Dyslipidemias: Clinical Features and Evaluation

Question 1

Which of the lipids has the highest correlation to CVD risk?

Answer 1

High levels of LDL are bad and lead to heart disease!

Question 2

Statin Benefit Groups

Answer 2

1. Clinical ASCVD
2. LDL-C > 190 without secondary cause
3. Primary prevention - diabetes, age 40-75, LDL 70-189
4. Primary prevention - w/o diabetes, age 40-75, LDL 70-189 = 7.5% risk from the risk estimator

Question 3

Who should get a lipid panel?

Answer 3

Adults 20 y/o and older every 4-6 years

Question 4

Calculate LDL (because clearly this is the most important)

Answer 4

LDL-C = Total cholesterol - (HDL-C + TG/5)

Question 5

Major risk factors for CHD

Answer 5

1. Age, Male > female
2. African American vs. Caucasian
3. Cigarettes smoking - current
4. HTN systolic >140
5. High total cholesterol
6. Low HDL
7. Diabetes

Question 6

Assessing Acquired causes of dyslipidemia

Answer 6

1. Lifestyle
2. Meds
3. Diabetes (test with glucose, HbA1c)
4. Thyroid disease (TSH)
5. Liver disease (liver function tests)
6. Kidney disease (creatinine, urine protein)

Question 7

LOF of PCSK9

Answer 7

Leads to lower LDL, decreased incidence of heart disease

Question 8

Familial hypercholesterolemia

Answer 8

1. Most often a defect in the LDL receptor
2. Decrease in LDL removal
3. Autosomal dominant
4. Premature death from atherosclerosis

Question 9

Clinical findings of FH

Answer 9

1. Arcus cornealis (lipid deposits at the limbs of cornea)
2. Xanthelasmas (lipid deposits in the skin of the eyelid)
3. Tendinous xanthomas and big ass achilles tendons

Question 10

Levels of triglycerides

Answer 10

1. Normal 500

Age + 100 is upper limits of normal

Question 11

Genetics of hypertriglyceridemia

Answer 11

1. No single gene that explains hypertriglyceridemia

2. A number of SNPs on known and unknown genes have been identified

Question 12

Exam findings associated with severe hypertriglyceridemia

Answer 12

1. Lipemia retinalis
2. Eruptive xanthomas
3. Lipemic serum

Question 13

Familiar broad beta disease (dysbetalipoproteinemia)

Answer 13

Manifest as increases in triglycerides or increased LDL

1. Autosomal recessive
2. ApoE2 rather than E3 or E4
3. Accumulation of chlyomicron remnants and IDL
4. Increased risk for premature CHD

Diagnosis: lipoprotein electrophoresis, apoE genotype

Clinical signs: Palmar xanthomas

Question 14

Low HDL-C importance?

Answer 14

HDL reverses cholesterol transport
Antioxidant and anti-inflammatory effects

Clear assoc. between low HDL-C and increased risk for CVD in many but not all populations.

Question 15

ABCA1 Gene in Severe HDL Deficiency

Answer 15

1. ABC is ATP Binding Cassette
   - Gene family
   - Transmembrane proteins
   - Transport ligands
   - Altered in Tangier disease (orange tonsils) and familial hypoalphalipoproteinemia

Question 16

Acquired Causes of Low HDL

Answer 16

1. Diet (high carb or obesity)
2. Drugs
3. Others (hypertriglyceridemic disorders, sedentary lifestyle)

Question 17

Goals for Tx of Low HDL

Answer 17

1. First reach LDL goal then:
2. Intensify weight management, and increase physical activity
3. If triglycerides are high (>200 mg/dL), consider drug treatment

Can raise HDL by alcohol intake (only modest)

HDL raising drugs are not indicated

Question 18

2 reasons Lp(a) confers risk for atherosclerosis and CHD

Answer 18

1. Proatherogenic

2. Prothrombotic - plasminogen sequence homology blocks fibrinolysis