CCRP AACVPR
How are lipids carried - on lipoproteins in the blood because they are insoluble in water
Proteins found on lipoproteins - apolipoproteins
Density of lipoprotein with less lipid and greater protein - more dense
Density of lipoprotein with more lipids and less protein - less dense
Major bloodstream lipoproteins - chylomicrons, vLDL, LDL, HDL
Chylomicrons - least dense of the lipoproteins and are triglyceride-rich particles that are
formed in the intestine
Function of Chylomicrons and where they can be found - Transport dietary fat and can
be found in the bloodstream at highest concentration soon after a meal
Least to most dense lipoprotein particles - Chlyomicron, vLDL, LDL, HDL
lipoprotein that is the most atherogenic of all lipoproteins - LDL
LDL carries - 60-70% of the cholesterol in the blood
HDL carries - 20-30% of the cholesterol in the blood
Equation for total LDL-C in bloodstream - LDL= TC-(HDL-C-(TG/5))
When does calculating LDL-C obecome oinaccurate o- owhen oTG oexceeds o400mg/dL
Desirable ototal ocholesterol olevel o- o<200
Borderline ohigh ototal ocholesterol olevel o- o200-240
High ototal ocholesterol olevel o- o>240
Optimal oTG olevel o- o<150
Borderline ohigh oTG olevel o- o150-199
High oTG olevel o- o200-499
Very ohigh oTG olevels o- o>500
Optimal oin omen oHDL olevels o- o>40
Optimal oin owomen oHDL olevels o- o>50
,CCRP AACVPR
Optimal oLDL-C olevels o- o<100
Near ooptimal oLDL-C olevels o- o100-129
Borderline ohigh oLDL-C olevels o- o130-159
High oLDL-C olevels o- o160-189
Very ohigh oLDL-C olevels o- o>190
Hypertriglycerdemia ois oassociated owith ohigh olevels oof o- oVLDL-C
Non-HDL-Cholesterol ocalculation o- oHDL-C o- oTotal ocholesterol
Atherogenic odyslipidemia o- oElevated olevels oof oTG, olow oHDL-C oand oonly omodest
oelevations oof oLDL-C
Metabolic osyndrome o- orequires othe opresence oof oany o3 oof othe ofollowing oconditions:
oabdominal oobesity, oelevated oTG, olow oHDL, oelevated oBP oand ohyperglycemia
Criteria ofor ometabolic osyndrome: oAbdominal oobesity o- oWC o>102 ocm o(40 oin) ofor
omen oWC o>88cm o(35 oin) ofor owomen
Criteria ofor ometabolic osyndrome: oHypertriglyceremia o- o≥150 oor odrug otreatment
Criteria ofor ometabolic osyndrome: oLow oHDL o- o<40 ofor omen
<50 ofor owomen
Criteria ofor ometabolic osyndrome: oElevated oBP o- oSBP
o≥130 oDBP o≥85
or odrug otreatment
Criteria ofor ometabolic osyndrome: oHyperglycemia o- oFasting oglucose
o≥100 oor odrug otreatment
AACVPR ounderstanding oof oatherosclerosis o- oTraditional orisk ofactors oare oa osource
oof oinflammatory ochanges oin othe oblood ovessel owall o--> owhich oattract olipid oladen
omacrophages oand oother oinflammatory ocells oto oenter othe oblood ovessel owall o-->
owhere othey oproliferate o and odevelop oatherosclerotic oplaques o--> owhich oare othe
osource oof othe oclinical omanifestations oof oCHD
Fatty ostreaks o- olipid odeposition o(daily olipid oladen omacrophages) oin othe oarterial owall
Lumen o- oopening oinside oof othe oblood ovessel
fibrous oplaque o- oLarger oand omore oobstructive olesoions oconsisting oof oan oouter
ofibrous
,CCRP AACVPR
Why odo oplaque oruptures ooccurs oprior oto othe odevelopment oof ocardiovascular
osymptoms oin omany ocases o- oAtherosclerotic oplaques othat oare oprone oto orupture
otend oto obe oyounger, omore oimmature oplaques othat ousually odo onot oproduce othe
odegree oof oluminal onarrowing orequired oto odevelop oexertion osymptoms
What ooccurs oafter oa oplaque orupture o- oClot oformation owithin othe olumen oof othe
