Lipids

Question 1

Describe two components of hypertriglyceridemia.

Answer 1

VLDL (synthesized in liver, endogenous) and chylomycrons (from diet)

Question 2

Describe treatment of acute / severe hypertriglyceridemia and how it works.

Answer 2

1) IV insulin (+/- glucose), as insulin promotes synthesis of lipoprotein lipase

Question 3

Describe treatment of chronic hypertriglyceridemia.

Answer 3

Gemfibrozil (lopid) - reduces the increase in hepatic VLDL-TG production due to high carb diet. Activates Peroxisome proliferator-activated receptor-alpha (PPARα), a nuclear receptor that is involved in metabolism of carbohydrates and fats, as well as adipose tissue differentiation. This increase in the synthesis of lipoprotein lipase thereby increases the clearance of triglycerides

Question 4

What statins are best in renal failure?

Answer 4

Atorvastatin and fluvastatin.

Question 5

What is data for statins in CKD patients?

Answer 5

1) RCT showed that atorvastatin can lower albumin excretion in patients with CKD
2) SHARP Trial (Study of Heart and Renal Protection) 9,000 pts non HD CKD simva + ezetimibe reduced risk of CVD.