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Lipid Physiology

Cardiology

QuestionAnswer
Fredrickson phenotype I Serum conc of chylomicrons elevated; trigs are elevated to >99th percentile
Fredrickson phenotype IIa Serum LDL chol elevated; the total chol is >90th percentile. Triglyceride and/or apolipoprotein B may also be ≥ 90th percentile
Fredrickson phenotype IIb Serum LDL & VLDL elevated; TC and/or trigs may be ≥ 90th percentile and apolipoprotein B ≥ 90th percentile
Increased Apo A-I prodn has what effect in animals? Anti-atherogenic (reduced atherosclerosis progression; regression of existing dz)
Mechanisms by which oxidized LDL causes atherogenesis Endothelial damage; changes in vasc tone; Monocyte/ macrophage recruitment; increased LDL uptake by macrophages (foam cell formation); Induction of GF; Increased plt aggregation; Formation of auto-Abs to oxidized LDL
HDL antiatherogenic properties include: Reverse chol transport; antioxidation; protection vs thrombosis; maintenance of endothelial fn; maintenance of low blood viscosity thru permissive action on red cell deformability
Process whereby excess cholesterol in cells and in atherosclerotic plaques is removed Reverse cholesterol transport
Fredrickson phenotype III Serum VLDL remnants & chylomicrons elevated; TC & trigs >90th percentile
Fredrickson phenotype IV Serum VLDL elevated; TC may be >90th percentile & may also see trigs >90th percentile or low HDL
Fredrickson phenotype V Elevated serum chylomicrons & VLDL; triglycerides >99th percentile
Hypertriglyceridemia & CHD: Assoc disorders Accumulation of chylomicron remnants & VLDL remnants; generation of small, dense LDL-C; assoc w/ low HDL-C; increased coagulability (inc plasminogen activator inhibitor (PAI-1); inc factor VIIc; activation of prothrombin to thrombin
Lipids carried by LPs for: energy utilization; lipid deposition; steroid hormone prodn; bile acid formation
Lipoprotein consists of: esterified & unesterified chol, trigs, phospholipids, & protein
Protein components of the lipoprotein = apolipoproteins or apoproteins.
Apolipoproteins = cofactors for enzymes and ligands for receptors
Defects in apolipoprotein metabolism lead to: abnormalities in lipid handling
Very large particles that carry dietary lipid = chylomicrons
Chylomicrons are assoc with: Apolipoproteins (including A-I, A-II, A-IV, B-48, C-I, C-II, C-III, and E)
LDL carries: cholesterol esters
LDL assoc with [which protein]: apolipoprotein B-100.
HDL carries: cholesterol esters
HDL is associated with [proteins]: apolipoproteins A-I, A-II, C-I, C-II, C-III, D, and E
One mechanism by which LDL promotes atherosclerosis oxidative modification
VLDL carries: endogenous trigs (& to a lesser degree chol)
Major apolipoproteins assoc with VLDL: B-100, C-I, C-II, C-III, and E
Intermediate density lipoprotein (IDL) carries: chol esters & triglycerides
IDLs are assoc with [proteins]: apolipoproteins B-100, C-III, and E
Function of CETP transfers oxidized lipids from LDL to HDL
The oxidized lipids in HDL are reduced by: HDL apolipoproteins
What does the liver do with reduced lipids? Liver takes up reduced lipids from HDL more rapidly than from LDL
Hypoalphalipoproteinemia = Low serum HDL; assoc w/ increased risk of overt CHD
Strategies for HDL metab as tx target Increase apo A-I prodn; promote reverse chol transport; delay HDL catabolism
Effect of ETOH (wine, beer) on HDL-C increases HDL-C
Theoretical effect of CTEP inhibitors Lower LDL; increase HDL
Familial Dyslipidemias Fredrickson phenotypes III, IV, & V
high levels of trigs may directly promote: atherothrombosis
high levels of trigs assoc w/ increases in: fibrinogen, clotting factors VII & X, & blood viscosity
Framingham focuses on which lipid: TC (but LDL is primary tx target)
Framingham 10-yr CHD risk categories r >20%, 10-20%, and <10%
Low HDL-C is an Independent Predictor of CHD Risk even when: LDL-C is Low
Metab syndrome/girth increases genetic susceptibility to: dyslipidemia, hypertension, type 2 DM
Metabolic syndrome 3 of 5: abd obesity (waist men >40 in & women >35 in. TG ≥150 or tx for TG. HDL <40 (M) & <50 (F) or tx for low HDL. BP ≥130/85 or tx for HTN. FPG ≥100 or tx
3 levels of prevention Primary: remove risk factors; secondary: early detection & tx; tertiary: reduce complications
A: fat contribute to CV dz; B: fat may be cardioprotective A: Saturated & trans fat; B: monounsaturated & polyunsaturated fat
Lipids carried by LPs for: energy utilization; lipid deposition; steroid hormone prodn; bile acid formation
Lipoprotein consists of: esterified & unesterified chol, trigs, phospholipids, & protein
Protein components of the lipoprotein = apolipoproteins or apoproteins.
Apolipoproteins = cofactors for enzymes and ligands for receptors
Low HDL: risk factors SMK; sedentary;obese; insulin resistant/ DM; hypertriglyceridemia; chronic inflammatory dz
Cardioprotective HDL = >60 mg/dL (>75 assoc w/ longevity syndrome)
Familial Dyslipidemias Fredrickson phenotypes III, IV, & V
high levels of trigs assoc w/ increases in: fibrinogen, clotting factors VII & X, & blood viscosity
HLD primary risk factors Diet, genetic, obesity, sporadic
HLD secondary risk factors DM, uremia, metabolic & nephrotic syndromes, hypothyroid, PG, acromegaly, Cushing dz, drugs
Drugs associated with secondary HLD risk factor: BB, diuretics, steroids, OCP, progestins, EtOH (for TGs)
Created by: Abarnard