CLINICAL ASPECTS OF SERUM CHOLESTEROL | Tutorial D-1 CVS

130110110177|Gabriella Chafrina| 23/09/13

The Serum Cholesterol is correlated with the Incidence of Atherosclerosis and Coronary Heart Disease
- plasma cholesterol levels (>5,2 mmol/L) major factor in promoting atherosclerosis, triacylglycerol are an independent RF
- Atherosclerosis is characterized by deposition of cholesterol and cholesteryl ester from plasma lipoproteins into the artery wall.
- Prolonged elevation of levels of VLDL, IDL, chylomicron remnant, or LDL in blood (eg, DM, lipid nephrosis, hypothyroidism,
hyperlipidemia) are often accompanied by premature or severe atherosclerosis.
- The inverse relationship between HDL concentration and coronary heart disease, making LDL:HDL cholesterol ratio is a good
predictive parameter
- The American Heart Association endorses the National Cholesterol Education Programs (NCEP) guidelines for detection of high
cholesterol: All adults age 20 or older should have a fasting lipoprotein profile which measures total cholesterol, LDL (bad)
cholesterol, HDL (good) cholesterol and triglycerides once every five years. This test is done after a nine- to 12-hour fast without
food, liquids or pills.

CLINICAL ASPECTS OF SERUM CHOLESTEROL | Tutorial D-1 CVS

130110110177|Gabriella Chafrina| 23/09/13
Factors Influence Serum Cholesterol:
1. Hereditary factors: the greatest role in determining individual serum cholesterol,
2. Dietary factors : substitution in the diet of PUFA (corn oils and sunflower seed oils) and MUFA (olive oils) for saturated fatty acid.
One of the mechanisms involved is the up-regulation of LDL receptors by poly- and monounsaturated as compared with saturated
fatty acids in the catabolic rate of LDL (main atherogenic lipoprotein) + formation of VLDL particles (contain relatively
more cholesterol and utilized by extrahepatic tissues at a slower rate than are larger particles)
3. Environment/Lifestyle factors
Additional factors in coronary heart disease: high blood pressure, smoking, male gender, obesity (particularly abdominal
obesity), lack of exercise, and drinking soft as opposed to hard water
Factors associated with elevation of plasma FFA followed by output of triacylglycerol and cholesterol into the circulation in
VLDL include emotional stress and coffee drinking. Premenopausal women appear protected related to the beneficial effects
of estrogen
Regular exercise plasma LDL but HDL + triacylglycerol concentrations (due to insulin sensitivity enhances the
expression of lipoprotein lipase)

When Diet Changes Fail, Hypolipidemic Drugs Will Reduce Serum Cholesterol & Triacylglycerol
Statins: inhibiting HMG-CoA reductase and up-regulating LDL receptor activity. Ex: atorvastatin, simvastatin, fluvastatin, and
pravastatin.
Other drugs used include fibrates such as clofibrate and gemfibrozil and nicotinic acid: plasma triacylglycerols by the
secretion of triacylglycerol and cholesterol-containing VLDL by the liver.
Ezetimibe: blocking uptake via Neimann-Pick C like 1 protein inhibit absorption of cholesterol by the intestine blood
cholesterol levels. Belongs to azetidinone class of cholesterol absorption inhibitors.

Primary Disorders of the Plasma Lipoproteins (Dyslipoproteinemias) Are Inherited
Inherited defects in lipoprotein metabolism primary condition of either hypo- or hyperlipoproteinemia (all of the primary
conditions are due to a defect at a stage in lipoprotein formation, transport, or destruction)


Reference: Harpers Illustrated Biochemistry 28
th
edition; heart.org