Lipids Flashcards
Physical signs of severe hypercholesterolemia
1- tendinous xanthoma
2- xanthelasma - less specific
3- arcus cornealis
Order of particles from high TGs to low TGs
1) chylomicron (intestinal)
2) VLDL
3) LDL
4) HDL
Which 2 particles have the ApoB100 on them?
VLDL
LDL
In a lab test the Triglycerides are a measure of which particle?
VLDL
Tissues that break down triglycerides/contain lipoprotein lipase
Muscle and fat
A 1mmol/L reduction in LDL is associated with
23 and 21% reduction in major coronary and vascular events
How does HMG coA reductase work?
By inhibiting cholesterol synthesis and upregulating LDL receptor
how much more does 80 mg Atorvastatin reduces risk of CV events compared with 10mg
22%
3 doublings of the statin dose only leads to a
18% reduction in LDL-C
The first reduction in LDL-C is
40% reduction
how does ezetmibe work?
blocks the absorption of cholesterol in the intestine
reduces TG,
Single dose ezetimibe 10mg is the same as
3 dose titration of a statin from 20 to 40 to 80 mg - 18% reduction
what is the effect on CV health of addition of ezetimibe to a statin (40mg)
incremental benefit - 6% reduction in risk
Ideal TG levels
< 1.7
Extreme elevation in fasting TG levels and health risk
> 10mmol/L –> pancreatitis
MODEST elevation in fasting TG levels and health risk
3- 10 mmol/L –> CHD
Acute treatment of pancreatitis secondary to hypertriglyceridemia
- NPO(reduce chylomicron TGs)
- FLUIDS
- Low fat diet
Pharmacologic therapies of HIGH triglycerides
- Fibrates
- Niacin
- omega 3s
- Statins
Physical signs of severe hypertriglyceridemia
- Lipemia retinalis
- Eruptive xanthomas - acute lesions
How does alcohol affect TGs?
increases production of VLDL
Mechanism of action of fibrates
- Activate LPL
- Lower TGs
Intermediate risk level of FRS
10-19%
When do you treat an intermediate risk patient?
If LDL >= 3.5 mmol/L
if LDL < 3.5 but ApoB >1.2 or non-HDL-C >4.3
What 2 risk modifiers are not included in the Framingham calculator?
1- family Hx - (multiple by 2)
2- Metabolic syndrome - (High LDL, low HDL, hypertension, IGT)
how do we calculate LDL-C?
Total cholesterol = (TG/2.2)+ LDL+ HDL
When is the formula to calculate LDL invalid
when TG > 4.5
Non-HDL-C refers to all
ApoB containing molecules
Primary treatment target is always
LDL (<2 or 50% reduction)
Bile acid sequestrants can be used if not on target
can help reduce diabetes
with ezetimibe can reduce LDL by 40-45%
Effects of niacin on LDL, HDL, and TG
Decrease LDL by 20%
increase HDL by 30%
Decrease TG by 40%
