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Flashcards in Hyperlipidemia Deck (59):
1

stabilized plaques have what that keeps them from rupturing 

  • thick fibrous cap 
  • small lipid pool

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2

coronary heart disease 

narrowing of the small blood vessels that supply blood and oxygen to the heart 

3

list the modifiable risk factors of CHD

  • HTN (BP > 140/90 or on antihypertensive)
  • hyperlipidemia or HDL < 40
  • DM
  • tobacco use
  • obesity
  • physical inactivity 

4

what HDL values are a negative risk factor for CHD

> or = 60

5

list the non-modifiable risk factors for CHD

  • gender: men > women
  • age
  • FHx
    • men < 55; women < 65
    • MI/CV death in first degree relative < 45 yo

6

Knowing the hyperlipidemia is one of the major modifiable risk factors for CHD, what is the primary target for therapy 

LDL

7

only 15% of MIs are due to "tight blockages," majority of MIs are caused by what

lesions with < 50% stenosis 

  • "vulnerable plaques" 

8

vulnerable plaques 

  • these plaques are filled with a lipid core and lipid laden macrophage foam cells and inflammatory cells
    • foam cells produce tissue factor, a potent pro-coagulant that stimulates thrombus formation when in contact with blood
    • thin fibrous caps seperate lipid core form blood in artery lumen
  • plaques rupture and cause thrombosis, resulting in MI

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9

cholesterol is necessary and essential to formation of ?

  • bile acids
  • vit D
  • progesterone
  • estrogens
  • androgens
  • glucocorticoid hormones
  • mineralocorticoid hormones

10

what are the two main lipids in blood 

  • cholesterol
  • triglycerides
    • both are carried in lipoproteins 

11

lipoproteins, the higher the lipid content, the lower the density. List the classification of lipoproteins based on their lipid content 

  1. chylomicrons: high lipid content, low density
  2. VLDL: very low density lipoproteins
  3. LDL
  4. HDL: lowest lipid content

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12

traveling pathway of chylomicrons 

  • derived from dietary fat
  • travel via portal vein into liver 
  • liver to thoracic duct into circulation 

13

which lipoprotein is this

  • manufactured in the liver from stores of fat and carbohydrates
  • consists mainly of triglycerides 

VLDL

14

which lipoprotein is metabolized to LDL

VLDL

15

normal function of LDL

  • delivers cholesterol to cells in organs where it is used for cell membrane biosynthesis and bile acid synthesis in liver
  • about 70% of LDL is take up by the liver (via LDL receptors) and cholesterol they contain is excreted into bile 

16

how/when does LDL promote atherosclerosis 

  • increased LDL in arterial endothelium
    • consume large amt of saturated fatty acids and/or cholesterol
    • have defects in LDL receptor (familial hypercholesterolemia) 

17

name three ways to reduce LDL

  • decrease cholesterol synthesis: HMG-CoA reductase inhibitors (Statins)
  • increase cholesterol excretion
    • bile acid sequestrants bind to bile acids and block normal reabsorption
  • decrease cholesterol absorption

18

what lipoprotein consists of apoproteins and cholesterol 

HDL

19

function of HDL

  • participates in reverse cholesterol transport
    • transfers cholesterol into other lipoproteins or directly into liver 
  • increased HDL is cardioprotective
  • risk of MI increases by 25% for every 5 mg/dl below median values

20

name 4 things that increase HDL

  • exercise
  • estrogen
  • alcohol (1-2 drinks/day)
  • niacin 

21

name factors that decrease HDL

  • obesity
  • hypertriglyceridemia
  • smoking
  • anabolic steroids

22

what is primary hyperlipidemia 

  • familial - inherited - rare
  • most due to genetic defect in LDL receptor
  • can result in premature coronary heart disease 
  • **screen first degree family members of those with premature ASCVD (atherosclerotic CV disease) 

23

what is secondary hyperlipidemia 

  • acquired
  • common

24

premature arcus senilis 

gray or white arc visible above and below the outer part of the cornea

  • can be seen in severe hyperlipidemia 

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25

xanthelasma 

  • cholesterol filled, soft, yellow plaques that usually appear on the medial aspects of the eyelids bilaterally
  • occuri n 75% of older patients with familial hypercholesterolemia
  • benign lesions

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26

tuberous xanthoma 

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yellow-orange nodules up to 2 cm in diameter, often located over knees and elbows

27

eruptive xanthomas 

  • red-yellow papules
  • triglycerides > 1000

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28

Lipemia retinalis 

  • cream colored blood vessels in fundus
  • triglycerides > 2000

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29

screening for cholesterol/triglycerides should be done via 

  • fasting lipid panel 
    • cholesterol not affected much by eating but triglycerides are greatly affected

30

acutely ill patients can have what happen to cholesterol levels 

can have falsely low levels

31

american academy of family physicans screening protocol 

  • males > or = to 35 yo
  • females > or = to 45 yo

32

desirable, optimal lipid panel values for total cholesterol, triglycerides, LDL, and HDL

  • total cholesterol: < 200
    • total cholesterol = HDL + LDL + VLDL
  • triglycerides: < 150
  • LDL: < 100
  • HDL: > or = 60 

33

(NCEP III) adult treatment panel (ATP) III lipid screening protocol. Who? What? how often?

