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Lab Dx 2 > week 6- CV risk testing > Flashcards

week 6- CV risk testing Flashcards

1
Q

• what are some tests for determining risk of CAD?

A

o Lipid Panel: direct (Total cholesterol, HDL, TGs), Calculated (LDL, VLDL, Ttl Chol/HDL ratio)
o Lp(a): Lipoprotein (a)
o Lipoprotein electrophoresis
o Hcy: Homocysteine
o hs-CRP: Highly-sensitive C-Reactive Protein
o Fibrinogen

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2
Q

• What are some tests for determining cardiac damage?

A 
o	CK: Total Creatine Kinase
o	CK-MB: Isoenzyme of CK, myocardial-bound
o	cTnT: Cardiac TroponinT
o	cTnI: Cardiac Troponin I
o	AST
o	LDH
o	Myoglobin
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3
Q

• Facts on heart dz?

A

o Leading cause of death (M and F), 600,000 americans per year (1/4 deaths) = each minute
o Coronary heart dz MC (385,000 deaths)
o MI every 34 secs in US
o US $108.9 billion each year

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4
Q

• Compare rates of CA and CVD deaths by age:

A

o CA slightly higher in 40s-70s

o >75 CVD rates get much higher

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5
Q

• Rank the US regions with highest heart dz death rates?

A

o South//Midwest
o NE coast
o SW (CA and NV)

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6
Q

• What is the Framingham risk calculator?

A 
o	Estimate 10-yr risk of MI
o	For 20+, don’t have CVD or DM
o	Age and gender
o	Meds for HTN?
o	total cholesterol, HDL, smoker, systolic BP
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7
Q

• what is a lipid panel/lipoprotein profile?

A

o Measures blood cholesterol
o Direct: total chol, HDL, TGs
o Calculatd: LDL, VLDL, ttl chol/HDL ratio

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8
Q

• What are blood lipids?

A

o water-insoluble, extractable by nonpolar (fat) solvents (alcohol, ether)
o = fatty acids, neutral fats, waxes, steroids
o Compound lipids: glycolipids, lipoproteins, phospholipids
o Main groups: cholesterol/esters, glycerol esters (TG), FAs, PLs

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9
Q

• How do lipids move thru body?

A 
o	intestinal mucosa →chylomicrons → liver
o	Chylo (huge) release TGs and some cholesterol to muscle and adapocytes → remnants taken up by liver
o	VLDL, IDL, LDL, formed in liver, carries fat and cholesterol to body’s cells.
o	HDL (tiny) carry fat and cholesterol back to liver for excretion
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10
Q

• What happens when oxidized LDL gets high

A

o →atheroma in walls of arteries → atherosclerosis (foam cells, smooth mm, necrotic core, LDL; bw intima and endothelium)
o HDL can remove cholesterol from atheroma
o Atherogenic cholesterol = LDL, VLDL, IDL

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11
Q

• What is cholesterol?

A

o A sterol, → bile acids, steroid hormones, cell membranes
o Mostly endogenous, made in liver
o Diet influences blood levels 10-20%
o 30-60% in diet absorbed → mixed w conjugated bile acids, PLs, FAs, MGs

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12
Q

• What are normal and critical cholesterol levels?

A

o Adult: 400, look at genetic markers

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13
Q

• What are relative % of cholesterol constituents?

A

o 60-70% LDL
o 25-35% HDL
o Rest is VLDL, chylomicrons
o Day-to-day values can vary by as much as 15%, 8% in 1 day

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14
Q

• What can interfere w total chol measurement?

A

o Seasonal: higher in fall & winter than in spring & summer
o Estrogens: ↓ plasma LDL; PG ↑ all Cholesterols
o Position: Standing higher than sitting; sitting higher than recumbent by 15%

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15
Q

• When are ↑ total cholesterol levels seen?

A

o Type II familial hypercholesterolemia: faulty LDL uptake recpetors, tx resistant
o Hyperlipoproteinemia Types II and III, st IV & V
o Cholestasis; Hepatocellular dz & Biliary cirrhosis
o Nephrotic syndrome; Chronic renal failure
o Pancreatic neoplasms; Hypothyroidism (LDL); DM
o High cholesterol diet; Obesity

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16
Q

• When are ↓ total cholesterol levels seen?

A 
o	Severe liver dz
o	Myeloproliferative dzs
o	Hyperthyroidism
o	Diet: malabsorption, malnutrition, Vegan 
o	Certain chronic anemias
o	Inflammation
o	Acute illness
o	COPD
o	Tangier Dz
o	30-50% drop from baseline 1 week after acute MI
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17
Q

• What are triglycerides?

