnormalities->increased risk for:

A

• Type 2 DM
• Cardiovascular disease
• Stroke
• Fatty liver
• Certain cancers

53
Q

Metabolic Abnormalities

A

• Intra-abdominal obesity
• Dyslipidemia
• Hypertension
• Insulin resistance (w/ or w/o insulin impaired glucose tolerance)
• Proinflammatory state
• Prothrombotic state

54
Q

Metabolic Syndrome: Epidemiology

A

• Predominant age: >60 years old
• Male = female
• >1/3 US affected

55
Q

In order to be diagnosed with metabolic syndrome, we need 3+ of the following:

A

Abdominal obesity
•Waist circumference:
• >40 inches men
• >35 inches women

• TGs >150 mg/dL

Low HDL cholesterol
• Men: <40 mg/dL
• Women: <50 mg/dL

• BP >130/85 mm Hg
• Fasting glucose ≥100 mg/dL but <126 mg/dL (prediabetes)

56
Q

Metabolic Syndrome: Management

A

• Primary therapeutic goal is to prevent or reduce obesity
• Aggressive lifestyle modification (diet and exercise) considered first line therapy
• Treat lipid and non-lipid risk factors if they persist despite lifestyle changes

57
Q

Metabolic Syndrome: Prognosis

A

-Increased risk of: Type 2 DM (5x), CAD (3x), Acute myocardial infarct (3x), All-cause mortality (1.5x)

58
Q

A risk assessment primarily includes:

A

History, physical exam, lipoprotein panel, additional lab testing

59
Q

A lipoprotein panel primarily assesses:

A

Cardiac risk

60
Q

Most risk assessment still focuses on:

A

LDL-c, Total Cholesterol, HDL-c

61
Q

CRP measures levels from:

A

10 mg/L to 10,000 mg/L (general inflammation)

62
Q

Hs-CRO measures levels from

A

0-10 mg/L (cardio CS/inflammation-endothelial damage

63
Q

Hs-CRP: Levels

A

-Normal: <0.3mg/L
-Low: <1mg/L
-Average: 1-3mg/L
-High>3mg/L
-General Inflammation: >10mg/L

64
Q

Lipoprotein particle size

A

Small/dense (more athrogenic), large/pillowy (less athro.

65
Q

AHA Guidelines: Dietary pattens

A

Mediterranean, DASH, low glycemic index/load, plant-based

66
Q

AHA guidelines: Activity

A

Activity: About 150 minutes of moderate to vigorous exercise per week (3-4 40-minute sessions)

67
Q

AHA guidelines: Other factors

A

• Maintaining healthy body weight
• Smoking cessation
• Limiting alcohol use
• Sleep

68
Q

Lipid Panel: What factors must we determine if abnormalities are due to primary causes or secondary

A

• Biliary obstruction
• Hypothyroidism
• Chronic kidney disease
• Pancreatic disease (diabetes mellitus, chronic pancreatitis)
• Pregnancy
• Certain medications

69
Q

Statin use Guidelines

A
  1. LDL-c >190 (21+ years of age)
  2. LDL-c 70-189 in adults 40-75 with diabetes
  3. LDL-c 70-189 in adults 40-75 with moderate risk
70
Q

Neutraceuticals

A

• Red yeast rice: LDL, TC
• Plant sterols and stanols: LDL
• EPA/DHA: Triglycerides
• CoQ10
-Niacin

71
Q

Statin induced myopathy: Symptoms

A

• Fatigue, muscle pain/tenderness, weakness, tendon pain, nocturnal muscle cramping
• Proximal, generalized, worse with exercise (bilateral)

72
Q

Lower CRP by:

A

Exercise, alcohol

73
Q

Lower homocysteine

A

Exercise, B6, folate, B12

74
Q

Risk Assessment: Follow-Up and Monitoring

A

• Discuss other risk factors: Lp(a), homocysteine, HsCRP
• Rule out pathology as secondary cause: Diabetes, hypothyroid, pregnancy, Ckd, meds
• Recommend dietary lifestyle changes for 6 months
• Retest lipid panel at 6-8 weeks, 3 months, and 6 months
• If pharmaceutical intervention is decided upon:
• Liver enzymes and CPK should be measure before initiation and after several months

Clinical Pathology II (10 decks)

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