Lipid Disorders Lecture Powerpoint

Question 1

Genetic dyslipidemia

Answer 1

Genetic predisposition to excessive LDL levels regardless of diet and lifestyle often (not due to obesity or other controllable circumstances)

Question 2

LDL

Answer 2

Low density lipoprotein, a source of vascular disease thru deposition in the form of plaque buildup on vessel walls

Question 3

HDL

Answer 3

High density lipoprotein, act via reverse transport mechanism of LDL deposition removing plaque buildup and bringing it back to the liver, acting cardioprotective against heart disease

Question 4

Fatty streak development

Answer 4

Intracellular lipid accumulation in the early stage progression of atherosclerosis, often seen in ages 4-5 in about 50% of patients and indicative of slight increasing endothelial dysfunction (but does not manifest with any clinical symptoms and is clinically “silent”)

Question 5

Stable plaque vs vulnurable plaque

Answer 5

Stable - a buildup of cholesterol that has fibrous scar tissue forming around it as well as migrating smooth muscle tissues that narrow the lumen of the artery (fibrous plaque)
Vulnurable - occurs in more advanced stages of atherosclerosis, where scar tissue has calcified over and if endothelium is damaged collagen is exposed causing platelets to aggregate and clot forming a thrombus at risk for embolism

Question 6

Arteriosclerosis

Answer 6

General term for several diseases resulting from hardening of the arteries either by atherosclerosis (plaque deposition) arteriosclerosis (prolonged hypertension, DM), or monckeberg’s arteriosclerosis (Ca2+ deposition in small to med sized arteries)

Question 7

Atherosclerosis

Answer 7

Most common type of arteriosclerosis and caused by fatty tissue deposition and plaque formation that eventually calcifies over

Question 8

Leading cause of death in US

Answer 8

Coronary heart disease

Question 9

Vascular dimentia

Answer 9

A potential consequence of atherosclerosis occlusion resulting in chronic decreased blood flow to the brain, other causes could be acute episodes such as stroke, hypoxia, etc.

Question 10

Ethnicity and coronary heart disease and theory as to what impacts it

Answer 10

Blacks and hispanics > whites, thought to be due to increased obesity and diabetes levels in these populations

Question 11

Dyslipidemia definition

Answer 11

Elevated plasma conc. of either total or LDL cholesterol, or low HDL, can be primary (genetic) but can also be secondary

Question 12

Funduscopic exam for heart disease

Answer 12

One of the only spots in the body we can visualize vessels and potential plaque build up, a staple of work up for heart disease as allows for visualization of dilated or broken vessels as well as fatty streak deposition

Question 13

Xanthelasma/tendon xanthomas

Answer 13

A condition seen in primary genetic dyslipidemia leading to cutaneous manifestations of cholesterol deposits on the joints and palms (and eyelids lol)

Question 14

Most common familial hyperlipidemia and what is elevated?

Answer 14

Type IIa, LDL

Question 15

Most common hyperlipidemia in those with metabolic disorders and what is elevated?

Answer 15

Type IIb, LDL and VLDL

Question 16

Most common hyperlipidemia in diabetics and what is elevated?

Answer 16

type IV, VLDL

Question 17

Primary vs secondary dyslipidemia (3 things that can cause secondary elevated LDL)

Answer 17

Primary is genetic, Secondary is due to other underlying conditions such as DM, steroid treatment, and thyroid disease

Question 18

2 medications that can cause 2ndary elevation of triglyceride or drop in HDL

Answer 18

• B blockers

- thiazide diuretics

Question 19

Metabolic syndrome

Answer 19

A condition characterized by 3 of the following

• abdominal obesity (>40 inch males and 35 inch in females)
• HDL below 40mg/dL male and 50mg/dL female
• hypertension >130/85mmHg
• elevated fasting glucose to either pre-diabetic (>110mg/dL) or diabetic stage (>125mg/dL)

Question 20

Fasting lipid profile

Answer 20

A sampling with no food for 12 hours before to measure total cholesterol, LDL-C, HDL, and triglycerides

Question 21

Before we could request directly measured LDL, had to calculate LDL-C using this formula

Answer 21

LDL-C=TC-HDL-(trig/5)

Question 22

Apolipoprotein B100 serum lab study and healthy values

Answer 22

Measurement test of secondary marker for LDL measuring a substrate of LDL indicating risk of developing cardiovascular disease, with normal values below 100mg/dL

Question 23

___LDL particles are more atherogenic than ___ ones

Answer 23

Smaller, larger

Question 24

Lpa serum lab study

Answer 24

A measurement test that detects levels of lipoprotein a, a component in HDL and LDL in blood, elevated value puts at risk for foam cell development and decreased thrombolysis putting them at higher risk for cardiovascular disease

