Molecular Biology: Clinical Significance of Lipoproteins Flashcards
What is PCSK9?
A regulatory protein in LDL-receptor metabolism
What are the pre-2013 guidelines for HDL cholesterol levels that are considered “high risk”?
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What are the main drugs/drug types that are used to increase HDL levels?
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Where do fibrates, niacin, and CEPT inhibitors fit into this figure, and what do they do?
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- All increase HDL
- CETP inhibitors decrease LDL
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What are the pre-2013 guidelines for HDL cholesterol levels that are considered “low risk”?
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Describe how LDL receptors are activated and what happens once they are activated
- Decreases in cholesterol induces an increase in LDL-receptors
- This causes endocytosis of LDL and thus a decrease in serum LDL.
- LDL will donate cholesterol to cells
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What are the pre-2013 guidelines for total cholesterol levels that are considered “Desirable”?
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Does the use of Ezetimibe and Simvastatin as combo-therapy cause a decrease in LDL? What about a decrease in cardiovascular disease?
- Does the use of Ezetimibe and Simvastatin as combo-therapy cause a decrease in LDL?
- Yes
- What about a decrease in cardiovascular disease?
- No
What are the general ADRs for statins?
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- What is the regulatory step in cholesterol synthase?
- What kind of regulation does this enzyme have?
- How do statins affect this mechanism?
- HMG-CoA Reductase
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Feedback inhibition
- Cholesterol, the product, will inhibit the enzyme, HMG-CoA Reductase
- Bind to HMG-CoA Reductase as competitive inhibitors, inhibiting cholesterol synthase. The cell then uses the mechanism of increasing LDL receptors to get cholesterol instead of synthesizing it on its own.
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- What are the pre-2013 guidelines for LDL cholesterol levels that are considered:
- The goal for people with very high attack of heart disease
- The goal for people with heart disease or diabetes
- The goal for people who are generally healthy
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What are the main takeaways from the Framingham Heart Study?
- HDL
- High HDL is good, probably independent of other types of cholesterols
- LDL
- Low LDL levels with high HDL levels has the lowest risk of cardiovascular disease
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What statistic is important in remembering the relation to lipid profiles and MIs?
Only 50% of PTs who suffer from an MI have bad lipid profiles
Concerning algorithms for calculating statin use,
- What alarming pattern is seen in older patients?
- What measurement is being considered as an addition to the algorithms?
- Why should the outcome of an algorithm be taken with a grain of salt?
- Healthy old people are recommended to be on statins
- Coronary artery calcium levels
- Many different algorithms. Some may say a PT needs to be on statins and others say they do not need a statin.
What are the pros and cons of PCSK9 inhibitors?
Longterm effects are also unknown
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