Met 1: Dyslipidemia Clinical features Flashcards
Larger lipoproteins are ____ dense
LARGER lipoproteins are LESS dense
HDL is secreted by which two organs?
Liver
GI Tract
What organ do chylomicrons come from?
GI tract
What 3 apoproteins are in chylomicrons?
What is the function of each?
- apoB48: structural
- apoC2: ligand for lipoprotein lipase
- apoE: ligand for liver receptor
What is produced when lipoprotein lipase digests chylomicrons?
Where do these products go next?
Chylomicron digestion by LPL produces
- Free fatty acids (go to adipose and muscle tissue)
- IDL’s (go to liver)
What apoproteins are found on IDL?
- apo48 (structural)
- apoE (ligand for liver receptor)
What apoproteins are found on VLDL?
What is the function of each?
VLDL has
- apoB100: structural
- apoC2: ligand for lipoprotein lipase
- apoE: ligand for liver receptor
What is produced when VLDL is digested by lipoprotein lipase?
VLDL digestion by LPL produces
- Free fatty acids
- LDL
What apoproteins are found on LDL?
What is LDL made from?
- LDL is a derivative of VLDL
- LDL has apoB100
LDL _______ CVD risk
HDL ________ CVD risk
So, you’d want your lipid panel to be high in ____ and low in ____.
LDL increases CVD risk
HDL decreases CVD risk
So, you’d want your lipid panel to be high in HDL and low in LDL.
All adults ____+ yo should have a fasting lipid panel every ______ yrs
All adults 20+ yo should have a fasting lipid panel about every 5 years
What 3 things does a lipid panel directly measure?
Lipid panel directly measures
- Total cholesterol
- TG’s
- HDL
Most cardiac events occur in people with ____ cholesterol
Most cardiac events occur in people with AVERAGE cholesterol!
What is the inheritance and defect in familial hypercholesterolemia?
Name 2 signs on physical exam
Familial Hypercholesterolemia
- autosomal dominant
- LDL receptor is mutated or absent, so liver can’t clear LDL from blood
- Signs: Arcus cornealis, xanthomas
The presence of arcus cornealis and xanthomas suggests
The presence of arcus cornealis and xanthomas suggests familial hypercholesterolemia
Describe the role of PCSK9 in lipid clearance
- 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
What is a normal TG level?
What is considered VERY high?
Normal TG: under 150
Very high TG: over 500
Hypertriglyceridemia is associated with CVD in ______________
Hypertriglyceridemia is associated with CVD in women with metabolic syndromes
How do you estimate the risk of CVD events in someone without dz?
(primary prevention)
For primary prevention, use risk calculator tool
What is a normal LDL level?
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
What is the major complication of elevated TG’s?
Pancreatitis
Signs of hyperTGemia (4)
lipemia retinalis
lipemic serum
hepatosplenomegaly
xanthomas
For people with hypertriglyceridemia, we try to keep TG’s below _____ because, above this level….
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
Name 3 functions of HDL
Anti-inflammatory
anti-oxidant
reverse cholesterol transport
What is the effect of HDL on CVD risk?
What is the effect of HDL drugs on CVD risk?
low HDL raises your CVD risk (HDL is protective)
BUT, all drugs that have raised HDL have not demonstrated a decrease in CVD events
How does lp(a) affect CVD risk?
Lp(a) increases CVD risk
