SFP: dyslipidemias

Question 1

What is high cholesterol a major risk factor for?

Answer 1

Atherosclerotic and cardiovascular diseases

Question 2

What events does high cholesterol increase the risk of?

Answer 2

MI, stroke, aortic aneurysm and dissection, PVD

Question 3

What molecule is unequivocally atherogenic?

Answer 3

LDL

Question 4

What cholesterol molecule is considered protective?

Answer 4

HDL

Question 5

At what age do we typically start cholesterol screening?

Answer 5

40-75, unless there is a history or risk factors

Question 6

What condition is a one-way ticket for treatment of cholesterol?

Answer 6

Diabetes

Question 7

An LDL of over what value indicates treatment?

Answer 7

190

Question 8

What is the LDL range for considering treatment?

Answer 8

70-190

Question 9

What risk ratio indicates treatment options?

Answer 9

7.5-20

Question 10

What is CAC scoring?

Answer 10

Looking for calcium in the arteries

Question 11

What age do we start screening for hyperlipoproteinemia in men? Women?

Answer 11

35 in men, 45 in women

Question 12

What tests do we do for hyperlipoproteinemia?

Answer 12

Total cholesterol, HDL, LDL, triglycerides

Question 13

How can we calculate LDL?

Answer 13

LDL = total cholesterol – HDL – (triglycerides/5)

Question 14

What is a normal triglyceride: cholesterol ratio in VLDL?

Answer 14

5:1

Question 15

In what instances can we not use the equation for LDL?

Answer 15

Super high triglycerides, presence of chylomicrons, or in people with familial dysbetalipoproteinemia

Question 16

What is associated with causing premature atherosclerosis?

Answer 16

LDL (not just triglycerides alone)

Question 17

What are tendinous xanthomas?

Answer 17

Lipid deposits in soft tissue of Achilles tendons, elbows, or knees. This is due to increased LDL and often remain even with treatment.

Question 18

What are tuberous xanthomas?

Answer 18

Deposits often on knees and elbows that can mimic tumors and are due to increased LDL. They may regress with treatment.

Question 19

What are xanthelasmas?

Answer 19

Yellow plaques around the eyes that are associated with high cholesterol and LDL. This is very suggestive in younger patients.

Question 20

What are eruptive xanthomas?

Answer 20

Clusters of yellow-white papules or nodules that can be seen in those with elevated triglycerides, chylomicrons, or VLDL. Often seen in uncontrolled diabetes and responds to treatment.

Question 21

What is acute pancreatitis?

Answer 21

Inflammation of the pancreas that can be due to elevated triglycerides (chylomicrons or VLDL)

Question 22

What is lipemia retinalis?

Answer 22

Condition associated with elevated triglycerides (chylomicrons or VLDL) that causes a milky appearance of the vessels and visual acuity changes. This can return to normal with treatment. Most commonly familial.

Question 23

What is palmar xanthoma?

Answer 23

Yellow plaques on the palms that is associated with elevated triglycerides and cholesterol. Most commonly familial.

Question 24

What condition alters cholesterol but not triglycerides?

Answer 24

Hypothyroidism

Question 25

How does obesity impact lipids?

Answer 25

Increases triglycerides, FA synthesis, and VLDL. HDL decreases.

Question 26

How does diabetes type 1 impact lipids?

Answer 26

Doesn’t usually cause hyperlipidemia, but diabetic ketoacidosis can cause increased transport of FFA to liver which can increase triglycerides.

Question 27

How does diabetes type 2 impact lipids?

Answer 27

They’re dyslipidemic even under good glucose control; they have decreased LPL activity, increased release and synthesis of FFA, increased VLDL production, and decreased HDL.

Question 28

How is LDL impacted in diabetes type 2?

Answer 28

It is not increased.

Question 29

How does hypothyroidism impact lipids?

Answer 29

Increased LDL due to reduction in receptor function, increased IDL.

Question 30

How does nephrotic syndrome impact lipids?

Answer 30

Mixed hyperlipidemia that can present with high cholesterol or triglycerides due to hepatic production and decreased clearance of VLDL with increased LDL production.

Question 31

How does chronic renal failure impact lipids?

Answer 31

Mildly high triglycerides due to VLDL accumulation, followed by eventual impaired lipolysis and clearance of chylomicrons and VLDL. Prone to heart issues.

Question 32

How do renal transplants impact lipids?

Answer 32

Hyperlipidemia due to immunosuppressive drugs.

Question 33

How does hepatitis impact lipids?

Answer 33

Increased VLDL synthesis leads to hypertriglyceridemia.

Question 34

How does liver failure impact lipids?

Answer 34

Decreased lipoprotein synthesis leads to decreased cholesterol and triglycerides.

Question 35

How does cholestasis impact lipids?

Answer 35

Blocks excretion of cholesterol into bile, which increases LDL/HDL.

Question 36

How does alcohol impact lipids?

Answer 36

Variable; can increase triglyceride levels by stimulating hepatic secretion of VLDL and may inhibit oxidation of FFA, promoting triglyceride synthesis. Increases HDL.

Question 37

How does estrogen impact lipids?

Answer 37

Increases VLDL and HDL, and may increase plasma triglycerides; it is cardio protective.

Question 38

How does Cushing’s syndrome impact lipids?

Answer 38

Increased VLDL hypertriglyceridemia; might be mild LDL elevation.