Dyslipidemia Flashcards
what is cholesterol
- where does it come from
- how is it carried through the body?
- what is its normal purpose in the body?
cholesterol: a type of lipid within the body which is nonpolar – meaning it cant travel well through the blood!
Cholesterol is taken in (via metabolism) into the body
- animal products (meat, butter egg yolks)
Cholesterol is also made in the body (made in cells)
cholesterol is carried inside a lipoprotein thorughout the body –> lipoprotein is the transport protein complex which contains cholesterol, triglycerides, apolipoproteins all together (these are LDL,HDL, VLDL & chylomicrons)
majority of cholesterol is contained within LDL particles
taken up by the liver and used in
- hormone synthesis (sex)
- creation of membranes (helps the lipid bylayer of cells)
- synthesizes bile acid synthesis
- helps in vit. D synthesis
- too much cholesterol leads to the formation of atherosclerosis
what is a lipoprotein
how are they characterized?
lipoproteins: a transporter for lipids (cholesterol and triglycerides) throughout the body
- they have apolipoproteins on their surface which are able to interact with the blood & the body
the density of the lipoprotein dermines its name!!
Chylomicrons: the least dense of them all (least apolipoprotein)
VLDL: from liver –> transport triglycerides to tissues
LDL: reabsored by liver – highest cholesterol amount
HDL: removes deposits from the vessels
- HDL and VLDL = produced in the liver
- LDL = formed during the breakdown of VLDL
pathogenesis for high cholesterol
- why is it bad?
high cholesterol can lead to atheroslcerosis!!!! ASCVD!!
atherosclerosis leads to…
LDL deposits and begins the atheroslecrosis process
- thrombus formation & clot formation
- ischemia
- aortic anyerusm
- CHD (MI)
ultimately –> mortality!
where is LDL made? what about chlyomicrons?
chylomicrons: carry triglycerides from the DIET through the thoracic duct to circulation to release the triglycerides to the cells for use – remains are dumped into the liver
VLDL: is made in the liver to go circulate and can come back to the liver as LDL
common secondary conditions which affected lipid levels?
- diabetes (insulin resistant) – increased LDL levels and low HDl
- thyroid disease (hypo) besucase TSH plasya role in metabolism of lipids
- obestiy more adipose tissue
- cigareete smoking insulin resistnat, and increase inflammatory response
- alcohol use impacts liver function
- medications OCPs, BB, olanzapen
clinical signs and symptoms of dyslipidemia?
- most pts. will be asymotomatic
if symptoms… - eruptive xanthomas: lipid which pops through skin at places
- if on tendons: like achilles tendon = tendinous xanthomas
- xanthelasma: lipid pop through on the eyelids
screening guidelines for dyslipidemia
ACC/AHA: screen ALL over age 20 for high cholesterol
USPSTF:
1. at age 20 screen those with cardiovascualr RG
2. men without RF: screen at 35
3. men and women without risk factors: no guideline for 20-35 years
scoring tools used to help decide treatment plan for dyslipidemia
factors which are risk enhancing
- ASCVD 10-year risk calculator
- cornary artery calcium score
- identify risk enhancing factors
- family history of disease
- primary hypercholesterol
- metabolic syndrome
- CKD (not end stage)
- chroni inflammatory conditions
- history of pre-eclampsia
- high triglycerides
- high CRP
- high lipoprotiens and apolipoprotein
- abi > .9
who will benefit from treatment for hyperlipidemia
- those with an LDL > 190
- those with a clinical ASCVD
- those ages 40-75, with DM & LDL > 70
- those ages 40-75 with LDL > 70 AND ascvd RISK of >7.5%
Non-pharmacological treatment of high cholesterol
- diet (decrease total fat < 25%)
- exercise & weight loss
- smoking cessasion
- HTN cntrol & DM contorl
- antithrombotic thearpy to reduce risk of CVD
Pharmacologic treatment
- what is first line treatment
- second line?
- statins should not be used in what population
First line treatment: statin thearpy
statins should be avoided in those of childbearing age or those who are currently pregnant
- if the pt. has CVD and is over 75 – continue statin tx.
Second line treatment: Ezetimibe & PSK9 inhibitors
**pt. LDL >70 on statin – add ezetimibe
pt. LDL > 70 on statin & ezetimibe – add PSK9 inhibitor
difference between high intensity and moderate statins?
- LDL lowering capibility by how much
- side effects of statins
how much does ezetimibe lower LDL?
High Intensity Statin: lowers LDL by 50%
Moderate Intesnity: lowers LDL by 30-50%
** side effects: muscle aches**
Ezetimibe: lowers LDL by 15-20%
as additive therapy with statin
when are PSK9 inhibitors used?
when are omega 3 Fatty acids used?
- how much can they lower triglycerides
PSK9: used ass triple tx. with ezetimibe and statin
alirocumab & evolcumab
Omega-3 Fatty Acids: reduce triglycerides by 30%
icosapent ethyl: used when triglycerides are above 150 + have risk factors for a CVD
what are Fibric Acid Derivatives used for?
- names
- side effects
what is Niacin used for?
- side effects
Fibric Acids: gemfibrozil & fenofibrate
- used to increase HDL & decrease triglycerides
- side effects: heaptitis, mysoitis, cholelthiasis
Niacin: decreases LDL
- side effects: hot flases & puritius
what statins are used for high intesnity therapy?
atorvostain & rosuvastatin
