Dyslipidemia Fall 2012 (1)

Total cholesterol tc hdl ldl tg5 calculated ldl ldl

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Total Cholesterol TC = HDL + LDL + (TG/5) Calculated LDL*:   LDL = TC – [HDL + (TG/5)] OR LDL = TC – HDL – (TG/5) * These numbers are only accurate when TG < 400 mg/dL
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HDL Exogenous Pathway Endogenous Pathway
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Lipoprotein Receptors Membrane proteins that facilitate cellular uptake  of LDL, VLDL, chylomicrons, and ILDL proteins Genetic abnormality may result in elevated  levels without increases in dietary cholesterol  and fat
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Disorders of Lipoproteins: Primary Dyslipidemia 6 categories   Based on composition of elevated lipoprotein (s) Type IIa: Familial hypercholesterolemia Gene mutation: deficient or defective LDL-receptor    Elevated LDL Homozygotes: develops in childhood Heterozygotes: develops in adulthood Xanthomas
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Disorders of Lipoproteins: Hypertriglyceridemia Worsened by: Obesity Physical inactivity Excessive alcohol use When elevated > 1000 mg/dL  increased risk of acute    pancreatitis
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Disorders of Lipoproteins: Secondary Dyslipidemia Lipoprotein Cause  LDL-C  TG  HDL-C Diseases Hypothyroidism Nephrotic  syndrome Obstructive liver  Alcoholism Diabetes mellitus Hypothyroidism Diabetes mellitus Hyperthyroidism Hypertriglyceridemia Drug- induced Anabolic steroids Bile acid sequestrants Systemic estrogens Systemic retinoids Protease inhibitors Anabolic steroids
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Dyslipidemia and Cardiovascular Disease Age > 20: TC >200 mg/dL: 102.2 million Americans LDL >130 mg/dL: 32.6% 81.1 million Americans have cardiovascular  disease (CVD) In 2006, 34.3% of deaths were due to CVD #1 cause of death Heart Disease and Stroke Statistics. 2010 Update.
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Atherosclerosis Sclerosis = hardening Atherosclerosis Hardening of the arteries   blood flow obstruction Formation of fibrofatty lesions in the intimal  lining of the medium and large arteries Aorta and its branches Coronary arteries Large vessels that supply the brain
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Complications of Dyslipidemia: The Beginning *____*
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Atherosclerosis Types of lesions associated with  atherosclerosis Fatty streaks   Fibrous atheromatous plaque Complicated lesion
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Fatty Streaks Thin, flat, yellow, intimal discolorations that progressively  enlarge by becoming thicker and slightly elevated as they  grow in length Consists of macrophages and smooth muscle cells that  become distended with lipids to form foam cells Can occur as early as 1 st  decade of life until 20 years of age
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Atheromatous Plaque Clinical Atherosclerosis Accumulation of intracellular and extracellular lipids Proliferation of vascular smooth muscle cells Formation of scar tissue Lesions lead to thickening of vessel intima Core composed of lipids Covered by fibrous cap of connective tissue and  smooth muscle
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