Question 25

Ultra sensitive CRP and homocystine serum lab studies

Answer 25

Measurement test that detects non specific marker of inflammation that could be indicating increased inflammation of vessels and heart putting patient at risk for heart attack, but could also be due to any number of inflammatory conditions or infection

Question 26

CPK serum lab studies

Answer 26

Measures CPK in blood stream, a biproduct of muscle tissue breakdown, elevated in conditions such as rhabdomyolysis or heart disease and administered prior to starting lipid lowering therapy

Question 27

Screening guidelines for hyperlipidemia

Answer 27

• fasting lipid profile in all pediatric patients age 9-13 (2 readings 13 weeks apart)
• screen adults if not screened as child starting at initial visit
• high risk repeat screening at 25-30 for males or 30-35 for females
• if low risk (serum lipid profile) then repeat screening at 35 for males 45 for females
• screen every 5 years of sooner if change in clinical status

Question 28

Dyslipidemia/cardiovascular disease lifestyle modifications that should be recommended to patients(2)

Answer 28

• low fat, low cholesterol diet

- 30 min of sustained aerobic exercise daily

Question 29

Bile acid sequestrants

Answer 29

Dyslipidemia pharmacologic treatment option minimally effective and act only on gut absorption, used in kids or pregnancy

Question 30

HMG co-reductase inhibitors (statins)

Answer 30

Dyslipidemia/hypertriglyceridemia pharmacologic treatment option to lower LDL production in liver, can cause rhabdo or liver dysfunciton in some rare cases, and require LFT and TSH monitoring while on medication as well as baseline CPK

Question 31

Ezetimibe (zetia)

Answer 31

Dyslipidemia pharmacologic treatment option that systemically blocks cholesterol absorption at the bowel, can cause abdominal pain or diarrhea, and requires LFT and CPK monitoring while on medication

Question 32

Fibrates

Answer 32

Hypertriglyceridemia pharmacologic treatment option that inhibits triglyceride synthesis and stimulates catabolism of triglyceride lipoproteins, can cause abdominal pain or diarrhea or pancreatitis, requires LFT and pancreatic enzymes monitoring while on medication

Question 33

Statin therapy intensity indications

Answer 33

Low intensity - dietary changes to decrease LDL-C by <30%
Moderate intensity - those who don’t already have a vascular event or diabetes but need therapy to lower LDL-C by 30-50%
High intensity - those with history of vascular event or diabetes and need to lower LDL-C by >50%

Question 34

LDL >190 indicates a need for…

Answer 34

….high intensity dosing therapy

Question 35

Statin therapy in children

Answer 35

Often considered if there is family history of dyslipidemia or co-morbidities such as congenital heart disease or diabetes, considered if patient fails lifestyle modifications

Question 36

Statin therapy and pregnancy

Answer 36

Contraindicated!!! can be replaced with less effective bile acid sequestrant

Question 37

Patients with triglycerides greater than ___mg/dL are at risk for developing ___ and therefore require ____ therapy if triglycerides exceed ___mg/dL

Answer 37

1000mg/dL, Spontanous pancreatitis, fibrate, 500

Question 38

Lipid definition

Answer 38

Combination of cholesterol and triglycerides carried i lipoproteins thru the blood, produced in the liver and obtained thru diet

Question 39

Thrombus

Answer 39

A blood clot that forms in a vessel reducing flow thru the vessel and has a risk of embolism

Question 40

Embolism

Answer 40

Anything, but most often a piece of a thrombus that has broken free, that travels thru the blood stream and occludes a vessel further downstream

Question 41

Monckeberg’s arteriosclerosis

Answer 41

Degenerative poorly understood condition where Ca2+ deposition causes arteriosclerosis separate from any other atherosclerosis that might be occurring in the body

Question 42

Lifestyle factors that contribute to increased triglycerides and decreased HDL (4)

Answer 42

• DM
• lack of exercise
• alcohol
• renal insufficiency or B blockers/thiazide diuretics

Question 43

Framingham study shows risk of recurrent MI is ___x greater in women and ___x greater in men whose cholesterol levels are greater than ___mg/dL

Answer 43

9, 4, 275

Question 44

Hyperlipidemia primary prevention guidelines

Answer 44

-Calculate CVD risk model and if greater than 7.5% may discuss options of starting statin therapy with patient (which sees 20-30% reduction in risk depending on pros and cons as the patient sees fit

Question 45

Hyperlipidemia secondary prevention guidelines

Answer 45

-begin statin therapy independent of baseline LDL levels, if patients do not acheive <70 mg/dL LDL (monitored every six weeks) then maximize statin therapy and consider adding a second agent (Ezetimibe)