Dyslipidemia Part II Flashcards
(149 cards)
1
Q
Global lifestyle modification approach?
A
- Diet
- Weight management
2
Q
Why is weight management indirect cause of dyslipidemia?
A
Will serve to lower HDL levels, not our number one priority
3
Q
Weight loss can cause __
A
Decreased LDL, HDL and TG. After maintenance, HDL will increase
4
Q
PA of 1200-2200 kcal/week on lipids?
A
Decease TG and LDL while increasing HDL .. compares to the effects of medication.
5
Q
________ exercise has the greatest benefits while ____ has little effect
A
Volume/Intensity
Resistance
6
Q
Who set the stage that dietary cholesterol increases cholesterol in circulation?
A
Ancel-keys
7
Q
What did the predictive equation show?
A
The constant relating to the change in sat fat is higher than the change inc cholesterol and PUFA
8
Q
Limitations of predictive equations?
A
- Not all sat fats the same
- We now measure lipid fractions (measures total cholesterol)
- Assumes MUFA and CHO are neutral
9
Q
Key point from Ancel-Keys 7 country study?
A
High cholesterol increases with mortality, EXCEPT for Crete - med diet and protective effects.
10
Q
(T/F) Everyone responds to dietary cholesterol
A
False
Compensators (2/3) vs. non-compensators (1/3)
11
Q
______ decease in dietary cholesterol results in 0.05-0.2 mmol/L decrease in TC
A
100 mg/day (not huge)
12
Q
How does increased blood cholesterol impact LDL receptors?
A
Reduce activity of receptors in the liver, and the cholesterol in storage will decrease synthesis and will inhibit any further uptake from bloodstream –> Cholesterol remains in the bloodstream,
13
Q
What are other effects of high blood cholesterol?
A
- Increase CM and remnants
- Increase VLDL
- Interferes with ability of HDL to clear cholesterol
14
Q
(T/F) Cholesterol always linked with fat content
A
False, such as in seafood
15
Q
Why should we NOT limit fat?
A
Because if we sub with simple CHO, will increase TG and decrease HDL
16
Q
Recommended vs. current intake of fat?
A
25-35%
34-27%
We need to focus on QUALITY
17
Q
What may decrease HDL?
A
Very low fat diets
18
Q
What is the effects of SFA?
A
- Decrease clearance of VLDL and LDL
- Reduce LDL receptor activity
- Reduce transcription
19
Q
How does SFA interact with phospholipids?
A
Alter PL composition of cell membrane and influence activity and binding by changing the lipoprotein surface
20
Q
Goal of SFA?
A
<10% calories
21
Q
Issue in NA and SFA?
A
Consuming LARGE amounts of foods than contain moderate amounts of SFA (processed foods)
22
Q
What is the controversy with SFA?
A
Will increase HDL alongside LDL, and clear link between SFA and CVD is not clear
23
Q
Replacing SFA with MUFA PUFA =
A
Improve lipid profile and CVD risk
24
Q
What is the recommendation in Canada on SFA?
A
Currently no limit, but instead focus on healthy balanced diet, more MUFA and PUFA and less processed sources of SF
25
MC SFA
Caprylic and Caproic
26
IC SFA
Lauric
27
LC SFA
- Myrstic
- Palmitic
- Stearic
28
Carylic/Caproic?
No effects on scerum cholesterol
29
Lauric?
Increase LDL and HDL
30
Myristic?
Incease LDL
31
Palmitic?
Increase LDL, but usually only in presence of high dietary cholesterol
32
Stearic?
Neutral effect compared to other SFAs
33
Which SFA increase LDL? (LMP)
Lauric
Myristic
Palmitic
34
MCT <10 have ____
no effects on serum cholesterol
35
SFA have no effect on ___
VLDL
36
How does SFA from dairy products pose a neutral CVD risk?
Raise LDL but augment size of particles - and less atherogenic
37
_____ of cheese does not have the negative impact on CVD risk such as butter
Physical matrix
38
Coconut oil is mostly ____ which increases LDL and HDL
Lauric
39
(T/F) Chicken fat is mostly SFA
False, is mostly PUFA (not all animal fats are SFA)
40
Oleic acid -->
Eicosatrienoic acid
41
Linoleic acid (omega 6) -->
Arachidonic acid
42
Linolenic acid (omega 3) -->
Docosahexanoic acid
43
When we replace SFA in the diet with PUFA, such as omega-6. The LDL-lowering effect is partly passive, why?
Omega-6 will increase LDL clearance by suppressing the effects of SFA
44
When can omega-6 negatively impact lipid profile?
A diet very rich in PUFa may decrease HDL and apo-AI especially if >10% of total kcal.
45
What may a high PUFA diet do?Why?
- Increase inflammation and increased oxidative damage to LDL
- Double bond formation of PUFA means it is more susceptible to oxidation
46
PUFA goal %?
Goal is 5-10% of calories
47
MUFA % goal?