ocoronary oartery, opotential oresulting oin oan oacute ocoronary osyndrome ofrom othe
osudden odevelopment oof osevere oobstruction oto ocoronary oblood oflow
Examples oof ofoods ohigh oin odietary ocholesterol o- oAnimal oproducts o( omeat, opoultry,
ofish, oeggs, obutter, ocheese, owhole oand o2% omilk)
Examples oof ofoods ohigh oin osaturated ofatty oacids o- ohigh ofat omeats o(beef, olamb,
opork, opoultry owith oskin, obeef ofat, olard), odairy oproducts, otropical ooils o( opalm ooil,
opalm okernel ooil, ococonut ooil)
Examples oof ofoods ohigh oin otrans ofatty oacids o- ofried ofoods, obaked ogoods, ostick
omargarines, oshortenings
Examples oof ofoods ohigh oin omonounsaturated ofatty oacids o- ovegetable ooils o(olive ooil,
ocanola ooil, opeanut ooil, osunflower ooil, osesame ooil) o, oavocados, opeanutbutter, onuts
oand oseeds
Examples oof ofoods ohigh oin opolyunsaturated ofatty oacids o- ovegetable ooils o(soybean
ooil, osafflower ooil), ofatty ofish o( osalmon, omackerel, oherring, otrout) onuts o(walnuts),
oseeds o(sunflower oseeds)
ACC/AHA oLifestyle oManagement oGuidelines oDietary orecommendations ofor
olowering oLDL-C o- o1) oconsume oa odietary opattern othat oemphasizes; ovegetables,
owhole ograins oand ofruits; olow ofat odairy oproducts, ofish, olegumes, onon-tropical ooils
oand onuts; olimit osweets, osugared obeverages oand ored omeats
2) Aim ofor oa odiet oof o5-6% oof ocalories ofrom osaturated ofats
3) Reduce opercent ocalories ofrom osaturated ofats
4) Reduce opercent oof ocalories ofrom otrans ofats
What oare ounrefined ocarbohydrates oreferred oas o- owhole ograins
Strongest oevidence ofor odietary opatterns o- oDASH odiet
o(dietary oapproach oto ostop ohypertension)
Function oof ostatins o- oreduce ocholesterol oproduction oin othe oliver oby oinhibiting othe
oenzyme oHMG oCoA oreductase
When oto oinvestigate ointo opossible osecondary ocauses oof ohyperlipidemia o- oLDL-C
o>190 omg/dL oand otriglycerides o>600mg/dL
, CCRP AACVPR
LDL-C oreduction oon olow ointensity ostatin o- o<30%
LDL-C oreduction oon omoderate ointensity ostatin o- o30-<50%
LDL-C oreduction oon ohigh ointensity ostatin o- o>50%
Secondary ocauses oof oelevated oLDL o- odiets ohigh oin osaturated ofat/trans ofat, oweight
ogain, oanorexia, odiuretics, ocyclosporine, oglucocorticoids, oamiodarone, obinary
oobstruction, onephrotic osyndrome, ohypothyroidism, oobesity, opregnancy
Secondary ocauses oof oelevated otriglycerides o- oDiets ohigh oin orefined ocarbs, oweight
ogain, overy olow ofat odiets, oexcessive oalcohol ointake, oestrogens, oglucocorticoids, obile
oacid osequestrates, oprotease oinhibitors, oretinoid oacid, oanabolic osteroids, osirolimus,
oralozifene, otamoxifen, obeta oblockers, othiazide odiuretics, ochronic orenal ofailure,
onephrotic osyndrome, olipodystrophies, odiabetes, ohypothyroidism, oobesity, opregnancy
Rosuvastatin o5, o10mg ointensity o- omoderate
Rosuvastatin o20, o40 omg ointensity o- ohigh
Atorvastatin o10, o20 omg ointensity o- omoderate
Atorvastatin o40, o80mg ointensity o- ohigh
Simvastatin o10mg ointensity o- olow
Simvastatin o20, o40 omg ointensity o- omoderate
Pravastatin o10, o20 omg ointensity o- olow
Pravastatin o40, o80mg ointensity o- omoderate
Lovastatin o20mg ointensity o- olow
Lovastatin o40mg ointensity o- omoderate
Fluvastatin oXL o80mg ointensity o- omoderate
Fluvastatin o20, o40mg ointensity o- olow
Fluvastatin o40 omg oBID ointensity o- omoderate
Pitavastatin o1mg ointensity o- olow
Pitavastatin o2, o4mg ointensity o- omoderate
