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Flashcards in Lipids Deck (35)
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1

What are the main reasons to assess lipids?

1. diagnose lipid/lipoprotein metabolism disorders
2. Diagnose lipid storage disorders/mitochondrial oxidation disorders
3. cardiovascular risk assessment

2

ON THE TEST: WHat were the data points used in the traditional framingham risk score?

age, gender, smoking status, total cholesterol, HDL, systolic BP and HTN Rx

3

Where do most patients fall in the framingham risk score? Why is this an issue?

76% fell in the low risk category, but people in this category still had CV events

4

What do we use now instead of framingham?

the 2013 ACC/AHA guidelines, which has new pooled cohort equations for ASCVD risk assessment with different equations for nonwhite populations

5

Statin therapy is recommended in what 4 groups under the ACC/AHA guidelines?

1. Diabetics
2. LDL > 190
3. ASCVD risk > 7.5% with LDL 70-189
4. Secondary prevention in other high risk groups ??

6

True or false: the ACC/AHA guidelines have no LDL or non-HDL treatment targets

true

7

What risk factors are taken into account for the ACC/AHA ASCVD risk calculator?

sex, age, race, total chol, HDL, SBP, BP treatment, Diabetes, Smoker status

8

What are the 6 major classes of lipoproteins?

chylomicrons
VLDL
IDL
LDL
HDL
Liproprotein A

9

Which lipoprotein particle is the causal agent in atherosclerosis?

LDL particle - the more LDL a person has, the higher the risk for plaque buildup

10

Is LDL cholesterol and LDL particle?

No - LDL cholesterol is just the cholesterol that makes up the LDL particle. As such, it's not a perfect measure of LDL and LDL_attributable risk

11

Reduction in LDL cholesterol by 40 mg/dL reduces CHD risk by ___%

20%

12

What is the optimal LDL liprotein level?

50-70 mg/DL

There is NO atherosclerosis progression at LDL-C < 67 mg/dL

13

ON THE TEST: What equation is the most common method for reporting LDL?

The Friedewald equation, which assumes al cholesterol is VLDL, LDL and HDL

cLDL = [Tot Chol] - [HDL chol] - [Tg]/5

14

When should the Friedewald equation not be used?

when the TG > 400 because it assumed chylomicrons, IDL and liporpotein A are not signficant, but if you have a TG > 400, you definitely have some chylomicrons floating around

15

If someone does have elevated TGs, what is a better number to use for risk prediction beyond the LDL-C?

the non-HDL-c

16

What are the two primary reasons to perform lipid screening in pediatrics?

1. identify childhood dyslipidemia (in pediatric obesity and T2DM)
2. ID genetic hyperlipidemia (with fam hx of early CV)

note: we can differentiate normal lipids from abnormal lipid by age 2

17

Describe familial hypercholesterolemia.

an inheritable, AD disorder of mutation in the LDL receptor; resulting in severe hypercholesterolemia present starting in chldhood with CVD early in life

one of the most commonly occurring genetic disorders (1:200 to 500)

18

What LDL level would you expect with a heterozyote FH? Homozygote?

hetero > 190
Homo > 600-1000

19

How can cholesterol testing be used to make a phenotypic diagnosis of FH?

> 190 makes it likely
>160 with positive family hx
> 135 with positive genetic dx in family

20

What secondary causes should be ruled out before you move to genetic testing for FH

thyroid disease
liver disease
renal disease
medication effect
obesity

21

Ideally, when should you screen for discrimination of FH?

in childhood! Lipid screening is most effective in early childhood (ages 1-9)

22

Should we universally screen all children ages 1-9 then?

Hard to say. Some organizations say yes. USPSTF says inconclusive.

If strong family hx of early CV or physical findings of FH in the child, consider screening as early as age 2

23

In adult HF patients, what is the treatment titration goal?

get an LDL-C reduction of at least 50% from baseline

24

What is the treatment strategy to get to this goal?

start with mod to high statin monotherapy

then add ezetimibe

then add things like bile acid sequestrants, fibrates, nicotinic acids

apheresis is last resort for treatment in heterozygous FH, but actually a first-line therapy in homozygous FH because it won't respond to drugs or lifestyle modifications

25

ON THE TEST: Apo-A1 is associated which which lipoproteins? Functioning as what?

HDL - part of HDL structure
Chylomicrons: LCAT ativator

26

ON THE TEST: Apo-B100 is associated with what lipoproteins? Functioning as what?

VLDL, IDL, LDL

It binds the LDL receptor and is part of structure for all three

27

ON THE TEST: ApoB48 is associated with which lipoprotein? Function?

Chylomicron - structural

28

ON THE TEST: What are the two most common hyperlipidemia phenotype in the US?

IV (45%)
IIb (40%)

29

ON THE TEST: Describe phenotype I. WHat's elevated?

Mainly chylomicrons

so plasma cholesterol level is up, triglycerid level is waaay up

30

ON THE TEST: Describe phenotype IIa. What's up?

LDL is up

so plasma cholesterol is high but TGs are normal. very high athero-genicity