A

o Most abundant dietary fat; 95% of all fat stored in adipose
o Prime function: energy for cell
o hydrolyzed into FAs, glycerol, MGs in intestines w lipase and bile acids
o →absorption → reconstituted into chylo-microns
o Unlike cholesterol, diet greatly affects levels

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18
Q

• What are normal and critical TG levels?

A 
o	Desirable: < 150 mg/dl
o	Borderline High: 150 – 199
o	High: 200 – 499
o	Very High: > 500
o	Must fast; if >400, need Lp electrophoresis to directly measure LDL
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19
Q

• What can cause increased TG levels?

A 
o	Hyperlipoproteinemia Types I, IIb, III, IV, V
o	Liver disease, Alcoholism
o	Nephrotic syndrome/ renal disease
o	Hypothyroidism, DM, Pancreatitis
o	Glycogen storage diseases
o	MI, Gout, High fat diet
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20
Q

• What can cause dereased TG levels?

A 
o	Severe illness
o	Malnutrition
o	Malabsorption
o	Hyperthyroidism
o	Hyperparathyroidism
o	COPD
21
Q

• What can interfere w TG measurement?

A

o ↑: Transient after food or alcohol, prego, OCPs, acute illness colds flu, smoking, physical inactivity/obesity, drugs
o ↓: Transient decrease after exercise, drugs

22
Q

• What are lipoproteins?

A

o Lipid-protein complexes in which lipids (hydrophobic) are transported in blood
o spherical hydrophobic core of TG or cholesterol esters surrounded by amphophilic mono-layer of PLs, cholesterol, apolipoproteins

23
Q

• what are the 2 types of lipoprotein metabolism?

A

o Exogenous: dietary fat → chylomicrons → glycerol, FFAs, MGs
o Endogenous: chylomicron remnant → liver → VLDL, IDL, LDL, HDL

24
Q

• What are chylomicrons?

A

o Large particles made by intestines, ↑ diet TG (90%), ↓chol, PL, ↓ protein (1%)
o Less dense than water, ↑ lipid:protein ratio, floats
o Cause of “milky” plasma
o lipoprotein lipase → ↓TG = REMNANT.

25
Q

• What is HDL?

A

o 50% protein, mostly apoA-I and II.
o Subclasses: HDL2 and HDL3.
o ↓ apoA-I related to CAD

26
Q

• What are normal and CAD/CHD risk ranges for HDL?

A 
o	Males: 35-65 mg/dl
o	Females: 35-80 
o	Dangerous risk: 	< 25 
o	High CHD risk: 26-35
o	Moderate risk: 36-44
o	Average risk: 45-59
o	Below average: 	60-74
o	No risk: > 75
o	> 60mg/dl is considered protective
27
Q

What can cause ↑ and ↓ HDL levels?

A

o ↑: Regular aerobic exercise, Oral estrogen, Insulin, Genetically increased alpha-lipoprotein
o ↓: Cigarette smoking, Sedentary lifestyle, Obesity, Stress, recent illness, Tangier dz, Acute & chronic liver dz

28
Q

• What are the chol/HDL ratio risks for CHD (M; F)?

A

o ½ avg: 3.4; 3.3
o Avg: 5.0, 4.4
o 2x avg: 10.0; 7.0
o 3x avg: 24.0; 11.0

29
Q

• What is VLDL?

A

o Like chylomicrons, ↑ TG (50%), Chol and PLs (40%), protein (10%).
o Unlike chylomicrons, are endogenous (liver)
o → IDL via LpL
o float, turbid plasma

30
Q

• How does VLDL →IDL →LDL?

A

o HDL passes ApoC-II & ApoE to nascent VLDL in plasma
o LpL hydrolyze VLDL TG in capillary endothelium → ↓size & ↑density =IDL
o IDL returns ApoC-II and ApoE to HDL
o HDL passes cholesteryl esters to IDL in exchange for PLs and TGs =LDL

31
Q

• How is VLDL measured?

A

o Calc of lipid panel: VLDL = TG/5
o valid only if TG < 400 mg/dl in a fasting sample
o If >400, consider lipoprotein electrophoresis (VLDL is the pre-beta band)

32
Q

• What can cause ↑ VLDL levels?

A

o Hyperlipoproteinemia Types IIb, IV, & V
o ↑ cholesterol diet
o DM, Hypothyroidism, Nephrotic syndrome
o Cholestasis, Pancreatitis, Multiple myeloma
o Apoprotein CII deficiency (activates LpL)

33
Q

• What is LDL?

