Chapter 13 - Hyperlipidemia Flashcards
5 major lipoproteins
1) Chylomicron 2) VLDL 3) IDL 4) LDL 5) HDL
Chylomicron distinguinshing particle
one Apo B48
VLDL particle distinguishing feature
Apo C and E and Apo B-100
Adult treatment panel 3 guidelines on levels of LDL, HDL, TG
TABLE 13.2
MARS study on IDL
associated with carotid artery intima-media thickness
Another name for IDL
Remnant lipoprotein
LDL receptor
Discovered by Nabel and Braunwald (nobel prize 1985) liver has 70% of this higher expression means better = lower circulating LDL level reduces with syndrome X
HDL protein and physiology
Liver secrets Apo A-I = no lipid Forms cholesterol ester by lecithin-cholesterol acyltransferase HDL spherical –> return to liver
Reverse cholesterol transport
HDL exchange cholesterol for TG from VLDL through cholesterol ester transfer protein (CETP)
Atherosclerosis steps
Mononuclear cells in blood –> cholesterol enriched Intracellular droplets of cholesterol accumulate –> foam cells Foam cells adhere and damage endothelium –> migrate to intima layer Foam cells accumulate under endothelium = fatty streak APOPTOSIS lipid spills out = lipid core of atherosclerotic plaque Wall expand = positive remodeling plaque thicken and encroach lumen = negative remodeling cap break = platelet rich clot = thrombosis
Most predictive lipoprotein fraction for determining atherosclerotic risk
LDL-C
Non-HDL-C =
LDL-C + IDL-C + VLDL-C + lipoprotein A
Risk factors for CHD otherthan elevated LDL-C
1) smk 2) HTN > 140/90 3) low HDL < 40 4) FHx 5) age > 45 male; > 55 female
Family history that counts towards CHD risk factor
1) CHD in male 1st degree relative < 55 years 2) CHD in female first degree relative < 65 years
ATP pannel 1, 2 and 3 recommenadtions
ATP-1 = education and lifestyle intervention ATP-2 = patient with known CHD should have more aggressive LDL-C target ATP-3 = aggressive approach to risk assessment and therapy
CHD risk equivalents
1) other clinical forms: PAD, AAA, symp Carotid 2) diabetes 3) multiple risk factors with 10 year risk CHD > 20%
Comparison of LDL and non-HDL target by risk ATP-3
TABLE 13.3
ACC/AHA guidelines on targets for LDL-C and non-HDL-C at different risks
TABLE 13.4
ATP 3 treatment target and when to start TLC and DRUGS
TABLE 13.5
PREDIMED study in Spain
7447 patients with CVD risk Mediterranean diet supplemented with olive oil or nuts –> decrease major CV events
Essential components of therapeutic lifestyle changes
LDL-RAISING NUTRIENTS 1) sat fat < 7% total calories 2) dietary cholesterol < 200 mg/day LDL lowering 1) plant stanols/sterols 2g/day 2) soluble fiber 10-25g/day 3) total calories to prevent weight gain 4) physical activity to expend 200 kcal/day
Statin effect on LDLC HDLC
Lower LDL-C by 18-60% HDLC 5-20% TG 7-30% additional double statin dose = 6% reduction LDLC
Side effect of statin
1) transient elevation of transaminase level 2) rhabdo 4/10000
Contraindication to statin use
ABSOLUTE 1) active/chronic liver disease RELATIVE 1) cyclosporine, macrolide, antifungal, cytochrome P450 inhibitor (fibrates, nicotinic acid)
