Lipids

Question 1

If patient has VERY high triglycerides- they’re “vasculopaths”, meaning

Answer 1

all arteries are filled with plaques, have xanthomas, ocular effects

Question 2

With known cardiovascular disease, _________ leads to a consistent reduction in total mortality and recurrent cardiovascular events in men and women

Answer 2

cholesterol lowering

Question 3

The two main lipids in blood are ________, carried in lipoproteins.

Answer 3

cholesterol and triglyceride

Question 4

Classification of lipoproteins

Answer 4

High-density lipoproteins (HDL)
Low-density lipoproteins (LDL)
Very-low-density lipoproteins (VLDL)

Question 5

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.

Answer 5

the gut

portal vein

thoracic duct

Question 6

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

Answer 6

low-density lipoproteins (LDL) cholesterol

Question 7

The higher the ________, the lower the risk of coronary heart disease (CHD)

Answer 7

high-density lipoproteins (HDL) cholesterol

Question 8

High total cholesterol levels are also associated with an increased risk of

Answer 8

CHD (coronary heart disease)

Question 9

Arteriosclerotic cardiovascular disease requires treatment of

Answer 9

high to moderate intensity statin

Question 10

LDL-C at or over 190 requires

Answer 10

High intensity statin

Question 11

Goal for diabetics is to have LDL of

Answer 11

less than 70
(LDL of 60 is ideal)

Question 12

Treatment for diabetics is

Answer 12

moderate intensity statin, unless they have a ASCVD risk of over 7.5%, then use a high intensity statin

Question 13

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:

Answer 13

HDL + VLDL + LDL

Question 14

Equation for VLDL cholesterol

Answer 14

Triglycerides / 5

Question 15

Equation for LDL cholesterol

Answer 15

Total cholesterol - HDL - (Triglycerides / 5)

Question 16

Familial hypercholesterolemia is
rare in the homozygous state (about one per million) is a condition in which ________

Answer 16

the cell-surface receptors for the LDL molecule are absent or defective, resulting in unregulated synthesis of LDL

Question 17

Familial hypercholesterolemia- Homozygotes have extremely high LDL levels present with ___________

Answer 17

atherosclerotic disease in childhood

Question 18

Familial hypercholesterolemia- ***Heterozygotes have LDL concentrations _________; persons with this condition may develop _________***

Answer 18

twice normal

CHD in their 30s or 40s

Question 19

Familial hyperchylomicronemia-

notes say NOT on exam

Answer 19

Have marked hypertriglyceridemia with recurrent pancreatitis and hepatosplenomegaly in childhood

Question 20

Factors that increase triglycerides and total cholesterol

Answer 20

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)

Question 21

Factors the decrease total cholesterol

Answer 21

1. cirrhosis
2. malignancy

Question 22

Alcohol use and cholesterol

Answer 22

controversial (1-2 glasses of wine increases HDL)
-may increase triglycerides

Question 23

What will increase HDL?

Answer 23

ACTIVITY

Question 24

How do most patients with high cholesterol present

Answer 24

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.

Question 25

Eruptive xanthomas

Answer 25

-Red-yellow papules (especially on the buttocks)
-Extremely high levels of chylomicrons or VLDL particles

Question 26

Tendinous xanthomas

Answer 26

-On certain tendons (achilles, patella, back of the hand)
-High LDL concentrations
-On biopsy- may look like squamous cell carcinoma

Question 27

Lipemia retinalis

Answer 27

-Cream-colored blood vessels (in the fundus)
-Extremely high triglyceride levels

Question 28

KNOW PICTURES OF XANTHOMAS

Answer 28

WILL BE ON EXAM

Question 29

Who should have their lipids measured?

Answer 29

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

Question 30

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.

Answer 30

190 mg/dL

Question 31

For women, _____ may be more important than LDL.
Elderly >75 cholesterol may not be a risk factor.

Answer 31

low HDL

Question 32

Framingham 10-year calculator (Table 28–1) includes CHD but not stroke risk

Answer 32

very controversial

Flow chart on slide 30

Question 33

Criteria to asses risk:

Answer 33

Sex, age, total cholesterol, smoker/non smoker, HDL levels

Add all factors to get a 10 year risk; higher number= WORSE

Question 34

Risk stratification looks at:

Answer 34

-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

Question 35

Treatment is based on
KNOW FOR EXAM

Answer 35

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

Question 36

Diet as part of treatment

Answer 36

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

Question 37

Other risk factor reduction

Answer 37

-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)

Question 38

Treatment if clinical atherosclerotic CV disease (ASCVD) is present

EXAM

Answer 38

high intensity statin
moderate if over age 75

Question 39

Treatment if primary elevation of LDL is over 190

EXAM

Answer 39

high intensity statin

Question 40

Treatment if age 40-75, diabetic, LDL > 70

EXAM

Answer 40

moderate statin OR
high statin if 10 yr CVD risk is 7.5% or higher

Question 41

Treatment is age 40-70, no clinical ASCVD or diabetes, LDL 70-189, estimated 10 year CVD risk is 7.5% or higher

EXAM

Answer 41

treat with moderate to high intensity statins

Question 42

High intensity statins (lowers LDL by over 50%

Answer 42

Atorvastatin (high dose)
Rosuvastatin (high dose)

*Need a higher statin for people who have had a coronary event

Question 43

Moderate intensity statins (lowers LDL by 30-50%)

Answer 43

Atorvastatin (low dose)
Rosuvastatin (low dose)
Simvastatin
Pravastatin
Lovastatin
Fluvastatin

Question 44

Low intensity statins
(lowers LDL by less than 30%)

Answer 44

Pravastatin (lowest dose)
Lovastatin (lowest dose)

Question 45

Reason statins work so well

Answer 45

Decrease LDL and triglycerides and increase HDL

Question 46

Side effects of statins

Answer 46

muscle aches and myopathies (cant start someone on high dose), GI issues, liver toxicity

Question 47

Fibric acid- good for reducing _________

Answer 47

triglycerides

Gemfibrozil
Fenofibrate

Question 48

First way to treat high triglyceride levels

Answer 48

TREAT WITH DIET FIRST!

Question 49

Diet for treating high triglyceride levels

Answer 49

-Avoid alcohol, simple sugars, refined starches, saturated and trans fatty acids, and restricting total calories
-Control of secondary causes of high triglyceride levels

Question 50

Drug therapy for treating high triglyceride levels

Answer 50

-Niacin: a fibric acid derivative
-Omega-3-acid ethyl esters
-HMG-CoA reductase inhibitor) is indicated
-Combinations of these medications may also be used