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Triglycerides (TG)
Composed of 3 fatty acids and glycerol Main storage form of fuel, generate high-energy compound such as ATP, that provides energy for muscle contraction and metabolic reactions
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Hyperlipidemia Hyperlipoproteinemia
Increases concentrations of lipids and lipoproteins Hypercholesterolemia; high concentration of cholesterol
Atherosclerosis and coronary artery disease
Progression of CHD
Collagen and elastic fibers form a matrix around the cholesterol, macrophages and muscle cells
Chylomicrons- transport dietary lipids from the gut to the adipose tissue and liver Chylomicron remnantsproduced from Chylomicrons by lipoprotein lipases in endothelial cells and transport cholesterol to the liver VLDL-made in the liver and secreted in to plasma deliver triglycerides to adipose tissue in the process get converted to IDL and LDL LDL- (bad cholesterol) delivers cholesterol to peripheral tissues via receptors and is phagocytosed by macrophages thus delivering cholesterol to the plaques (atheromas) HDL- (good cholesterol) produced in gut and liver cells, HDL transports cholesterol from atheromas to the liver (reverse cholesterol transport) 6
Primary Hyperlipoproteinemia
Caused by a monogenic defect (a specific defect at a single gene) LDL cholesterol levels are severely high
Deficiency of LDL receptors Defect in the structure of apoprotien B
LDL receptors do not recognize LDL, LDL remains in circulation
Polygenic-environmental hyperlipidemia
Milder forms of hyperlipidemia Influence of several genes Excessive of dietary intake More common than primary form Responsible for most cases of accelerated atherosclerosis
Secondary hyperlipidemia
Alcoholism Diabetes melitus Uremia Drugs; b blockers, oral contraceptives, thiazide diuretics Diseases: hypothyroidism, nephrotic syndrome, obstructive liver disease
130 mg/dL
<130 mg/dL
130 mg/dL
160 mg/dL
<160 mg/dL
160 mg/dL
Risk factors: cigarette smoking, hypertension, low HDL-C, family history of premature CHD, and age 10
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Therapy
Other Effects
20-50%
10%
10-40%
Adverse effects: abdominal cramps, constipation, diarrhea, heartburn Hepatitis, elevate serum levels of hepatic enzymes, Myopathy (Myalgia, Myositis, 13 Rhabdomyolysis)
The liver increases the number of LDL receptors to obtain more cholesterol The levels of LDL-C in the serum are reduced as more cholesterol is delivered to the liver Little effect on levels of HDL-C and TG Excellent choice for people that cannot tolerate other types of drugs
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Adverse effects
GI side effects, constipation and fecal impaction, which can be prevented by increased water consumption, anal irritation and skin rash Bind to digoxin, varfarin, thyroxin; take resins 2 h before or after taking other medicines
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Practice Questions
List 4 risk factors associated with CHD Cigarette smoking Low HDL-C Hypertension Family history of premature CHD Age
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