Lipids: Metabolism and Disorders

Question 1

Lipid

Answer 1

any of various substances that are soluble in nonpolar organic solvents

usually insoluble in water

constitute principle structural components of living cells

Question 2

Two Major Lipids in the Body

Answer 2

Cholesterol and Triglycerides

Question 3

Lipoprotein

Answer 3

a protein-lipid complex which transports lipids in the body

HDL, LDL, VLDL

Question 4

LDL

Answer 4

low-density lipoprotein

carry most of the cholesterol in the blood

LDL over 190 (or non-HDL over 220) is considered very high

LDL under 70 is considered very low

Intermediate values assessed in clinical context

Question 5

HDL

Answer 5

high density lipoprotein

carries cholesteral from peripheral tissue to live

higher is better – 40-60

low HDL is abnormal and associated with metabolic syndrome

Question 6

Dyslipidemia

Answer 6

most are hyperlipidemias; either or both colesterol and triglycerides are elevated

abnormal lipids are technically endocrine disorders, but are considered in cardiovascular topics because of their effects on vascular disease

Question 7

Chylomicrons

Answer 7

largest lipoprotein; rich in TG

Question 8

VLDL

Answer 8

very low-density lipoprotein; similar to chylomicrons; high concentration of TG

Question 9

Triglyceride Levels

Answer 9

Over 500 = very high – can present with Xanthomas; can affect skin and tendons

200-500 = high

150-200 = borderline

Under 150 = normal

Question 10

Total Cholesterol

Answer 10

HDL + LDL + VLDL

non-HDL = LDL + VLDL (over 220 is very high)

Question 11

Primary Causes

Answer 11

familial hyperchosterolemias and hypertriglyceridemias

rare in homozygous (severe) forms

Question 12

Secondary Causes

Answer 12

more common

diabetes (metabolic syndrome)
obesity
chronic kidney disease
hypothyroidism
HIV
alcoholism
many medications, including estrogens, retinoids, B-blockers

Question 13

Metabolic Syndrome

Answer 13

a constellation of metabolic abnormalities which increase the risk for atherosclerotic disease (Coronary Artery Disease)
o	Type 2 Diabetes – insulin resistance
o	hypertension
o	elevated uric acid/gout
o	abdominal obesity
o	elevated triglycerides
o	low HDL
o	small, dense LDL

Treatment – optimal management of blood pressure, blood sugars, and lipids; weight management

metabolic syndrome includes dyslipidemia as part of its clinical picture

Question 14

What should you screen for?

Answer 14

a fasting lipid panel with total cholesterol, LDL, HDL and triglycerides provides adequate information

total cholesterol is not enough information

low-risk patients do not need to fast

Question 15

When should you screen children?

Answer 15

once between 9-11, and once between 17-21

screen if high risk is identified

Question 16

When should you stop screening patients?

Answer 16

after age 75 in those without CV disease

Question 17

When should you begin screening adults with CV disease risk?

Answer 17

20

Question 18

When should you begin screening men without CV disease risk?

Answer 18

35

Question 19

When should you begin screening women without CV disease risk?

Answer 19

45

Question 20

Recommendations for everyone, even low-risk

Answer 20

heart-healthy diet

healthy weight (BMI <25)

regular exercise

Question 21

Heart Healthy Diet

Answer 21

the DASH or Mediterranean diet (increased soluble fiber; plant stanols and sterols (wheat germ and bran, almonds), antioxidant foods; avoid saturated and trans fat)

Question 22

Treatment

Answer 22

healthy lifestyle

assumed to be taking low dose aspiring and treatment for co-morbid conditions

statins

Question 23

Medication treatments for patients with:

Answer 23

previously diagnosed atherosclerotic cardiovascular disease

LDL cholesterol over 190 mg/dL

diabetes, LDL over 70, age 40-75

calculated 10-year CV risk 7.5% or greater, age 40-75