EIM Quiz 2 cholesterol

What are the most common dyslipidemias?

Hyperlipidemia (high levels of lipids/fats in the blood)

• High total cholesterol (HTC)

• High low-density protein cholesterol (LDL-C)

• High triglycerides (TG)

Hypolipidemia (low levels of lipids/fats in the blood)

• Low High-density lipoprotein cholesterol (HDL-C)

Briefly, what was the Framingham Study and how does it relate to dyslipidemia? 

A long-term cardiovascular study

Made the Framingham score

• This score used 10-year risk of myocardial infarction or death

• Incorporates risk factors such as TC and HDL-C

What are the biological uses for cholesterol and triglyceride in the body? 

Cholesterol

• Membrane component for fluidity

• Production of bile acids and bile salts

• Base for steroid hormone production (adrenal cortex/reproductive tissues)

• Vitamin D synthesis

• Signaling between cells

Triglycerides

• Energy storage

• Energy utilization

• Transportation

• Lipid deposition

• Steroid hormone production

Where does cholesterol come from for use in the body?   

It is synthesized in the liver

Also, your diet

Do plants have cholesterol?

Plants do not have cholesterol, they have sterols

What is a lipoprotein?   

It is a particle structure of hydrophilic membrane surface made up of:

• Phospholipids 

• Free cholesterol  

• Apoliproteins 

• They surround a hydrophobic core (cholesteryl esters and triglycerides) 

Why lipoproteins – their point? 

• They allow for transportation of lipids through blood 

• Cholesterol and triglycerides 

What are the different lipoproteins found in the blood during fasting?    

Fasting (>8-12 hours)

• VLDL

• LDL

• HDL

• Very LOW on Chylomicrons  

What are the different lipoproteins found in the blood during the 8-12 hours after a meal is this different? 

Post meal (up to 8-12 hours)

• Mainly Chylomicrons

• VLDL

• LDL

• DLD

What are the major constituents of each lipoprotein? 

	Triglycerides (TG)	Cholesterol (C)	Phospholipids	Protein
Chylomicron	86%	5%	7%	2%
VLDL	55%	20%	18%	22%
LDL	6%	50%	22%	22%
HDL	5%	17%	33%	45%

Explain the association of cholesterol with atherosclerosis? 

Hyperlipidemia largest risk factor for buildup of arteries for atherosclerosis

High blood lipid levels lead to build up of plaque

Explain the association of cholesterol with coronary heart disease? 

Atherosclerosis leads to CHD

Constriction of arteries is caused by hyperlipidemia.

Leads to risk factors of CHD, Stroke, Heart attacks, and death.

Which lipoprotein is “bad”?  (when carrying excess cholesterol/triglycerides)  

VLDL 

LDL 

IDL 

Chylomicrn remnants 

• Excess amount can lead to buildup of arteries 

• Pro-atherogenic (promote buildup) 

Which lipoprotein is “Good”? 

HDL 

• Helps the body get rid of unneeded cholesterol. 

• Help with anti-oxidant, anti-inflammatory, anti-thrombotic, and anti-apoptotic 

What is forward lipid (cholesterol) transport?  (which lipoproteins, from/to where?) 

• Transporting lipids (triglycerides/Cholesterol) from the liver (LDL) and intestines (Chylomicrons) to peripheral tissues. 

Reverse lipid (cholesterol) transport?  (which lipoproteins, from/to where?) 

• Transports Cholesterol and other compounds to peripheral tissue back to liver  

• (HDL) 

Describe the association of blood lipids/dyslipidemia to mortality 

LDL and triglycerides have a strong positive association with mortality  

• This increases risk factors that lead to this. 

HDL have a moderate negative association with mortality  

Describe the relationship of abnormal blood lipids/dyslipidemia to conditions – diseases, disorders, abnormal function/pathophysiology 

Dyslipidemia can lead to 

Cardiovascular disease (CVD): 

• Atherosclerosis, Stroke, Acute MI (Heart Attack), Arrhythmias, Sudden Death, Hypertension, and Hemostatic issues. 

Metabolic Disease: 

• Diabetes Mellitus, Metabolic Syndrome, and Osteoporosis. 