No more than 20% total calories
48
Compared to PUFA, MUFA does not ____ and is beneficial when substituted from ___
lower HDL
| SFA
49
Advantages of MUFA (4)
- Do not decrease HDL
- Less oxidation
- Do not increase TG
- Do not increase cancer
50
Dietary sources of linoleic acid
- Safflower oil
- Sunflower oil
- Soybean oil
- Corn oil
51
Dietary sources of oleic acid
- Olive oil
- Canola oil
- Peanut oil
- Nuts
52
What are the two animal sources of Omega-3?
EPA: Eicopentanoic acid
DHA: Docahexanoic acid
53
What is the plant source of omega-3?
Alpha-linolenic acid
54
Omega-3s do what in hyperlipidemic patients?
Decrease TG
55
There is an inhibition of ____ associated with consumption of Omega-3
VLDL-TG
56
(T/F) Omega-3s decrease LDL
False, they decrease content of TGs synthesis within the VLDL particle
57
What is the key role of Omega-3 and decreasing CVD risk?
Reducing platelet aggregation and prevent coronary thrombosis, retard the proliferation of fibroblasts
58
(T/F) Evidence is strong enough in omega-3 and CVD risk to recommend supplements
F
59
How do omega-3s impact the progression of atherosclerosis?
By preventing the inflammation that occurs in atherosclerosis
60
How do trans-fats render LDL more atherogenic?
By increasing number and decreasing size
61
What are the other disadvantages of trans-fats?
- Reduce HDL
| - Increase inflammatory markers and endothelial damage
62
Goal for fibre? From grains/cereals?
20-30 g/day where 50% should be soluble (cereals and grains)
63
What does soluble fibre decrease?
Total C and LDL-C
64
What is another benefit of fibre?
Lower energy and fat intake
65
Overconsumption of simple carbs will increase __ and decrease
VLDL-TG
| HDL-C (as TG are increased)
66
What will overproduce VLDL-TG without excess/overconsumption?
ANY consumption of high fructose corn syrup
67
How does excess carbs result in more TGs?
Lead to accumulation of Acyl-Coa (Glycogen limit exceeded) and will be destined for TG synthesis.
68
Does fructose in fruits cause same effect as HFCS?
NO -due to small amounts
69
Disadvantages of high CHO diet?
- Decreased HDL and increased TG
- HyperTF
- May increase blood glucose and hyperinsulinemia
70
What may elevate HDL and inhibit cell-mediated oxidation of lipoproteins?
Red wine
71
Which polyphenol is found in alcohol?
Reveratrol
72
(T/F) Consumption of alcohol is recommended especially for those with established CHD
False
73
What does alcohol inhibit? When should it be avoided?
Acyl-CoA --> TG
| Avoid in hypertriglyceridemia
74
Effects of soy-protein?
Reduction in TC, LDL-C and TG without an effect on HDL-C in patients with or without CVD
75
What is found in soy protein?
Isoflavones and phytoestrogens
76
What is the US and Canada Health claim about soy protein ?
25 grams of soy protein as part of a diet low in cholesterol and saturated fat may reduce the risk of heart disease
77
How do antioxidants reduce atherosclerosis risk?
Inhibit LDL-ocidtion
78
Should we supplement with antioxidants?
No firm recommendations - focus on varied diet
79
When do levels of homocysteine increase risk of heart disease?
If greater than 14 umol/L
80
Each increase of _____ of fasting concentration of homocysteine will increase CVD by ____
5 umol/L
| 1.6-1.8 fold
81
Elevated homocysteine levels appear in up to ___ of patients with CVD
40%
82
When are folate supplements recommended?
In persons with high levels of hct or family history of CVD
83
(T/F) Low levels of B12 are associated with an increased risk of CHD
False, low levels of folate are. B12 has not been associated
84
Phtyosterols and stanols are plant cholesterols which will compete with cholesterol absorption, and increasing fecal excretion. What is the main source?
Fortified margarines (hard to obtain recommended amount in natural foods)
85
Nuts are rich in what? Which nut is rich in SFA?
- MUFA, PUFA
| - Brazil nuts
86
What else are nuts rich in?
- Protein
- Soluble fibre
- Folic acid
- Antioxidants (NO precursor)
87
_____ of nuts reduced risk of CHD and moderate intake improves ___
High intake
| endothelial function
88
(T/F) There is a signifiant impact of nuts on body weight
False
89
What is the FIRST target in the dietary approach for dyslipidemia?
Lowering LDL-C
90
What is the TLC model?
Therapeutic Lifestyle changes
91
What does TLC recommend in terms of SFA and cholesterol for those who are at higher risk?
<7% SFA and <300 mg cholesterol
92
SFA recommendations?
<7% of E
93
Trans fat ?
Avoid
94
PUFA?
Increase omega-3s form fish
95
MUFA?
Use MUFA and PIUFA to replace SFA
96
Cholesterol?
<200 mg/day for those with dyslipidemia and at high risk
97
Total lipids?
<30%
98
CHO?