How are lipids carried - on lipoproteins in the blood because they are insoluble in water
Proteins found on lipoproteins - apolipoproteins
Density of lipoprotein with less lipid and greater protein - more dense
Density of lipoprotein with more lipids and less protein - less dense
Major bloodstream lipoproteins - chylomicrons, vLDL, LDL, HDL
Chylomicrons - least dense of the lipoproteins and are triglyceride-rich particles that are
formed in the intestine
Function of Chylomicrons and where they can be found - Transport dietary fat and can
be found in the bloodstream at highest concentration soon after a meal
Least to most dense lipoprotein particles - Chlyomicron, vLDL, LDL, HDL
lipoprotein that is the most atherogenic of all lipoproteins - LDL
LDL carries - 60-70% of the cholesterol in the blood
HDL carries - 20-30% of the cholesterol in the blood
Equation for total LDL-C in bloodstream - LDL= TC-(HDL-C-(TG/5))
When does calculating LDL-C obecome oinaccurate o- owhen oTG oexceeds o400mg/dL
Desirable ototal ocholesterol olevel o- o<200
Borderline ohigh ototal ocholesterol olevel o- o200-240
High ototal ocholesterol olevel o- o>240
Optimal oTG olevel o- o<150
Borderline ohigh oTG olevel o- o150-199
High oTG olevel o- o200-499
Very ohigh oTG olevels o- o>500
Optimal oin omen oHDL olevels o- o>40
Optimal oin owomen oHDL olevels o- o>50
,CCRP AACVPR
Optimal oLDL-C olevels o- o<100
Near ooptimal oLDL-C olevels o- o100-129
Borderline ohigh oLDL-C olevels o- o130-159
High oLDL-C olevels o- o160-189
Very ohigh oLDL-C olevels o- o>190
Hypertriglycerdemia ois oassociated owith ohigh olevels oof o- oVLDL-C
Non-HDL-Cholesterol ocalculation o- oHDL-C o- oTotal ocholesterol
Atherogenic odyslipidemia o- oElevated olevels oof oTG, olow oHDL-C oand oonly omodest
oelevations oof oLDL-C
Metabolic osyndrome o- orequires othe opresence oof oany o3 oof othe ofollowing oconditions:
oabdominal oobesity, oelevated oTG, olow oHDL, oelevated oBP oand ohyperglycemia
Criteria ofor ometabolic osyndrome: oAbdominal oobesity o- oWC o>102 ocm o(40 oin) ofor
omen oWC o>88cm o(35 oin) ofor owomen
Criteria ofor ometabolic osyndrome: oHypertriglyceremia o- o≥150 oor odrug otreatment
Criteria ofor ometabolic osyndrome: oLow oHDL o- o<40 ofor omen
<50 ofor owomen
Criteria ofor ometabolic osyndrome: oElevated oBP o- oSBP
o≥130 oDBP o≥85
or odrug otreatment
Criteria ofor ometabolic osyndrome: oHyperglycemia o- oFasting oglucose
o≥100 oor odrug otreatment
AACVPR ounderstanding oof oatherosclerosis o- oTraditional orisk ofactors oare oa osource
oof oinflammatory ochanges oin othe oblood ovessel owall o--> owhich oattract olipid oladen
omacrophages oand oother oinflammatory ocells oto oenter othe oblood ovessel owall o-->
owhere othey oproliferate o and odevelop oatherosclerotic oplaques o--> owhich oare othe
osource oof othe oclinical omanifestations oof oCHD
Fatty ostreaks o- olipid odeposition o(daily olipid oladen omacrophages) oin othe oarterial owall
Lumen o- oopening oinside oof othe oblood ovessel
fibrous oplaque o- oLarger oand omore oobstructive olesoions oconsisting oof oan oouter
ofibrous
,CCRP AACVPR
Why odo oplaque oruptures ooccurs oprior oto othe odevelopment oof ocardiovascular
osymptoms oin omany ocases o- oAtherosclerotic oplaques othat oare oprone oto orupture
otend oto obe oyounger, omore oimmature oplaques othat ousually odo onot oproduce othe
odegree oof oluminal onarrowing orequired oto odevelop oexertion osymptoms
What ooccurs oafter oa oplaque orupture o- oClot oformation owithin othe olumen oof othe
