Term
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Definition
| An elevation of one or more of the following: cholesterol, cholesterol esters, phospholipids, or triglycerides (TG) |
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Term
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Definition
Lipid and protein complexes that transport cholesterol, triglycerides, and phospholipid
We usually call them "lipids" |
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Term
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Definition
Large TG-rich lipoproteins which deliver TG to adipose tissue or skeletal muscle
Synthesized from fatty acids or dietary triglycerides and cholesterol and bile acid (why lipid panel needs to be fasting) |
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Term
| How are chylomicrons broken down? |
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Definition
Catabolized by lipoprotein lipase (LPL) which forms chylomicron remnants
Taken up by the liver to free cholesterol intracellularly
TG converted to free fatty acids, apolipoproteins, or phospholipids |
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Term
| List 5 types of lipoproteins |
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Definition
1. Chylomicrons
2. VLDL
3. LDL
4. HDL
5. Apolipoproteins |
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Term
| Define VLDL (very low density lipoproteins) |
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Definition
Formed in the liver and intestine
Carries 15-20% total serum cholesterol and most of the TG
Precursor to LDL |
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Term
| Define LDL (low density lipoprotein) |
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Definition
Formed from VLDL catabolism by LPL and hepatic lipase (HTGL)
Carries 60-70% total serum cholesterol
Greatest contributor to atherosclerosis |
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Term
| How are lipoproteins identified? |
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Definition
| By the density of the lipoprotein- protein is more dense than fat |
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Term
| What properties are unique to LDL? |
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Definition
-More artherogenic
-Longer half life
-More easily oxidized |
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Term
| What is the purpose of LDL? |
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Definition
| To carry cholesterol from the liver to organs that need it |
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Term
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Definition
| Interaction with LDL receptors in liver triggers degradation |
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Term
| What feedback changes occur with high intracellular LDL? |
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Definition
1. Inhibition of HMG-CoA reductase
2. Decreased LDL receptors
3. Increased storage of intracellular cholesterol
4. Increased excretion into bile portion of stools |
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Term
| Give the Freidwald equation to calculate LDL |
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Definition
LDL= TC- (HDL+TG/5)
If triglycerides >400, this equation is inaccurate |
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Term
| What is the primary role of HDL? |
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Definition
Reverse cholesterol transport:
Removes excess systemic and peripheral cholesterol (coronary arteries) and delivers it to liver for uptake and excretion |
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Term
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Definition
| Proteins on outside of lipoprotein particles, provides structure, activates enzymes, and binds with cell receptors |
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Term
| What is ApoA associated with? |
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Definition
HDL and chylomicrons
(Good ones) |
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Term
| What is ApoB associated with? |
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Definition
LDL, VLDL, IDL, and chylomicrons
(Bad ones) |
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Term
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Definition
Lipoprotein lipase
In fat and muscle, hydrolyzes TG, chylomicrons, and VLDL & releases free fatty acids (which are stored as fat or used for energy) |
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Term
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Definition
Hepatic lipase
Converts VLDL to LDL by removing TG from VLDL |
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Term
| What is the role of Lecithin-cholesterol acyl transferase (LCAT)? |
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Definition
| Allows HDL to collect cholesterol |
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Term
| What is the role of Cholesterol ester transfer protein (CETP)? |
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Definition
| Involved in the exchanges of cholesterol between TG and HDL |
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Term
| What lipoproteins are elevated in type I dyslipidemia? |
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Definition
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Term
| What lipoproteins are elevated in type IIa dyslipidemia? |
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Definition
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Term
| What lipoproteins are elevated in type IIb dyslipidemia? |
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Definition
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Term
| What lipoproteins are elevated in type IV dyslipidemia? |
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Definition
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Term
| What lipoproteins are elevated in type V dyslipidemia? |
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Definition
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Term
| What lipoprotein phenotypes associated if a patient has high triglycerides? |
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Definition