Reduce simple and refined, choose whole grains
99
Fibres total and soluble fibres?
Increase F&V and 10-25 g/day
100
Protein?
Increase soy protein and nuts to replace animal protein
101
Sterols?
Increase intake
102
What were the results of the Med diet in the PREDIMED trial?
30% decrease in CV events., decreased LDL, apo-B and TG while HDL increases
103
Secondary prevention is what?
Preventing CVD after CVD events
104
What did the Lyon study find regarding the medi diet and secondary prevention?
70% mortality post-MI
105
Describe the portfolio diet
Low in SFA
High in phytosterols, soy protein, soluble fiber, almonds
Vegetarian
106
How much LDL decrease on portfolio diet compared to low-fat diet + statins?
Portfolio: 29%
| Low-fat + statin: 31%
107
What else decreased in the portfolio diet?
CRP
108
What is a disadvantage of the portfolio diet?
Adherence is low (~40-45%)
109
What dietary factors increases HDL?
- SFA
- Dietary choleserol
- Alchohol (<2 drinks faily)
110
What non-dietary factors increase HDL?
- Long term aerobic exercise
- Estrogen
- Female sex
111
What dietary factors decrease HDL?
- Simple sugars/high-carb diet
- PYFA
- Obesity
112
What non-dietary factors decrease HDL?
- Androgens
- Male sex
- Anabolic steroids
- Anti-HTN drugs
- DM
- Cigarettes
113
First line of medicatins?
statins
114
BAS?
Block the enterohepatic reabsorption of cholesterol, increase excretion and may increase LDL receptors
115
PCSK9 inhibitors?
Monoclonal antibodies block PSCK9 (enzyme), which will prevent the catabolism of the LDL-receptor which typically undergoes endocytosis and is degraded.
116
Fibrates and Nicotinic acid?
Will aim on lowering TG in bloodstream by inhibiting VLDL production while enhancing LPL activity (more TG to tissues, less to blood)
117
Effects of statin?
-Decreased LDL and TG while HDL increase
118
Cholesterol absorption inhibitor examples?
-Ezetimibe
119
BAS examples?
- Cholestryamine
| - Colestipol
120
CAI effects
Decrease LDL
121
BAS effect?
Decrease LDL
122
PCSK9 examples?
Evolucumab
| Alirocumab
123
PCSK9 effects?
+++ decreased LDL
124
Fibrate examples?
Gemfibroil
| Fenofibrate
125
Fibrate and nicotinic acid effects?
Decrease TG and LDL (more TG) while increasing HDL
126
Nicotinic acid examples?
Nicotinic acid slow release
127
Besides decreasing the endogenous synthesis of cholesterol, what else do statins do?
- Decrease VLDL production, less remnants, less LDL
- Enhances clearance of VLDL remnant and LDL
- Increased activity of LDL receptors
128
What are the adverse effects of statins?
-Myalgia, myopathy, increased liver enzymes, low risk of diabetes
129
Which statin negatively interacts with grapefruit?
Simvastatin
130
What is the first step to prevent non-statin add-on therapy
Maximize behavioural modifications and statin dose
131
What can be suggested to add on if targets not yet met?
Ezetimibe/BAS as first line, then PCSK9 as second line
132
Side effects of ezetimibe?
GI problems, diarrhea, rash, fatigue, muscle weakness and pain
133
What may increase VLDL-C and VLDL-TG transiently, and decrease absorption of fat and liposoluble vitamins?
BAS (Cholestryamine)
134
Side effects of BAS?
Significant constipation
135
Side effects of PCSK(?
Diarrhea, muscle and joint pain
136
Target TG level for high risk?
None, but usually should be <2.6 mmol/L
137
What are the interventions for hyperTG?
Health behaviour interventions, then fibrates may be recommended in pateitns with extreme hyper TG (>10mmol/L)
138
____ may pose No risk depending on genetic type
HDL-C
139
When are fibrates used?
Highly elevated TG (Familial TG)
140
Fibrate side effects?
Gi reactions, taste changes. abdominal pain
141
Fibrate contraindications?
Hepatic/renal dysfunction, gallbladder disease, do NOT combine with simvastatin
142
What drug is used for hypercholesterolemia, hypertriglyceridemia and hypoalphalipoproteneima?
Nicotinic acid
143
Which drugs are NOT recommended to add-on to statin therapy?
Nicotinic acid and fibrates
144
What is the issue with nicotinic acid?
Only 50-60% can tolerate, GI distress, skin flushing, itching, hepatotoxicity, arrhythmia
145
What may nicotinic elevate?
Liver ALT and blood glucose levels
146
What may be recommended to reduce side effects of nicotinic acid?
- ASA to reduce flushing
- Extended release
- Monitor uric acid levels
147
What may cause reversible increases in plasm creatinine?
Fibrates
148
When must renal function and lipid parameters be monitored?
Fibrates
149
In combination with statin therapy, which drugs saw further reduction on CVD events?
Ezetimibe
