Dyslipidemia

• What is atherosclerosis?

  A chronic inflammatory condition in arteries characterized by plaque formation.
• What triggers the onset of atherosclerosis?

  It begins with endothelial damage due to hypertension, smoking, or high LDL cholesterol levels.
• What are the key steps in the pathophysiology of atherosclerosis?

  1. Endothelial dysfunction leads to increased permeability and leukocyte adhesion.
  2. LDL particles accumulate and oxidize, triggering inflammation.
  3. Monocytes enter the intima, become macrophages, and form foam cells.
  4. Foam cells aggregate to form a "fatty streak."
  5. Smooth muscle cells migrate, proliferate, and stabilize the plaque.
  6. A fibrous cap forms over the plaque, which can rupture.
• What is the role of hypertension in atherosclerosis?

  It increases shear stress, damaging the endothelium and promoting inflammation.
• How does diabetes contribute to atherosclerosis?

  It elevates pro-inflammatory cytokines and oxidative stress, disrupting endothelial function.
• What effect does smoking have on atherosclerosis?

  It contributes to oxidative LDL, inflammatory response, and endothelial damage.
• What is dyslipidemia's role in atherosclerosis?

  High LDL and low HDL levels enhance lipid accumulation and inflammation in the arterial wall.
• What is LDL known as?

  Low-Density Lipoprotein, or "bad" cholesterol.
• What is HDL known as?

  High-Density Lipoprotein, or "good" cholesterol.
• What are triglycerides primarily transported in?

  Chylomicrons and VLDL.
• What does total cholesterol represent?

  The sum of cholesterol across all lipoproteins.
• What is non-HDL cholesterol?

  Total cholesterol minus HDL, associated with atherogenic particles.
• What is Lp(a)?

  A genetic marker for atherosclerosis risk.
• What is ApoB?

  ApoB is found in all atherogenic lipoproteins except HDL.
• What characterizes familial hypercholesterolemia?

  Elevated LDL and total cholesterol levels.
• What is combined familial hyperlipidemia?

  Elevated triglycerides and decreased HDL levels.
• What are hypolipidemias?

  Rare conditions, except for low HDL levels which increase atherosclerosis risk.
• What is the difference between primary and secondary dyslipidemia?

  Primary is due to genetic factors, while secondary is linked to lifestyle or diseases.
• What lifestyle changes can help manage dyslipidemia?

  • Diet: Low in saturated fats, trans fats, salt, and alcohol.
  • Physical Activity: Regular exercise to improve lipid profile.
  • Weight Management: Maintain BMI between 20-25 kg/m².
  • Smoking Cessation: Reduces oxidative LDL and inflammation.
• What is the mechanism of statins in treating dyslipidemia?

  Statins inhibit HMG-CoA reductase, reducing cholesterol synthesis and increasing LDL receptor expression.
• What are the pleiotropic effects of statins?

  They reduce LDL oxidation, increase nitric oxide, and stabilize plaques.
• What does ezetimibe do?

  Ezetimibe inhibits dietary cholesterol absorption and is often added to statins.
• How do bile acid resins work?

  They bind bile acids in the intestine, increasing cholesterol consumption for bile production.
• What is a caution when using fibrates?

  They may increase triglycerides in certain patients and have limited effect on cholesterol levels.
• What do PCSK9 inhibitors do?

  They prevent LDL receptor degradation, significantly reducing LDL levels.
• Who are PCSK9 inhibitors indicated for?

  High-risk patients who can't achieve target LDL levels with statins alone or have statin intolerance.
• What is the role of niacin in dyslipidemia treatment?

  Niacin inhibits lipolysis, reducing triglycerides and mildly lowering LDL.
• What is lipoprotein apheresis?

  It is the extracorporeal removal of LDL, VLDL, and Lp(a) particles to lower blood lipid levels.
• When is lipoprotein apheresis indicated?

  For high-risk individuals with genetic dyslipidemia or those unresponsive to medication.
• What are the recommended lipid levels for low-risk individuals?

  • Total Cholesterol: <200 mg/dL
  • LDL: <100 mg/dL
  • HDL: >40 mg/dL for men, >50 mg/dL for women
  • Triglycerides: <150 mg/dL fasting, <200 mg/dL otherwise