Lipid Disorders - waldron

Question 1

what are the subclasses of lipids

Answer 1

fatty acids
triglycerides
cholesterol
phospholipids

Question 2

what is the importance of lipids

Answer 2

storing energy
signaling
structural components of cell membranes
provide insulation
source of fat-soluble vitamins (A,D, E, K)
protection

Question 3

what does cholesterol in circulation originate from

Answer 3

either endogenous of exogenous pathway

Question 4

what must lipids attach to to be soluble

Answer 4

lipoproteins

Question 5

what is atherosclerosis

Answer 5

chronic inflammatory disease characterized by buildup of lipids in/on artery walls

Question 6

what is the underlying process responsible for the majority of cardiovascular events

Answer 6

atherosclerosis

Question 7

what make a atherosclerotic plaque vulnerable

Answer 7

thinning of the fibrous cap

Question 8

what occurs with plaque rupture

Answer 8

formation of thrombus

Question 9

what is the framingham heart study

Answer 9

identified risk factors:
blood cholesterol levels as predictive
C-reactive proteins as predictive in higher risk patients
equivocal on homocysteine as a predictor

Question 10

what are non-modifiable risk factors of atherosclerosis

Answer 10

age
sex
family history

Question 11

what are modifiable risk factors for atherosclerosis

Answer 11

smoking
High BP
High blood cholesterol levels
inflammatory and hyper-coagulable states
DM
overweight/obesity
sedentary lifestyle
high stress
unhealthy diet

Question 12

what are considerations for risk calculations for atherosclerosis

Answer 12

age
sex
race
cholesterol levels
BP
Meds
Diabetes status
smoking status

Question 13

over what percentage is considered high risk for ASCVD

Answer 13

> 20%

Question 14

what are risk enhancers for ASCVD

Answer 14

family hx of early onset ASCVD
continually elevated LDL
chronic kidney disease
metabolic syndrome
preeclampsia or premature menopause
inflammatory disease (RA, psoriasis, HIV/AIDS)
south asian ancestry
continually elevated triglycerides
elevated biomarkers

Question 15

what are the types of lipid disorders

Answer 15

Primary (familial/hereditary) hyperlipidemia
secondary (acquired) hyperlipidemia: hypercholesterolemia and hypertriglyceridemia

Question 16

what are the typically causes of hypercholesterolemia/hyperlipidemia

Answer 16

high fat diets
sedentary lifestyle
obesity
DM
Genetic causesL: familial hypercholesterolemia

Question 17

what is familiar hypercholesterolemia

Answer 17

genetic disorder
causes significant elevation of LDL-C levels
leads to early cardiovascular disease (CVD)

Question 18

What is the friedewald equation

Answer 18

Total cholesterol = LDL + HDL + (TG x 20%)

Question 19

what can affect total cholesterol

Answer 19

can vary due to stress, minor illness

Question 20

what is LDL (low-density lipoprotein)

Answer 20

primary measure for cardiovascular disease risk assessment and treatment guidance
made up mostly of cholesterol
high levels increases risk for heart disease and stroke

Question 21

what is HDL (high-density lipoproteins)

Answer 21

inversely associated with adverse cardiac outcomes
absorbed cholesterol and takes it back to the liver

Question 22

what are triglycerides

Answer 22

store unused calories and provide body with energy

Question 23

What are the different LDL particles and what do each contain more or less of

Answer 23

Small LDL particles - less cholesterol
Large LDL particles - more cholesterol

Question 24

What is ApoB

Answer 24

primary apolipoprotein attached to atherogenic particles
involved in metabolism and transport of lipids
high # indicative for increased risk for Heart dx

Question 25

what is lipoprotein A

Answer 25

genetically determined increased may indicate increased risk for MI, stroke or aortic stenosis in the future

Question 26

what are cholesterol treatments

Answer 26

dietary changes weight loss aerobic exercise tobacco cessation pharmacotherapy: statins, bile acid sequestrants, fibrates

Question 27

what are the considerations when choosing treatment options

Answer 27

overall cardiovascular disease risk factor cost of treatment patient preferences

Question 28

what is considered first line therapy for lipids

Answer 28

statins

Question 29

what are statin intolerance

Answer 29

muscle symptoms rhabdomyolysis ALT rise >3x normal serious liver disease

Question 30

what is personal hx that increases risk for statin intolerance

Answer 30

age (>80) sex (f) ethnicity (asian) neuromuscular, kidney, or liver conditions hypothyroidism new intensive exercise

Question 31

what should be monitored when using long term statin

Answer 31

check lipid panel LFTs CK level

Question 32

how do BAS work

Answer 32

sequestering bile acid in the GI tract, prevents being absorbed into bloodstream - liver removes cholesterol from blood to make more bile acid, thus reducing cholesterol levels

Question 33

what is the primary indication for fish oils

Answer 33

hypertriglyceridemia

Question 34

what is the use of fibrates

Answer 34

reduces liver production of VLDL and speeds up removal of TG from blood consider with high triglycerides

Question 35

what is Ezetimbie (zetia)

Answer 35

hyperlipidemia medication that inhibits absorption of cholesterol from small intestine decreases amount of cholesterol normally available to liver cells reduces CV events, reduces LDL-c

Question 36

what is Niacin

Answer 36

hyperlipidemia medication that reduces TC, LCL-C, TG and increases HDL-C

Question 37

What are PCSK9 Inhibitors

Answer 37

monoclonal antibodies that block PCSK9 protein from working - LDL receptors increase and LDL-c decreases may be used with or separate from statin medications

Question 38

what can high triglycerides be a sign of

Answer 38

type 2 diabetes or prediabetes metabolic syndrome hypothyroidism certain rare genetic conditions that affect how the body converts fat to energy

Question 39

what medications can have a side effect of high triglycerides

Answer 39

diuretics estrogen and progestin retinoids steroids BB some immunosuppressants some HIV meds

Question 40

what are the initial management choices for triglycerides

Answer 40

healthy lifestyle exercise avoid sugar/refined carbs lose weight choose healthier fats limit alchohol intake

Question 41

what is the medication management for triglycerides

Answer 41

statins fibrates fish oil niacin

Question 42

what are metabolic syndromes associated wtih

Answer 42

insulin resistance prothrombotic and pro-inflammatory states risk of DM, MI and CVA

Question 43

what are risk factors for metabolic syndrome

Answer 43

obesity sedentary lifestyle family hx hyperlipidemia HTN

Question 44

how often should screenings be done for metabolic syndromes

Answer 44

repeat every 3 years

Question 45

how are metabolic syndromes diagnosed

Answer 45

impaired glucose metabolism lipid profile insulin resistance

Question 46

what is the management of metabolic syndrome

Answer 46

key is to prevent progression of diabetes weight reduction/loss aerobic exercise decreased caloric intake pharmacologic tx for glucose control and cardiac risk management