1. Lipid profiles in Cardio Vascular Diseases

2. What is a lipid profile? The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. They are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerois). The lipid profile typically includes:coronary heart diseaseheart attackstrokeatherosclerois Total cholesterol High density lipoprotein cholesterol (HDL-C)High density lipoprotein cholesterol (HDL-C) — often called good cholesterol Low density lipoprotein cholesterol (LDL-C)Low density lipoprotein cholesterol (LDL-C) —often called bad cholesterol Triglycerides

3. How is a lipid profile used? The lipid profile is used to help determine your risk of heart disease and to help guide you and your health care provider in deciding what treatment may be best for you if you have borderline or high risk. The results of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up.heart diseaserisk factors Depending on your results and other risk factors, treatment options may involve life- style changes such as diet and exercise or lipid-lowering medications such as statins.statins

4. Risk factors include: Cigarette smoking. Age (if you are a male 45 years or older or a female 55 years or older). Low HDL cholesterol (less than 40 mg/dL (1.04 mmol/L)).HDL cholesterol Hypertension (Blood Pressure of 140/90 or higher or taking high blood pressure medications). Hypertension Family history of premature heart disease (heart disease in a first degree male relative under age 55 or a first degree female relative under age 65)heart disease Diabetes. Diabetes

5. What do the results mean? In general, we will take into consideration the results of each component of a lipid profile plus other risk factors to determine whether treatment is necessary and, if so, which treatment will best help to lower the risk of heart disease.risk factors LDL Cholesterol Optimal: Less than 100 mg/dL (2.59 mmol/L) Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L) Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L) High: 160-189 mg/dL (4.15-4.90 mmol/L) Very high: Greater than 190 mg/dL (4.90 mmol/L) Total Cholesterol Desirable: Less than 200 mg/dL (5.18 mmol/L) Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L) High: 240 mg/dL (6.22 mmol/L) or higher

6. HDL Cholesterol Low level, increased risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women Average level, average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women High level, less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women Fasting Triglycerides Desirable: Less than 150 mg/dL (1.70 mmol/L) Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L) High: 200-499 mg/dL (2.3-5.6 mmol/L) Very high: Greater than 500 mg/dL (5.6 mmol/L)  The risk categories for children and adolescents are different than adults.

7. How is treatment determined? Treatment is determined by your overall risk of coronary heart disease. Based on the results of lipid tests and other major risk factors, your target LDL cholesterolis identified. If your LDL-C is above the target value, you will be treated.coronary heart diseaserisk factorsLDL cholesterol Your target LDL-C value is: Less than 100 mg/dL (2.59 mmol/L) if you have heart disease or diabetes.diabetes Less than 130 mg/dL (3.37 mmol/L) if you have 2 or more risk factors.risk factors Less than 160 mg/dL (4.14 mmol/L) if you have 0 or 1 risk factor.

8. A young girl with a history of severe abdominal pain was taken to her local hospital at 5 a.m. in severe distress. Blood was drawn, and the plasma appeared milky, with the triacylglycerol level in excess of 2,000 mg/dl (normal = 4–150 mg/dl). The patient was placed on a diet severely limited in fat, but supplemented with medium-chain fatty acids. Which of the following lipoprotein particles are most likely responsible for the appearance of the patient's plasma? A. Chylomicrons. B. Very-low-density lipoproteins. C. Intermediate-density lipoproteins. D. Low-density-lipoproteins. E. High-density-lipoproteins.

9. Correct answer = A. The milky appearance of her blood was a result of triacylglycerol-rich chylomicrons. Because 5 a.m. is presumably several hours after her evening meal, she must have difficulty clearing these lipoprotein particles. IDL, LDL, or HDL contain primarily cholesteryl esters and, if one or more of these particles was elevated, it would cause hypercholesterolemia. VLDL do not cause the described “milky appearance” in plasma.