Hyperlipidemia

Front 1

Functions of cholesterol?

Back 1

Maintenance of cell walls,
Hormone formation,
Synthesis of Vit D,
Formation of bile acids

Front 2

How are cholesterols carried through blood?

Back 2

Attached to lipoproteins

Front 3

3 types of lipoproteins?

Back 3

High density,
Low density,
Very low density.

Based on protein to fat ratio.

Front 4

What is the "good" cholesterol?
What does it do?

Back 4

HDL.

Helps transport LDL out of the body (returns it to the liver).
High levels of HDL = CARDIOPROTECTIVE!

Front 5

What is VLDL?

Back 5

Similar to LDL but has a higher content of triglyceride with lower protein content.

Front 6

Calculation of LDL?

Back 6

Total chol - HDL - (Trig/5) = LDL

Front 7

How is triglycerides transported?

Back 7

by VLDL

Front 8

5 contributing factors to hyperlipidemia?

Back 8

Genetics,
Tobacco (decreases HDL),
Sedentary lifestyle,
Obesity,
Diet

Front 9

The presence of 3 or more out of these 5 components = metabolic syndrome:

Back 9

Elevated waist circumference (men> 40, woman > 35),
Elevated trigs (>/= 150),
Reduced HDL (men <40, women <50),
Elevated BP (>/= 130/ 85),
Elevated fasting gluc (>100)

Front 10

What is the MAIN dietary source of elevated cholesterol levels?
Foods with this?

Back 10

Saturated fat

Red meat, dairy, coconut oil, hydrogenated vegetable oils

Front 11

What are two other dietary sources of elevated cholesterol levels?

Back 11

Monosaturated fats (plant oils like olive oil and peanut oil)

Polyunsaturated fats (plant oils like sunflower oil. Omega 3)

Front 12

What are the sx of initial hyperlipidemia?

Back 12

There are none!!!

Causing atherosclerosis initially.

Front 13

What total cholesterol is considered:
Best/ ideal?
Borderline high?
High?

Back 13

Best/ideal: <200

Borderline high: 200-239

High: >/= 240

Front 14

What LDL levles are considered:
Best for ppl w/ CAD, CVD, high risk?
Best for ppl at risk for CAD?
Ideal for most ppl?
Borderline high?
Very high?

Back 14

Ppl w/ CAD, CVD, very high risk: 70-100
At risk for CAD: <100
Most ppl: 100-129
Borderline high: 130-159
High: 160-189
Very high: 190 or above

Front 15

Tx plan for ppl at low to moderate risk for heart disease?

Back 15

Lifestile modification advised

Front 16

Tx plan for ppl w/ 2 or more risk factors for heart disease (moderate to increased risk)?

Back 16

Lifestyle modification and medical therapy.

Front 17

Tx plan for ppl w/ known vascular dz (CV/ cerebrovascular), diabetes, or mltpl risk factors (high or very high risk)?

Back 17

Lifestyle modification and intense medical therapy

Front 18

New recommendations for LDL in high risk patients?

>2 risk factors?

Back 18

High risk: <70

>2 risk factors: <100

Front 19

What is the percentage of health care spending on treatment of hyperlipidemia vs prevention?

Back 19

95% on treatment
5% on prevention

Front 20

What is the mean HDL in men?

In women?

Back 20

Men: ~45

Women: ~ 55

Front 21

What are the protective properties of HDL?

Back 21

Reverse cholesterol transport,

Inhibit LDL oxidation,

Increases fibrinolysis,

Reduction of adhesion molecules.

Front 22

The effects of HDL on CHD and MI/CHD?

Back 22

For every 1% increase in HDL or 1 mg/dL rise, you will see a 3-6% decrease in MI/CHD

Front 23

Therapies to increase HDL?

Back 23

Smoking cessation (5-9 mg/dl increase),
ETOH,
Weight loss,
Cut out trans fatty acids,
Increase monosatruated fats,
Exercise,
Cranberry juice,
Helicobacter eradication?,
Meds: niacin, fibrates

Front 24

What is the most widely used and most effective drugs used for treatment of hyperlipidemia?

