Met 1: Dyslipidemia Clinical features

Question 1

Larger lipoproteins are ____ dense

Answer 1

LARGER lipoproteins are LESS dense

Question 2

HDL is secreted by which two organs?

Answer 2

Liver

GI Tract

Question 3

What organ do chylomicrons come from?

Answer 3

GI tract

Question 4

What 3 apoproteins are in chylomicrons?

What is the function of each?

Answer 4

• apoB48: structural
• apoC2: ligand for lipoprotein lipase
• apoE: ligand for liver receptor

Question 5

What is produced when lipoprotein lipase digests chylomicrons?

Where do these products go next?

Answer 5

Chylomicron digestion by LPL produces

1. Free fatty acids (go to adipose and muscle tissue)
2. IDL’s (go to liver)

Question 6

What apoproteins are found on IDL?

Answer 6

• apo48 (structural)
• apoE (ligand for liver receptor)

Question 7

What apoproteins are found on VLDL?

What is the function of each?

Answer 7

VLDL has

• apoB100: structural
• apoC2: ligand for lipoprotein lipase
• apoE: ligand for liver receptor

Question 8

What is produced when VLDL is digested by lipoprotein lipase?

Answer 8

VLDL digestion by LPL produces

1. Free fatty acids
2. LDL

Question 9

What apoproteins are found on LDL?

What is LDL made from?

Answer 9

• LDL is a derivative of VLDL
• LDL has apoB100

Question 10

LDL _______ CVD risk

HDL ________ CVD risk

So, you’d want your lipid panel to be high in ____ and low in ____.

Answer 10

LDL increases CVD risk

HDL decreases CVD risk

So, you’d want your lipid panel to be high in HDL and low in LDL.

Question 11

All adults ____+ yo should have a fasting lipid panel every ______ yrs

Answer 11

All adults 20+ yo should have a fasting lipid panel about every 5 years

Question 12

What 3 things does a lipid panel directly measure?

Answer 12

Lipid panel directly measures

• Total cholesterol
• TG’s
• HDL

Question 13

Most cardiac events occur in people with ____ cholesterol

Answer 13

Most cardiac events occur in people with AVERAGE cholesterol!

Question 14

What is the inheritance and defect in familial hypercholesterolemia?

Name 2 signs on physical exam

Answer 14

Familial Hypercholesterolemia

• autosomal dominant
• LDL receptor is mutated or absent, so liver can’t clear LDL from blood
• Signs: Arcus cornealis, xanthomas

Question 15

The presence of arcus cornealis and xanthomas suggests

Answer 15

The presence of arcus cornealis and xanthomas suggests familial hypercholesterolemia

Question 16

Describe the role of PCSK9 in lipid clearance

Answer 16

• PCSK9 prevent the LDL receptor from going back to cell surface.
• So, more active PCSK9 reduces the liver’s clearance of blood LDL
• active PCSK9 is bad

Question 17

What is a normal TG level?

What is considered VERY high?

Answer 17

Normal TG: under 150

Very high TG: over 500

Question 18

Hypertriglyceridemia is associated with CVD in ______________

Answer 18

Hypertriglyceridemia is associated with CVD in women with metabolic syndromes

Question 19

How do you estimate the risk of CVD events in someone without dz?

(primary prevention)

Answer 19

For primary prevention, use risk calculator tool

Question 20

What is a normal LDL level?

Answer 20

The average LDL level in US is about 115

But, this is much higher than the LDL average in hunter/gatherer populations. And, most CAD events happen with this “normal” LDL

Question 21

What is the major complication of elevated TG’s?

Answer 21

Pancreatitis

Question 22

Signs of hyperTGemia (4)

Answer 22

lipemia retinalis

lipemic serum

hepatosplenomegaly

xanthomas

Question 23

For people with hypertriglyceridemia, we try to keep TG’s below _____ because, above this level….

Answer 23

For people with hypertriglyceridemia, we try to keep TG’s below 500 because, above this level TG clearance gets saturated and TG’s build up in blood very quickly

Question 24

Name 3 functions of HDL

Answer 24

Anti-inflammatory

anti-oxidant

reverse cholesterol transport

Question 25

What is the effect of HDL on CVD risk?

What is the effect of HDL drugs on CVD risk?

Answer 25

low HDL raises your CVD risk (HDL is protective)

BUT, all drugs that have raised HDL have not demonstrated a decrease in CVD events

Question 26

How does lp(a) affect CVD risk?

Answer 26

Lp(a) increases CVD risk