Hormonal: 

• Low Testosterone (T), Menopause, and Cushing’s Disease. 

Systemic/Muscular: 

• Kidney diseases, Ocular diseases, Skeletal issues, Urogenital problems, and Muscle disorders (e.g., Muscular Dystrophy). 

 

Briefly, explain production vs removal of lipoproteins – chol/TG and how this is the underpinning of the cause and treatment of dyslipidemias. 

Dyslipidemia is caused by the production of lipid proteins (cholesterol/Triglycerides) exceed their removal rate from circulation 

Briefly, understand how nutrition/diet contribute/cause dyslipidemia. 

• Diets high in consumption of Cholesterol and Triglycerides lead to high levels of chylomicrons. 

• Leads to increased C/TG delivery to liver 

• Which then leads to higher secretion of VLDL and LDL 

Briefly, understand how genetics contribute/cause dyslipidemia. 

• Genetic defects (Familial Hypercholesterolemia) 

• Can cause to much cholesterol production 

• Lead to increase in VLDL-C and LDL-C production (High VLDL/LDL levels) 

• Can also inhibit HDL-C production (Low HDL levels) 

Briefly, understand how obesity contribute/cause dyslipidemia. 

• Obesity increases cholesterol production and consumption  

• Increases VLDL-TG/C and LDL-C, less consumption of these lipoproteins 

• Limits HDL-C production  

• Creates a toxic environment, leading to dyslipidemia 

Explain the use of threshold for diagnosing degrees of dyslipidemias.  200mg/dL TC & 130mg/dL LDL-C 

LDL 

• LDL-C ≥ 130 mg/dL 

HDL 

• HDL-C <40 mg/dL 

Total Cholesterol  

• Total Chol ≥ 200 mg/dL 

Explain the use of the Framingham score. 

Estimates an individual's 10-year risk of developing myocardial infraction (heart attack) or death 

Uses: 

• TC (Total Cholesterol)

• LDL 

• HDL 

• Age 

• SBP 

• Smoking status  

What is the primary target for treatment of dyslipidemia?  (which blood lipid most closely associated with mortality) 

• LDL-C is the is the primary target  

• Shows a strong positive association to mortality  

 

Briefly, how is diet/nutrition used to treat dyslipidemia?  

Consuming less cholesterol and triglycerides

• To reduce chylomicrons

Calories restriction to reduced stored TG in adipose tissue, by lowering VLDL, TG, C, LDL.

Low carb and high protein can aid in metabolism of VLDL-C and removal

Briefly, how is Pharmacology used to treat dyslipidemia?  

Use of statins

• They turn off cellular cholesterol production

Sequestrants

• These bind bile acids in the small intestine, preventing reabsorption and pooping it out

Are pharmacologic agents good at treating dyslipidemia?  Issues with use? 

They can be a way to treat dyslipidemia but it's not the most effective.

Exercise and lifestyle change in the most effective long-term.

• There can be side effects when using the drugs

What changes to blood lipids would you expect to see in acute exercise?  What must happen for these changes to occur (with acute exercise) 

• Decreased in VLDL-TG and a little of Chylomicron-TG 

• Increased HDL-C  

• Valid for 12-72 hrs post exercise 

• They must burn off enough energy. 

How is physical fitness related to the impact?   i.e., what must a high fit individual do MORE of to see a change? 

• The more fit an individual the greater dose he must have for exercise  

• Dose response curve  

• They need to increase volume to get a greater effect  

What changes to blood lipids (dyslipidemia) would you expect to see with long term exercise training?  

• Increased HDL-C and size 

• Decreased VLDL-TG/C 

• Decreased LDL-C  

• Decreased Total Cholesterol (TC) 

• Decrease in chylomicron size 

What blood lipid changes are associated with cessation from exercise training? 

• Decrease HDL-C and size 

• Increased VLDL-TG/C 

• Increased LDL-C  

• Increased Total Cholesterol (TC) 

• Increased in chylomicron size 

What is the prescription of exercise for blood lipid changes? 

• 150 minutes of moderate aerobic intensity  

• 2x a week of resistance training of major muscle groups