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Flashcards in Lipids Deck (50)
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1
Q
If patient has VERY high triglycerides- they’re “vasculopaths”, meaning
A
all arteries are filled with plaques, have xanthomas, ocular effects
2
Q
With known cardiovascular disease, _________ leads to a consistent reduction in total mortality and recurrent cardiovascular events in men and women
A
cholesterol lowering
3
Q
The two main lipids in blood are ________, carried in lipoproteins.
A
cholesterol and triglyceride
4
Q
Classification of lipoproteins
A
High-density lipoproteins (HDL)
Low-density lipoproteins (LDL)
Very-low-density lipoproteins (VLDL)
5
Q
Chylomicrons are made in ______ and travel via the _____ into the liver and via the ________ into the circulation.
Normally completely metabolized, transferring energy from food into muscle and fat cells.
A
the gut

portal vein

thoracic duct
6
Q
The plaques in the arterial walls of patients with atherosclerosis contain large amounts of cholesterol, the higher the level of______, the greater the risk of atherosclerotic heart disease
A
low-density lipoproteins (LDL) cholesterol
7
Q
The higher the ________, the lower the risk of coronary heart disease (CHD)
A
high-density lipoproteins (HDL) cholesterol
8
Q
High total cholesterol levels are also associated with an increased risk of
A
CHD (coronary heart disease)
9
Q
Arteriosclerotic cardiovascular disease requires treatment of
A
high to moderate intensity statin
10
Q
LDL-C at or over 190 requires
A
High intensity statin
11
Q
Goal for diabetics is to have LDL of
A
less than 70
(LDL of 60 is ideal)
12
Q
Treatment for diabetics is
A
moderate intensity statin, unless they have a ASCVD risk of over 7.5%, then use a high intensity statin
13
Q
Composition of cholesterol may be more important than just total cholesterol number
-Discrepancies on how to screen (athletes vs regular people)
Equation for calculating total cholesterol:
A
HDL + VLDL + LDL
14
Q
Equation for VLDL cholesterol
A
Triglycerides / 5
15
Q
Equation for LDL cholesterol
A
Total cholesterol - HDL - (Triglycerides / 5)
16
Q
Familial hypercholesterolemia is
rare in the homozygous state (about one per million) is a condition in which ________
A
the cell-surface receptors for the LDL molecule are absent or defective, resulting in unregulated synthesis of LDL
17
Q
Familial hypercholesterolemia- Homozygotes have extremely high LDL levels present with ___________
A
atherosclerotic disease in childhood
18
Q
Familial hypercholesterolemia- ***Heterozygotes have LDL concentrations _________; persons with this condition may develop _________***
A
twice normal

CHD in their 30s or 40s
19
Q
Familial hyperchylomicronemia-

notes say NOT on exam
A
Have marked hypertriglyceridemia with recurrent pancreatitis and hepatosplenomegaly in childhood
20
Q
Factors that increase triglycerides and total cholesterol
A
1. obesity (decreases HDL)
2. sedentary lifestyle (decreases HDL only)
3. DM
4. hypothyroidism
5. nephrotic syndrome
6. chronic kidney disease
7. obstructive liver disease
8. Cushing disease (corticosteroid use)
9. oral contraceptives
10. diuretics
11. beta blockers (decrease HDL)
21
Q
Factors the decrease total cholesterol
A
1. cirrhosis
2. malignancy
22
Q
Alcohol use and cholesterol
A
controversial (1-2 glasses of wine increases HDL)
-may increase triglycerides
23
Q
What will increase HDL?
A
ACTIVITY
24
Q
How do most patients with high cholesterol present
A
Most patients with high cholesterol levels have no specific symptoms or signs
Most are detected by the laboratory, either as part of the workup of a patient with cardiovascular disease or as part of a preventive screening strategy.
25
Q
Eruptive xanthomas
A
-Red-yellow papules (especially on the buttocks)
-Extremely high levels of chylomicrons or VLDL particles
26
Q
Tendinous xanthomas
A
-On certain tendons (achilles, patella, back of the hand)
-High LDL concentrations
-On biopsy- may look like squamous cell carcinoma
27
Q
Lipemia retinalis
A
-Cream-colored blood vessels (in the fundus)
-Extremely high triglyceride levels
28
Q
KNOW PICTURES OF XANTHOMAS
A
WILL BE ON EXAM
29
Q
Who should have their lipids measured?
A
All patients with cardiovascular disease and diabetes should have their lipids measured (ALWAYS TRUE- EXAM)