  • adults aged > or = 20
  • complete lipid panel
  • how often: every 5 years if 0-1 risk factors 

34

what are the major risk factors that modify LDL goals 

  • cigarette smoking
  • HTN
  • low HDL
  • family hx of premature CHD
  • age
    • men > 45
    • women > 55
  • ***HDL > 60 is a negative risk factor

35

treating lipids: what is ATP III protocol (step wise approach) 

  1. complete fasting lipid profile
  2. identify CHD risk equivalent
  3. determine presence of major risk factors
  4. if 2+ risk factors are present (with or without CHD equivalent), assess 10 year CHD risk 
  5. establish LDL goal
  6. initiate therapeutic lifestyle changes if LDL above goal 
  7. add drug
  8. identify metabolic syndrome

36

what are  CHD risk equivalents

 

  • CAD

  • Peripheral artery disease

  • AAA

  • DM

37

 you can assess 10 year CHD risk using what calculator? what are the three levels of 10 year risk

framingham risk calculator 

  • inputs
    • age
    • gender
    • total cholesterol
    • HDL
    • smoker
    • systolic BP 
  • three levels of 10 year risk
    • > 20% CHD equivalent
    • 10-20%
    • <10%

38

these risk categories are associated with what LDL goals

  • CHD, CHD equivalent, 10 yr risk > 20%
  • 2+ risk factors, 10 yr risk < 20%
  • 0-1 risk factors 

  • CHD, CHD equivalent, 10 yr risk > 20%
    • LDL goal: < 100
  • 2+ risk factors, 10 yr risk < 20%
    • LDL goal <130
  • 0-1 risk factors 
    • LDL goal < 160

39

therapeutic lifestyle changes 

  • diet
    • saturated fat < 7% calories
    • cholesterol < 200 mg/day
    • soluble fiber 30 g/day
    • plant sterols
  • weight management
  • physical activity 

40

clinical identification of metabolic syndrome involves 3 of the following 

  • abdominal obesity
  • triglycerides > or = 150 mg/dl
  • low HDL
  • BP > 130/85
  • fasting glucose >110 mg/dl

41

function of statins in treatment of CAD

  • stabilize vulnerable plaques
  • treat underlying inflammation
  • vasodilators
  • decrease incidence of major vascular events, coronary mortality and CVA
  • **not effective in patients with familial hypercholesterolemia 

42

what is the first line treatment for high LDL 

  • statins

43

MOA of statins. how does this lower LDL

  • competitively inhibits HMG-CoA reductase, the enzyme that catalyzes the rate limiting step in cholesterol biosynthesis 
  • causes increase in synthesis of LDL receptors which increases hepatic uptake of LDL

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44

side effects of statins 

  • myalgias -> myositis -> rhabdomyolosis 
    • check serum creatine kinase 
  • elevated ALT

45

statins create ubiquinone deficiency in muscle which can lead to myopathy. what can you give the patient to help avoid this 

CoQ10 

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46

ideal first line agent for diabetics with hypertriglyceridemia 

fibrates 

47

MOA and function of fibrates in treatment 

  • MOA: stimulate lipoprotein lipase; decreases VLDL secretion
    • decreases triglycerides 

48

Lopid, Tricor, Trilipix, and Atromid-S are examples of what class of drug

Fibrates

49

function of Nicotinic Acid in treatment 

  • moderately increases HDL

50

side effect of Nicotinic Acid 

cutaneous flushing 

51

function of bile acid sequestrants in treatment 

  • decreases LDL
    • forms a nonabsorbable complex with bile acids in intestine causing fecal loss of LDL

52

questran and colestid are examples of what class of drug 

bile acid sequestrants

53

side effects of bile acid sequestrants

  • constipation
  • flatulence
  • dyspepsia 

54

function of cholesterol absorption inhibitor 

  • lowers LDL
    • inhibits absorption of cholesterol at brush border of small intestine leading to a decreased delivery of cholesterol to the liver, lowering hepatic cholesterol stores

55

ezetimibe (Zetia) is an example of what class of drugs 

cholesterol absorption inhibitor 

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56

function of omega-3 fatty acids (fish oil) in treatment 

  • lowers triglycerides 

57

omacor and lovaza are examples of what class of drugs 

omega -3 fatty acids

  • AHA recommends 1 g/day for CHD and 2-4 g/day for hypertriglyceridemia 

58

When do patients in these risk categories need to initiate theraputic lifestyle changes

  • CHD, CHD equivalent, 10 yr risk > 20%
  • 2+ risk factors, 10 yr risk < 20%
  • 0-1 risk factors 

  • CHD, CHD equivalent, 10 yr risk > 20% = > or = 100 mg/dl
  • 2+ risk factors, 10 yr risk < 20% = > or = 130 mg/dl
  • 0-1 risk factors  = > or = to 160 mg/dl

59

When do patients in these risk categories need to initiate drug therapy

  • CHD, CHD equivalent, 10 yr risk > 20%
  • 2+ risk factors, 10 yr risk < 20%
  • 0-1 risk factors 

  • CHD, CHD equivalent, 10 yr risk > 20%
    • > or = 130 mg/dl
  • 2+ risk factors
    • 10 yr risk factor 10-20% = > or = 130 mg/dl
    • 10 yr risk factor < 10% = > or = 160 mg/dl
  • 0-1 risk factors 
    • > or = 190 mg/dl