Lipids in Heart Disease Flashcards

1
Q

Role of lipids

A
  • make up cell membranes
  • absorption of fat soluble vitamins
  • maintain membrane fluidity
  • thermal insulation
  • cellular metabolic regulator
  • hormone synthesis
  • organ padding
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2
Q

CV RF

A
Smoking
High cholesterol
HTN
High blood glucose
Obesity
Age
Gender
FH
Ethnicity
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3
Q

What is cholesterol required for?

A

Synthesis of :
Vitamin D
Bile Salts
Steroid

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4
Q

Role of chylomicrons

A

Transport fats from intestinal mucosa to liver

Release TG and some cholesterol and become LDLs

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5
Q

Role of LDLs

A

Carry fat and cholesterol to bodys cells

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6
Q

Role of HDLs

A

Carry fat and cholesterol back to liver for excretion

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7
Q

Fasting lipid profile

A
Serum total cholesterol
Serum LDL cholesterol
Serum fasting TG
Serum HDL cholesterol
Cholesterol - HDL ratio
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8
Q

2ry hyperlipidaemia causes

A
Diet
Alcohol
Hypothyroidism
Nephrotic Syndrome
Anorexia Nervosa
Obstructive Liver disease
Obesity
Diabetes Mellitus
Pregnancy
Acute hepatitis
SLE
Drugs = thiazides, beta blockers, antiretroviral drugs, antidepressants
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9
Q

Familial Hypercholesterolemia

A
  • hereditary cause
  • codominant
  • heterozygous
  • LDL receptor mutation
  • atherosclerosis high risk
  • tendon xanthoma
  • tuberous xanthoma
  • eye xanthelasma
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10
Q

Familial Combined Hyperlipidaemia

A
  • autosomal dominant

- increased secretion of VLDL

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11
Q

Dysbetalipoproteinemia

A
  • apoE2 = binding defective form of apoE
  • atherosclerosis risk
  • peripheral vascular disease risk
  • tuberous xanthoma
  • striae palmaris
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12
Q

What is the source of cholesterol in blood?

A
  • diet

- synthesises by liver for steroid hormones

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13
Q

What happens when you take in cholesterol from diet?

A
  • converted to chylomicrons
  • LPL (lipoproteinipase) converts it to chylomicron remnant
  • goes to liver
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14
Q

What happens if there is a deficiency of LPL?

A

Increase in chylomicron and less remnant goes to the liver

  • increases in VLDL
  • high cholesterol in circulation
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15
Q

Cause of FH?

A

Gene mutation in pathway which clears LDL from bloodstream

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16
Q

What can FH lead to?

A

Early atherosclerosis and CHD

17
Q

Inheritance of FH?

A

Autosomal dominant

18
Q

Significance of early treatment with FH

A

High risk of premature CHD

Early treatment = near normal LE

19
Q

When should you consider FH?

A

In all adults with total cholesterol greater than 7.5mmol/l

Exclude secondary causes before

20
Q

How to diagnose FH

A

Use Simon Broome Criteria

21
Q

What should patients with definite or possible FH be offered?

A

Referred to specialist lipid clinic for

  • confirmation of diagnosis
  • initiation of cascade testing
  • treatment
22
Q

What are the requirements for definite FH in adults diagnosis according to the Simon Broome Criteria?

A
  • total cholesterol >7.5
  • LDL-C >4.9
  • tendon xanthomata or evidence of these in 1st or 2nd degree relative
    OR
  • identified genetic mutation for FH
23
Q

What are the requirements for possible FH diagnosis in adults according to the Simon Broome Criteria?

A
  • total cholesterol >7.5
  • LDL-C > 4.9
    AND at least 1 of
  • family history of premature CHD
  • family history raised total cholesterol in 1st or 2nd degree relative
24
Q

Causes of tissue lipid accumulation?

A
  • atheromatous plaques

-

25
Q

What is eruptive xanthomata?

A
  • small itchy nodules
  • VLDL/chylomicron associated
  • reversible
26
Q

What is tuberous xanthomata?

A
  • yellow plaques over elbows and knees

- IDL induced

27
Q

What is xanthelasma?

A
  • periorbital skin deposits

- LDL associated

28
Q

What are some examples of tissue lipid accumulation?

A
  • xanthelasma
  • tuberous xathomata (subcutaneous tissue)
  • eruptive xanthomata (subcutaneous tissue)
  • corneal arcus (cornea)
  • extensor tendons/Achilles tendons
29
Q

How does hypothyroidism affect LPL?

A

Reduces activity

30
Q

Causes of high serum CK

A

Ethnicity

Hypothyroidism