Lipids

Question 1

List the lipid treatment cutoffs

Answer 1

LDL: Treat if >4.2 + 1 risk factor OR >4.9 if no risk factors Target <3.5 HDL: Target >1.03 TG: Consider medications if consistently >5 Target <1.7 Non-HDL: Treat if >4.9 Target <3.5

Question 2

List 5 cardiovascular disease risk factors

Answer 2

1. Hyperlipidemia
2. Hypertension
3. Smoking
4. Diabetes
5. Physical inactivity
6. Decreased HDL
7. Hyperhomocysteinemia
8. Hypercoagulable state

Question 3

Which cholesterols contain Apo B-100?

Answer 3

The atherogenic ones (LDL, IDL, VLDL)

Question 4

Which cholesterol has Apo B-48?

Answer 4

Chylomicron and chylomicron remnants

Question 5

List three primary (genetic) causes of hypertriglyceridemia

Answer 5

1. LPL deficiency (familial hyperchylomicronemia)
2. Heterozygous LPL deficiency (endogenous lipemia = elevated VLDL, or mixed lipemia = VLDL and chylomicrons)
3. Familial combined hyperlipidemia (overproduction of VLDL)
4. Familial dysbetalipoproteinemia (type III hyperlipoproteinemia, homozygous for Apo E2)

Question 6

List three causes of secondary hypertriglyceridemia

Answer 6

1. Poorly controlled type 1 or type 2 diabetes
2. Endocrine: obesity, metabolic syndrome, hypothyroidism, hypercortisolism
3. Pregnancy
4. Renal disease: nephrotic syndrome, renal failure
5. Liver disease: acute hepatitis, NAFLD
6. Excessive alcohol intake
7. Medications: estrogen, steroids, isotretinoin, sirolimus, second generation antipsychotic medications, TZD’s, beta blockers, antiretroviral

Question 7

List three causes of primary (genetic) hypercholesterolemia

Answer 7

1. Familial hypercholesterolemia (FH) - deficiency of LDL receptors
2. Familial combined hyperlipidemia - VLDL and LDL elevation
3. Lp(a) hyperlipoproteinemia
4. Familial ligand-defective Apo B 100
5. Cholesterol 7alpha hydroxylase deficiency

Question 8

List three causes of secondary hypercholesterolemia

Answer 8

1. Hypothyroidism
2. Nephrosis
3. Immunoglobulin disorders
4. Anorexia nervosa
5. Cholestasis

Question 9

List 2 mechanisms by which type 2 diabetes leads to hypertriglyceridemia

Answer 9

1. Relative insulin deficiency (insulin is necessary for LPL activity)
2. Overproduction of VLDL activity by the liver
3. Secondary lipemia of nephrosis

Question 10

List three classes of medications used for pediatric lipid disorders and one side effect for each

Answer 10

1. Bile acid binding agents (ex. cholestyramine) - constipation/abdominal cramping
2. HMG CoA reductase inhibitors (Statins) - elevated DK, transaminitis, myositis
3. Fibrates (ex. fenofibrate) - constipation, myositis, anemia
4. Niacin - flushing, headache, increased liver transaminases
5. Cholesterol absorption blockers (ezetimibe) - not reported in children/teens