On average women have higher _______ levels but lower _________ and ______________than men
HDL cholesterol
triglycerides
total cholesterol
after menopause cholesterol levels
no difference in total cholesterol
Total and LDL cholesterol and triglycerides are much _________ in children than in adults
lower
total and LDL cholesterol and triglyceride levels all ______________with age in both men and women
increase
___________rates of LDL cholesterol and heart disease in Asian population
Lower
Cholesterol reference range
national range
140-200mg/dL
Desirable cholesterol range
less than 200 mg/dL
Borderline High cholesterol
200-239
High cholesterol
>240
Triglyceride reference range
60-150mg/dL
Normal triglyceride range
<150
Borderline high TG
150-199
High TG
200-499
Very high TG
>500 mg/dL
LDL refernce range
50 to 130
optimal LDL
<130
Borderline high LDL
130-159
High LDL
160-189 mg/dL
Very High LDL
>190 mg/dL
VLDL normal range
<30 mg/dL
High VLDL
>30mg/dL
Total chol (TC)
LDL + HDL + VLDL
TG/5 = ?
VLDL
- we don't measure, we just calculate this
TC - (HDL + TG/5) =
LDL
DOES NOT WORK IF TG IS >400
Major Risk factors for CHD
Cigarette smoking
Hypertension (BP > or equal to 140/90)
Low HDL (<40)
Family Hx of premature coronary heart disease
Age (M>45, F>55)
Dyslipidemia
abnormal lipid concentrations
are lipidemias due to genetic mutations?
usually no identifiable genetic mutations - many different environmental and genetic factors
single leading cause of death and disability in the US
arteriosclerosis
Excess _____________ deposit on the artery walls and over time will develop into plaque
esterified cholesterol
Peripheral vascular disease (PVD)
deposits in arms and legs
Coronary artery disease (CAD)
deposits in heart
Cerebral vascular disease (CVD)
lipid deposits in brain
These 3 diseases are collectively referred to as coronary heart disease
PVD, CAD, and CVD
where else can cholesterol esters deposit?
liver, kidneys, and skin
How does high levels of LDL central to promoting plaque formation (4)
Deposited in macrophages which......
Promotes inflammatory response
Generates plaque
Increases pressure in the vascular spaces
How is cholesterol lowered by statin drugs?
Inhibit HMG-CoA reductase to block creation of cholesterol
Increases LDL receptors
Removes LDL from circulation
Disorders of lipoprotein metabolism are due to these three issues
Too much cholesterol or TG are synthesized or too little is removed
Too little HDL produced
Faulty transportation mechanisms of HDL
Hyperlipoproteinemia
hypercholesterolemia
hypertriglyceridemia
combined hyperlipidemia
(Both CHOL and TG are high)
Lipoprotein (A) elevation
Hypoalphalipoproteinemia
associated with several defects, often genetic, most of which are linked to increased risk of premature CHD
isolated but large decrease in circulating HDL (<40) without presence of hypertriglyceridemia (TG are normal)
Low HDL without high TG
ALPHA denotes
Hypoalphalipoproteinemia - Tangier disease
HDL as low as 1-2 mg/dL
orange tonsils
splenomegaly (deposition of cholesterol esters into macrophages)
Peripheral neuropathy
limited Tx options
Hypercholesterolemia
lipid abnormality closely linked to heart disease
Familial hypercholesterolemia is what
genetic abnormality predisposing people to elevated cholesterol levels.
there is no gene to test for it but we can predict based on FHx
What is FH caused by
defects in the LDL receptor pathway - production is normal but the chol can't enter the cells when transported.
Cells generate cholesterol intracellularly and can't get it out
results of FH
early death from myocardial infarction
Treatment of FH
seeks to reduce cholesterol production and stimulate generation of LDL receptors
What is hypertriglyceridemia
elevated TG levels caused by imbalance of production and clearance of VLDL in circulation!
deficiency in lipoprotein lipase or its cofactor Apo C
Deficiency prevents cleaning of chylomicrons and TG remain high
due to either genetic abnormalities or endocr
Are patients with hypertriglyceridemia likely to have CHD?
Nah, because chylomicrons are too big to enter into blood vessels so no plaque will form because of them
HDL is ____________ in hypertriglyceridemia
decreased
Treatment of hypertriglyceridemia
dietary modifications
Combined hyperlipoproteinemia (CH)
elevated levels of serum total cholesterol and TG due to apo-B 100 overproduction
Genetic forms = Familial CH
Is there an increased risk for CHD in CH?
Yes
What are the outcomes of Familial CH
some have only elevated cholesterol, others only elevated TG, and others have both
Type V hyperlipoproteinemia
increase in chylomicrons and VLDL, likely caused by increased production of VLDL or decreased removal of VLDL
Lipoprotein lipase activity is normal, as is apo C
Is there risk for CHD in Type V CH?
modestly increased risk
Lp(a) elevation (describe, Tx)
Lp(a) are variants of LDL with extra apo A
increased risk of CHD and cerebrovascular disease
higher levels are found in these patient populations
competes with plasminogen for fibrin binding sites, increasing plaque formation
no definitive treatment