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Term
| What lipoprotein phenotypes associated if a patient has high cholesterol? |
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Definition
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Term
| List five disease secondary causes of hypercholesterolemia |
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Definition
Hypothyroidism
Obstructive liver disease
Nephrotic syndrome
Anorexia nervosa
Acute intermittent porphyria |
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Term
| What drugs can cause secondary hypercholesterolemia? |
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Definition
| Progestins, thiazide diuretics, glucocorticoids, β-blockers, isotretinoin, protease inhibitors, cyclosporine, mirtazapine, sirolimus |
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Term
| List disease secondary causes of hypertriglyceridemia |
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Definition
Obesity
Diabetes mellitus
Lipodystrophy
Glycogen storage disease
Ileal bypass surgery
Sepsis
Pregnancy
Acute hepatitis
Systemic lupus erythematosus
Monoclonal gammopathy: multiple myeloma, lymphoma |
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Term
| What drugs can cause secondary hypertriglyceridemia? |
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Definition
| Alcohol, estrogens, isotretinoin, betablockers, glucocorticoids, bile-acid resins, thiazides; asparaginase, interferons, azole antifungals, mirtazapine, anabolic steroids, sirolimus, protease inhibitors |
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Term
| List 6 disease causes of secondary hypocholesterolemia |
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Definition
Chronic liver disease
Malnutrition
Malabsorption
Myeloproliferative diseases
Chronic infectious diseases: AIDS, tuberculosis
Monoclonal gammopathy |
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Term
| List disease causes of low HDL |
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Definition
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Term
| List drugs that can cause secondary low HDL |
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Definition
| Non-ISA β-blockers, anabolic steroids, probucol, isotretinoin, progestins |
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Term
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Definition
Plaques that form in medium and large arteries that contain lipids, inflammatory cells, smooth muscle cells, and connective tissue.
In most, the underlying cause of CAD and ACS |
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Term
| List the five vessel wall components |
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Definition
1. Endothelium
2. Basement membrane
3. Elastic tissue
4. Collagen
5. Smooth muscle |
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Term
| What is the function of the endothelium in the vessel wall? |
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Definition
| Regulates blood flow and active transport of circulating substances throughout the cytoplasm |
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Term
| What is the function of the basement membrane in the vessel wall? |
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Definition
| Transport barrier and membrane support |
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Term
| What is the function of the collagen in the vessel wall? |
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Definition
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Term
| What is the function of the smooth muscle in the vessel wall? |
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Definition
| Arterial metabolism and active contraction, facilitates entry of lipoproteins |
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Term
| What are the three layers of the vascular system, from inside to outside? |
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Definition
1. Intima
2. Media
3. Adventita |
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Term
| What are the effects of aging on the vascular system? |
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Definition
Increase in intimal thickness, rigidity
Accumulation of smooth muscle cells, connective tissue, and cholesterol
This leads to vasoconstriction, thrombosis, and inflammation- which promotes atherosclerosis |
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Term
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Definition
| Systemic increase in vein thickness, primarily affects lower extremity veins that are exposed to stasis and increased luminal pressure |
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Term
| List Risk factors for atherosclerosis |
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Definition
•Age
•Cigarette smoking
•Hypercholesterolemia
•Lifestyle
•Family HIstory
•Hyperhomocysteinemia
•Oxydized LDL
•Mechanical injury to the endothelium
•Immunologic attack
•Infection induced |
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Term
| What is the response to injury hypothesis |
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Definition
Injury to endothelium increases LDL transport and retention in intima
LDL binding to extracellular matrix increases its "residence time"
LDL changes via oxidation to cause an inflammatory response, which increases plasminogen, coagulation, and endothelin. Foam cells form, "fatty streak" |
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Term
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Definition
Develops into a lesion after repeated injury and repair within an atherosclerotic plaque
Leads to a fibrous cap protecting the underlying lipid core, collagen, and inflammatory cells
Maintenance of the fibrous cap is critical to prevent rupture and consequent thrombus |
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Term
| What are outcomes of plaque rupture? |
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Definition
A clot forms on the top of the ruptured plaque
Produces either a complete or incomplete occlusion of the lumen
This can cause angina, stroke, MI, death, PAD, arrhythmias, abdominal aortic aneurism |
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