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29 Cards in this Set

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What are the key Dx test for MI?
Troponins
LDL is used for Cholesterol _____. HDL?
transport, removal.
HDL has an atheroprotective role: how does it mediate this? (4)

- not super important
blocks adhesion molecule expression
blocks cytokine release
blocks LDL oxidation
Promotes Cholesterol efflux and egress of macrophages
What are the routine lipid tests?
TriG
Total C
HDL
Non-HDL-C (apoB associated cholesterol)
LDL
apoB (w/i the month)
CVs are ~ what for LDL testing?

What is the most significant source of variation? How do we overcome this?
~4% (reeeeaAAAllly good)

biological
Use avg of 2 specimens obtained 1-wk apart
____ hrs of fasting is required for a full profile?

Which values can be gotten w/o fasting?

Which types of tubes should be sent to the lab for testing?
10-12hrs

C, HDL, non-HDL

Serum or EDTA, *NOT* heparin, b/c it falsely lowers TriG by actv LpL
Is Lipemia related to elevated cholesterol?

What is lipemia?
No.

Chylomicrons and VLDL reflect light.
Name the change and the magnitude of it in the following values post-meal:
- C
- HDL
- TriG
- VLDL
- none/vsmall
- moderate depression
- HUGE elevation
- Elevated VLDL
What is the Friedewald equation? What is being substituded for VLDL lvls?

Pros/cons of calculated LDL vs direct assays for LDL?
LDL = total cholesterol - (HDL+(TriG/ 5))

Trig/5

Direct:
- good correlations
- can be measured w/ TriG>400
- heterogeneity of LDL molecule influences accuracy
- results vary b/t labs

Calculated:
- low cost, good correlations
- must fast
- TriG<400
Are reference ranges and interpretation based on population or on outcomes?
outcomes.
Which risk correlation C or LDL is steeper?

NCEP recommends that we screen all adults over 20 with a fasting lipid profile every ___ years. Which values should be included?
LDL, by ~30%

5 years. C, TriG, HDL, LDL
What are the primary targets for Tx? Secondary?
LDL
non-HDL C, apoB
What are the optimal cutoffs for the following values?
total C
LDL
HDL
non-HDL
TriG
<200
<100
>/= 40
<130
<150
What is the LDL target for those with 2+ risk factors?
those w/ CHD and CHD risk equivalents?

What do we do in kids?
What are the acceptable threshold for total C? LDL?
<130
<100

Screen 2-19yos if fami history of early CHD OR one parent w/ C>240

<170
<110
What is the ATP IV? What is non-HDL C?
coming soon, will focus on apoB and non-HDL C

Calculated value; = total C - HDL
Which are more proatherogenic - smaller, denser LDL or larger, less dense LDL?

Which is more atheroprotective, HDL2 or HDL3?

Do routine tests tell us either of these?

Are these measurements standardized?
smaller, denser LDL

HDL2

No, have to send it off for NMR or ultracentrifugation

No, just stick to one or the other. Only use them on pts who are borderline, where you're trying to decide whether to initiate therapy.
What is discoidal HDL? Where is this seend?

Can the normal, spherical HDL be damaged? by what?
it has imparied function and a weird shape.
LCAT deficiency and oxidative damage.

yes. Myeloperoxidase, AGE (in type I diabetes)
You should rule out a ____ disorder before Dx a ____ disorder.
2ndary (drugs, alcohol, nephrotic syndrome.... etc. many more of these)

Primary (increased lipoprotein production, abnormal processing, defective cellular uptake, decreased production or increased catabolism)
Is Male gender one of the risk factors for Atherosclerosis?

Does caffeine affect lipids?
Yes.

Yes.
Why aren't lipid lvls enough for testing?
35% of CHD occurs in patients whose total C is <200
From a pathological view, ______ stages of atherosclerotic plaque might be considered to be an inflammatory response to injury.
ALL STAGES
What are some markers of inflammation of plaque instability?

- don't need to have 100% memory of 'em.
Tape measure and BMI
hsCRP
homocysteine
MPO
Serum amyloid A protein...
this list grows every yera.
What makes CRP a good candidate for retrospective studies?

What produces it?
How long do CRP lvls stay elevated?

What is associated with acute inflammation in routine CRP assays?
it is a VERY stable molecule... it's NOT that specific to CHD.

the liver... in response to a variety of stimuli.
14days

>10mg/L
What is the difference b/t CRP and hsCRP?

hsCRP shows a very good correlation with morbidity if combined w/ _____?

Is one result enough?

*** If the hsCRP is greater than 10, what does that tell us?
hsCRP is much more sensitive. Both are standardized though, so the lvls will agree.

Troponin

No, need 2 results, 2wks apart.

Pt has infection, data is useless for CHD interpretation.
Is the biological variability of the hsCRP high?

Which gender has the higher variability?

Which interferring things can elevate lvls of hsCRP?
Yes, ~30%

Females.

smoking, BMI, insulin lvls, ETOH, depression
~30% of unstable angina pts have measurable ___ and ___.

Lvl of cTn (troponin) and CK-MB is related to what?

Patients w/ renal dz often have measurable ____.
cTn and CK-MB

risk of adverse event w/i 6-9 months

Troponin T, also Troponin i if the lab uses a high sensitivity thingy like UNC does.
Possible mechanisms of Troponin elevation in Renal Insufficiency? Why is this clinically significant?
failing kidney, subclinical ischemia, Hemodialysis, structural heart dz...

Pts come in with lvls of cTn above the cutoff for normal, but not 'spiking', lvls just stay there. There's no evidence of MI in these pts.
cTn is released because of cardiac cell ________. How does this jive with everything else?
necrosis.

basically, cardiac cells are dying, but different things could be causing that.
Do more patients with renal dz die of Cardio complications or ESRD (end stage renal dz)?
CV complications