A complete lipid profile (total cholesterol, HDL cholesterol, and triglyceride levels) after an overnight fast should be obtained
30
Q
LDL cholesterol greater than_____ are recommended for treatment independent of their 10-year risk of cardiovascular disease, all other patients are recommended for treatment based on their overall cardiovascular risk.
A
190 mg/dL
31
Q
For women, _____ may be more important than LDL.
Elderly >75 cholesterol may not be a risk factor.
A
low HDL
32
Q
Framingham 10-year calculator (Table 28–1) includes CHD but not stroke risk
A
very controversial

Flow chart on slide 30
33
Q
Criteria to asses risk:
A
Sex, age, total cholesterol, smoker/non smoker, HDL levels

Add all factors to get a 10 year risk; higher number= WORSE
34
Q
Risk stratification looks at:
A
-Initial cholesterol measurement (mostly LDL, some subtypes of LDL are worse than others)
-high sensitivity C reactive protein (CRP), only indicates people will have coronary event who are already sick!!
-EBCT
-Homocysteine
-Fibrinogen
-Lipoprotein
-LDL subfractions
-ankle brachial index
35
Q
Treatment is based on
KNOW FOR EXAM
A
1. Clinical cardiovascular disease or diabetes
2. Patient age
3. LDL cholesterol greater than 190 mg/dL
4. Estimated 10-year risk of developing cardiovascular disease
36
Q
Diet as part of treatment
A
1. Older thinking: Low fat, low cholesterol
2. Current thinking: Mediterranean diet (fish, red wine, olive oil, omega 3; “good fats”)
Soluble fiber, garlic, vitamin C, pecans, plant sterols
37
Q
Other risk factor reduction
A
-Smoking cessation
-Hypertension control
-ASA use, for pts after heart attack or stroke, or hypercoagulable patients, diabetic patients, LDL over 190
-Raising HDL? How? EXERCISE (aerobic), healthy fat, and low levels of alcohol (wine)
38
Q
Treatment if clinical atherosclerotic CV disease (ASCVD) is present

EXAM
A
high intensity statin
moderate if over age 75
39
Q
Treatment if primary elevation of LDL is over 190

EXAM
A
high intensity statin
40
Q
Treatment if age 40-75, diabetic, LDL > 70

EXAM
A
moderate statin OR
high statin if 10 yr CVD risk is 7.5% or higher
41
Q
Treatment is age 40-70, no clinical ASCVD or diabetes, LDL 70-189, estimated 10 year CVD risk is 7.5% or higher

EXAM
A
treat with moderate to high intensity statins
42
Q
High intensity statins (lowers LDL by over 50%
A
Atorvastatin (high dose)
Rosuvastatin (high dose)

*Need a higher statin for people who have had a coronary event
43
Q
Moderate intensity statins (lowers LDL by 30-50%)
A
Atorvastatin (low dose)
Rosuvastatin (low dose)
Simvastatin
Pravastatin
Lovastatin
Fluvastatin
44
Q
Low intensity statins
(lowers LDL by less than 30%)
A
Pravastatin (lowest dose)
Lovastatin (lowest dose)
45
Q
Reason statins work so well
A
Decrease LDL and triglycerides and increase HDL
46
Q
Side effects of statins
A
muscle aches and myopathies (cant start someone on high dose), GI issues, liver toxicity
47
Q
Fibric acid- good for reducing _________
A
triglycerides

Gemfibrozil
Fenofibrate
48
Q
First way to treat high triglyceride levels
A
TREAT WITH DIET FIRST!
49
Q
Diet for treating high triglyceride levels
A
-Avoid alcohol, simple sugars, refined starches, saturated and trans fatty acids, and restricting total calories
-Control of secondary causes of high triglyceride levels
50
Q
Drug therapy for treating high triglyceride levels
A
-Niacin: a fibric acid derivative
-Omega-3-acid ethyl esters
-HMG-CoA reductase inhibitor) is indicated
-Combinations of these medications may also be used