A

o up 50% of total lipoproteins, 50% Esterified cholesterol
o Formed in blood from VLDL
o Doesn’t cause turbidity of plasma, even if high
o deposits free cholesterol on cell surfaces or taken up by LDL receptors on cell surfaces
o carries ~75% blood’s cholesterol to body’s cells
o Excess cholesterol in cells inhibits LDL receptor synthesis (LDL stays in blood)

34
Q

• How is LDL related to atherosclerosis?

A

o ↑ LDL is most directly assoc w CAD & atherosclerosis
o Susceptible to peroxidation
o M0 → foam cells → GFs stim smooth mm, calcification →atherosclerosis

35
Q

• How is LDL measured?

A

o on a Lipid Panel = calculated value (Friedewald’s formula)
o LDL = (Ttl chol)-(HDL)-(TG/5) = Ttl chol-HDL-VLDL
o valid only if TG < 400 mg/dl in a fasting sample

36
Q

• What are lipoprotein subfractions?

A

o small particles w lower cholesterol/apoB ratio
o mb from LDL or HDL
o seen in dyslipoproteinemia, assoc w CAD

37
Q

• What is lipoprotein electrophoresis?

A

o Separates Lps by charge and MW
o highest protein content (HDL) move fastest and farthest
o used ONLY if TG >400
o Not commonly done since Lipid Panel came into use

38
Q

• What are the types of hyperlipoproteinemia?

A 
o	I: Extremely ↑TG dt chylomicrons
o	IIa: ↑ LDL
o	IIb: ↑ LDL and VLDL
o	III: ↑ cholesterol; w B-VLDL; VLDL-C/plasma TG ratio >0.3
o	IV: ↑VLDL
o	V: ↑ VLDL w chylomicrons
39
Q

• What is the Fredrickson classification for lipid-related dzs?

A

o Original method to correlate labs and lipid dzs
o Type; refrigerator test; electrophoresis
o I; + clear plasma creamy top layer; Normal
o IIa; - clear plasma; High b band
o IIb; - cloudy plasma; High b & pre-b
o III; +/- (occult) cloudy plasma; b band
o IV; - cloudy plasma; High a-2 band
o V; + cloudy plasma creamy top; High a-2 band

40
Q

• What is the standing plasma test?

A

o =refrigerator test in Fredrickson classification
o 2 ml plasma in test tube stands at 4o C overnight.
o Chylomicrons accumulate as a floating “cream” layer
o A turbid plasma contains excessive VLDL.

41
Q

• What are normal and critical LDL levels?

A

o Optimal: 189

o Any higher → ↑ risk CAD

42
Q

• What can cause ↑ and ↓ LDL levels?

A

o Primary ↑: Hypercholesteremia, Familial Type II Hyperlipidemia
o 2nd ↑: High cholesterol diet, DM, Hypothryoidism, Nephrotic syndrome, Chronic renal failure, Prego
o ↓: Severe illness, Hypolipoproteinemia/A-beta-lipoproteinemia (beta is LDL), Oral estrogen, Hyperthyroidism

43
Q

• What are the apolipoproteins?

A

o hydrophilic part of lipoproteins (for micelles)
o ApoA: major protein of HDL; ApoA-I activates LCAT (esterifies cholesterol in plasma)
o ApoB: major protein (95%) of LDL.
o ApoC: major protein of VLDL. ApoC-II activates LpL
o ApoD and ApoE

44
Q

• What are the 2 recommendations to check lipid panel?

A

o ATP of NCEP: start at 20, then every 5 years; ttl chol, LDL, HDL, TGs; fasting
o US preventative: F 45+, M 35+; total chol & HDL every 5 yrs; if ttl >200 or HDL<40 get fasting; start at 20 if FHx/risk factors

45
Q

• How should patient prepare for lipid panels?

A

o Cholesterol: Non-fasting acceptable for screening; 12-14 hr fast for dx
o HDL/LDL Cholesterol, TGs, apo-Lp’s: 12 hr + fasting

46
Q

• How is hyper-TG-emia dx? Tx?

A

o M > 160 mg/dL; F > 135 mg/dL

o 500: diet and drugs

47
Q

• What are risk factors for hyper-TG-emia?

A

o Alcoholism, meds, OCPs, prego
o DM, Glycogen Storage Dz, Hypothyroidism
o Hypertension, Hyperuricemia
o Pancreatitis, Renal do

48
Q

• What are risk factors for CHD?

A

o Cerebrovascular dz
o Cigarettes >10/day
o DM, HTN (or BP meds), Male
o Age: M >45, F >55, or premature menopause
o FHx: premature CHD, 30%
o Poor diet
o High lipids, low HDL (hi HDL >60 = NEG risk factor)

49
Q

• What has the trend been in smoking and obesity?

A

o Since 1970s, smoking has ↓, obesity has ↑

o Is there a trade-off for dzs??

Lab Dx 2 (8 decks)

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