Lipoprotein and Lipid disorders for M2 discovery curriculum Flashcards
ASCVD
what does it stand for and what does it include
atherosclerotic cardiovascular disease
MI+Stroke+peripheral arterial disease
What is the key determinant of CVD?
What else matters?
What are some factors for increased CVD?
LDL:HDL ratio; lifestyle is also important
DM, Smoking, HTN, obd obesity
What are three things that can guard against CVD?
exercise, eating fruits and veggies, and some alcohols
6 lifestyle related factors contributing the ASCVD and what values are disease inducing?
BMI >35 BP >135/85 FBS >100 AKA Dm Tobacco any/second hand Exercise less than 30 minutes/day Alcohol none or excess
lifestyle ways to increase LDL and Trigs
LDL: eat high fat, high cholesterol diets (thereby increasing chylomicrons)
Trigs/cause insullin resistance: eat SAD, drink sodas, sedentary lifestyle, and smoke
What’s included in the classic lipid profile? (5)
What are 2 other factors you can measure?
Total cholesterol triglycerides HDL LDL non HDL
ApoB, and LDL-Particle
Which lipoprotein amounts are calculated?
How are they calculated?
LDL and non-HDL
TC-(HDL+VLDL-C)=LDL
TC-HDL=nonHDL
called Friedewald equation
CVD pathologic limits of the following:
LDL-C
HDL
Trigs
LDL-C >100
HDL 1000 is risk for pancreatitis
What are optimal values for
TC, TG, HDL, LDL, nonHDL?
40M >50F, «100
What are normal values for TC, TG, HDL, LDL, nonHDL
40M/ >50F, <160
Two pillar determinants of lipid disorders.
What is the more realistic picture?
Genetics (recess or dom)
environment (diet, exercise, and drugs)
Genetics unmasked by lifestyle
Which subtypes of lipid disorder are mainly genetic and involves very little lifestyle changes? (2)
I and IIA
Which lipid disorder subtypes are heavily influenced by lifestyle? (4)
IIB, III, IV, V
Type I Hyperlipidemia Common Name Clinical Presentation what's in excess? What's defective? common or rare? abnormal lab value
severe Hypertriglyceridemia or Hyperchylomicronemia baby with >2,000 TG Chylomicrons are in excess defective LPL, apoC2, or apoC3 very rare TG is >2,000
IIa Common name clinical presentation what's in excess? What's defective? common or rare? abnormal lab value
Familial Hypercholesterolemia
CAD 275, LDL-C >190
IIb common name clinical presentation what's in excess? What's defective? common or rare? abnormal lab value
familial combined hyperlipidemia with metabolic syndrome
CAD risk 2x normal despite borderline nl lipid numbers
LDL and VLDL are in excess
due to ApoB100 over production
common
LDL 100, trigs 200-500, HDL <40
III common name clinical presentation what's in excess? What's defective? common or rare? abnormal lab value
dysbetalipoproteinemia premature CAD VLDL, IDL in excess due to ApoE2 over production rare TC and trig both are 200-500
IV Common Name presentation what's in excess? What's defective? common or rare? abnormal lab value
Hypertriglyceridemia pancreatitis VLDL in excess due to LPL or apoC3 defect common Trigs are 500-1000
V common name presentation what's in excess? What's defective? common or rare? abnormal lab value
Hypertrigliceridemia pancreatitis, usually with DM VLDL and chylomicrons in excess due to LPL or apoC3 defect uncommon trigs >1000
Type IIb-dyslipidemia
-major factors
western diet
metabolic syndrome/DM
diabesity
metabolic syndrome –>2x risk for CAD despite not having DM.
What lipoproteins are prominent?
VLDL remnants
LDL
These are atherogenic
MEtabolic syndrome (3/5)
- Waist >40 men, >35 women
- BP >135/85
- Glucose >100
- Trigs >150
- HDL men <50
Type IIB pathogenesis
increase in glucose–>storage in liver –>VLDL biosynthesis upreg–>CETP conversion between HDL, VLDL, and LDL. Increase in LDL content in general, and HL converts some LDL to small LDL which have even worse affinity for LDLR…
THEREFORE increased LDL–>atherosclerosis
HDL gets smaller due to CETP–>apoA1 and AII fall off and renal excretion…
THEREFORE less HDL
atherogenic dyslipidemia
caued by what?
what are the lipoprotein characteristics
caused by metabolic syndrome. characteristics: high TRIGS low HDL LDL-particles are wayyyyyyyy more than LDL-cholesterol