Back 24

HMG CoA reductase inhibitors. (statins)

Front 25

Function of statins?

Back 25

Block HMG Co-A reductase. Without this enzyme, the liver removes cholesterol from the bloodstream, effectively lowering cholesterol levels.

Also statins regress plaque build up on arterial walls.

Front 26

7 statins?

Back 26

Atorvastatin (lipitor),
Fluvastatin (lescol),
Lovastatin (mevacor),
Pravastatin (pravachol),
Rosuvastatin (crestor),
Simvastatin (zocor),
Pitavastatin (livalo)

Front 27

Adverse reactions to statins?

Back 27

GI distress,
Rashes,
Myalgias,
Abnormal liver function,
Rhabdomyolysis

Front 28

Contraindications of statins?

Back 28

Active liver disease,

Pregnancy

Front 29

How do bile acid - binding resins work as treatment to hyperlipidemia?

Back 29

The liver uses cholesterol to make bile acids which help digest fats. Bile acid binding resins lower chol by binding to bile acids which induces liver to use more chol to make bile acids which in turn reduces total cholesterol levels.

Front 30

bile acid binding resins (bile acid sequestrants)?

Back 30

Questran, Welchol, Cholestyramine, Colestipol, Colesevelam.

Front 31

Precautions to use of bile acid sequestrants?

Back 31

Inhibits absorption of many meds including thiazidee diuretics and coumadin.

Advers reactions: constipation, rash, gall bladder disease, myopathy, abd pain, flatulence.

Front 32

How much do bile acid sequestrants reduce LDL and increase HDL?

Back 32

Reduce LDL: 15-30%
Increase HDL: 3-5%

May increase triglycerides

Front 33

How do bile acid sequestrants effect other drugs?

How to prevent this?

Back 33

Bind other negatively charged drugs.

Also, impede absorption of drugs and/or fat soluble vitamins.

Give other drugs 1 hour before or 4-6 hours after bile acid seq.

Front 34

2 examples of cholesterol absorption inhibitors?

Back 34

Ezetemide

Exetamide + simvastatin

Front 35

2 treatments for high triglycerides?

Back 35

Fibrates,

Niacin

Front 36

How do fibrates decrease triglycerides?

Back 36

Decrease trigs by reducing liver's production of VLDL and by increasing the removal of trigs from the blood.

Front 37

How does NIacin decrease trigs?

Back 37

B vitamin which in high doses raises HDL and lowers trigs by limiting synthesis of LDL and VLDL.

Front 38

At what point should you put pts with high triglycerides on medical therapy? Why?

Back 38

trigs >500. They are at risk of pancreatitis.

Front 39

What are the risks of fibrates or nicotinic acid?

Back 39

Abnormal LFTs, myopathy, rhabdomyolysis, thromboembolitic disorders, etc.

Front 40

How is fish oil good for improving hyperlipidemia?

Back 40

Fish oils contain omega 3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid). In high doses, reduce trigs, improve HDL and have a benefit of reducing CV risk.

Front 41

What is the only FDA approved prescription fish oil?

Back 41

Lovaza - omega 3 fatty acid. It has been purified and chemically altered.

Front 42

Lifestyle modification tips for lowering total cholesterol?

Back 42

Decrease consumption of total fat and saturated fats.

Minimize trans fat.

Decrease daily consumption to less than 200 mg daily.

Front 43

Tips for lowering LDL?

Back 43

Avoid saturated fats, use polyunsaturated and monounsaturated fats instead. Increase soluble fiber

Front 44

In youth, consider drug therapy if >10 years (and have reached menarche in females) if:

Back 44

LDL >190 OR
LDL>160 w/ a fam hx of CAD or >2 risk factors.

Front 45

Treatment LDL goal in youth?

Back 45

<130, but ideal is <110.