ocoronary oartery, opotential oresulting oin oan oacute ocoronary osyndrome ofrom othe
osudden odevelopment oof osevere oobstruction oto ocoronary oblood oflow
Examples oof ofoods ohigh oin odietary ocholesterol o- oAnimal oproducts o( omeat, opoultry,
ofish, oeggs, obutter, ocheese, owhole oand o2% omilk)
Examples oof ofoods ohigh oin osaturated ofatty oacids o- ohigh ofat omeats o(beef, olamb,
opork, opoultry owith oskin, obeef ofat, olard), odairy oproducts, otropical ooils o( opalm ooil,
opalm okernel ooil, ococonut ooil)
Examples oof ofoods ohigh oin otrans ofatty oacids o- ofried ofoods, obaked ogoods, ostick
omargarines, oshortenings
Examples oof ofoods ohigh oin omonounsaturated ofatty oacids o- ovegetable ooils o(olive ooil,
ocanola ooil, opeanut ooil, osunflower ooil, osesame ooil) o, oavocados, opeanutbutter, onuts
oand oseeds
Examples oof ofoods ohigh oin opolyunsaturated ofatty oacids o- ovegetable ooils o(soybean
ooil, osafflower ooil), ofatty ofish o( osalmon, omackerel, oherring, otrout) onuts o(walnuts),
oseeds o(sunflower oseeds)
ACC/AHA oLifestyle oManagement oGuidelines oDietary orecommendations ofor
olowering oLDL-C o- o1) oconsume oa odietary opattern othat oemphasizes; ovegetables,
owhole ograins oand ofruits; olow ofat odairy oproducts, ofish, olegumes, onon-tropical ooils
oand onuts; olimit osweets, osugared obeverages oand ored omeats
2) Aim ofor oa odiet oof o5-6% oof ocalories ofrom osaturated ofats
3) Reduce opercent ocalories ofrom osaturated ofats
4) Reduce opercent oof ocalories ofrom otrans ofats
What oare ounrefined ocarbohydrates oreferred oas o- owhole ograins
Strongest oevidence ofor odietary opatterns o- oDASH odiet
o(dietary oapproach oto ostop ohypertension)
Function oof ostatins o- oreduce ocholesterol oproduction oin othe oliver oby oinhibiting othe
oenzyme oHMG oCoA oreductase
When oto oinvestigate ointo opossible osecondary ocauses oof ohyperlipidemia o- oLDL-C
o>190 omg/dL oand otriglycerides o>600mg/dL
, CCRP AACVPR
LDL-C oreduction oon olow ointensity ostatin o- o<30%
LDL-C oreduction oon omoderate ointensity ostatin o- o30-<50%
LDL-C oreduction oon ohigh ointensity ostatin o- o>50%
Secondary ocauses oof oelevated oLDL o- odiets ohigh oin osaturated ofat/trans ofat, oweight
ogain, oanorexia, odiuretics, ocyclosporine, oglucocorticoids, oamiodarone, obinary
oobstruction, onephrotic osyndrome, ohypothyroidism, oobesity, opregnancy
Secondary ocauses oof oelevated otriglycerides o- oDiets ohigh oin orefined ocarbs, oweight
ogain, overy olow ofat odiets, oexcessive oalcohol ointake, oestrogens, oglucocorticoids, obile
oacid osequestrates, oprotease oinhibitors, oretinoid oacid, oanabolic osteroids, osirolimus,
oralozifene, otamoxifen, obeta oblockers, othiazide odiuretics, ochronic orenal ofailure,
onephrotic osyndrome, olipodystrophies, odiabetes, ohypothyroidism, oobesity, opregnancy
Rosuvastatin o5, o10mg ointensity o- omoderate
Rosuvastatin o20, o40 omg ointensity o- ohigh
Atorvastatin o10, o20 omg ointensity o- omoderate
Atorvastatin o40, o80mg ointensity o- ohigh
Simvastatin o10mg ointensity o- olow
Simvastatin o20, o40 omg ointensity o- omoderate
Pravastatin o10, o20 omg ointensity o- olow
Pravastatin o40, o80mg ointensity o- omoderate
Lovastatin o20mg ointensity o- olow
Lovastatin o40mg ointensity o- omoderate
Fluvastatin oXL o80mg ointensity o- omoderate
Fluvastatin o20, o40mg ointensity o- olow
Fluvastatin o40 omg oBID ointensity o- omoderate
Pitavastatin o1mg ointensity o- olow
Pitavastatin o2, o4mg ointensity o- omoderate
