Hyperlipidemia Flashcards
What is hyperlipidemia
elevation of total cholesterol AND triglycerides, the two main types of lipids
What do cholesterol and triglycerides do
Chol: helps form steroid hormones and bile acids
Tg: transfer energy from food to skeletal muscle/adipose
What are lipoproteins
how lipids are transported. That contain apoproteins and can be:
Low density (more TG)
High density (more APOPROTEIN)
-VLDL, IDL, LDL, HDL, and chylomicrons
What is the process of lipid transport (VLDL/LDL)
Liver uses TG and CHO to make VLDL
VLDL transfers TG to cells. less TG= becomes LDL
LDL provides Chol to cells
Excess LDL taken up by liver, cholesterol excreted into bile
Where is HDL made
liver and intestine
helps apoprotein transport by taking CHOL from the cells and bring to liver or other lipoproteins
What preventions exist for CVD
Primary: preventing HLD without risk for disease/diet
Secondary: preventing progression and managing disease
What is primary dyslipidemia
Genetic abnormality of cholesterol metabolism
What is secondary dyslipidemia
Dz develops secondary to:
DM, excess alcohol, hypothyroid, cholestatic liver dz, renal dz, smoking, obesity
Meds (OCP, thiazide, BB, atypical antipsychotics, protease inhibitors (HIV))
What do most clinics measure
Total Chol (LDL, VLDL, HDL)
Tg
HDL
—-More difficult to measure VLDL and LDL so measure based on the above measurements
How can you tell what VLDL contains when calculating a lipid fraction
VLDL have 5x more Tg than chol
VLDL cholesterol= TG/5
How can you calculate LDL cholesterol
Total cholesterol- HDL cholesterol- TG/5
What are stipulations to calculating lipid levels
Pt must be fasting to give lowest TG
Tg level should be <400-500 (best LDL est. if TG <200)
What is ASVCD
When fatty materials collect in arterial walls and hardens over time
LDL can no longer put cholesterol into cells so it starts accumulating into plaques
What disorders can lead to ASCVD
Abnormal cholesterol metabolism disorders (genetic, insulin resistance, organ dysfunction) Lifestyle factors (sat and trans-fat, obesity, smoking, high BP)
How does plaque formation occur
small dense LDL enters and sticks to artery wall, triggering cascade
LDL is oxidized, attracting macrophages
Endothelial dysfunction
Vasoconstriction
–Usually not symptomatic (angina) until obstructive to blood flow
What can plaque rupture lead to
they are free to travel and can lodge in:
coronary arteries (MI)
brain (CVA/TIA)
What are the CVD risk factors
Non-modifiable (age, sex, race, FHx, etc.)
Modifiable (smoking, weight, diet, HTN, renal dz, low HDL)
What CVD risk factor calculators exist
Framingham risk score (what is the chance they will have a cardiac incident in the next 10 years) Non-DM
ACC/AHA risk score (what is the chance they will develop HD or stroke in the next 10 years)
What can lowering cholesterol reduce
Morbidity and mortality in men and women, middle aged and older
How does LDL reduction affect risk
1% LDL reduction= 1-1.5% CV risk reduction
2-3% HDL increase= 2-4% CV risk reduction
What evidence of CVD or secondary causes of HLD could you see on PE
elevated BP, BMI, waist circumference Xanthomas, rashes Corneal arcus, lipemia retinalis, AV nicking Adventitious sounds in lungs PMI, extra heart sounds hepatomegaly, kidney mass, bruits edema, PAD, diabetic foot abnormal DTR
How do most HLD patients present
asymptomatic!
However, can have xanthomatous tendons, corneal arcus, lipemia retinals, xanthelasma, eruptive xanthomas
What are the NCEPP ATP III guidelines for treating ASCVD
- Obtain fasting lipid profile (9-12 hours) LDL, HDL, total chol
- ID CHD risk equivalents (CAD, PAD, AAA, DM)
- Presence of major risk factors (smoking, HTN, HDL <40, FHx premature HD, men >45, women >55)
- Use framingham for 10 year risk (>20% if w/ CHD risk equivalent) (10-20% if 2+RF) (<10% if 0-1 RF)
- Determine risk category (CHD risk equivalent, LDL <70) (2+ RF, LDL <100) (0-1 RF, LDL <160)
- Initiate TLC if LDL above goal (can reduce LDL 25-30%)
- Add drug therapy if LDL still above goal after 3 mo.
- ID (3+ RF) and treat metabolic syndrome
- Treat elevated Tg and low HDL
What is the ATP III classification for lipids
LDL: optimal <100 (If with CAD, <70)
Total chol: desirable <200
HDL: low <40 (low women <50)
(step 9 says normal Tg are <150)
