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BLOOD LIPIDS

1) Assess risk for cardiovascular and cerebrovascular disease 2) Assess risk for pancreatitis

Chylomicrons VLDL TG
Lipoprotein lipase

1 5
TG Receptor
mediated endocytosis

Excess CBH

TG
3

Fatty Acids

6
IDL C

FA
Chylomicron remnant Lipoprotein is taken up by the liver lipase

Lipoprotein 8 lipase

14 10 13
Transfer of cholesterol to LDL or IDL

11

LDL

9
Endocytosis via LDL receptors

C HDL

12 CC C
C

Fatty Acids

Hyperlipidemias
Primary
Caused by genetic defects in the synthesis or metabolism of lipoproteins

Role of LDL Oxidation in Heart Disease


LDL

Oxidation

Oxidized LDL

Macrophage in lining of blood vessels

Role of LDL Oxidation in Heart Disease


LDL

Oxidation

Oxidized LDL

Foam Cell
Beginning stages in plaque formation

Hyperlipidemias
Primary
Caused by genetic defects in the synthesis or metabolism of lipoproteins

Secondary
Disorders precipitated by other disease states, medications, or lifestyle

Effects of Lifestyle
Obesity
Increases TG (primarily VLDL) Also increases LDL

Sedentary Lifestyle
Increases VLDL synthesis by the liver Decreases the peripheral utilization of fat and glucose All this increases TGs.

Effects of Lifestyle
Exercise
Increases HDL Decreases LDL and VLDL

Diet
Saturated fat and cholesterol increases LDL

Moderate Alcohol
Increases HDL (1 or 2 glasses of beer or wine per day)

NCEP Classification for TGs


< 200 mg/dl Desirable

200-400 mg/dl
400-1000 mg/dl > 1000 mg/dl

Borderline High
High Very High

After Overnight Refriferation

Chylomicrons

Normal Fasting Serum

Serum After a Meal

Normal Contributions to Total Cholesterol

<20% 20-30% 60-70%

LDL HDL VLDL

Risk Factors for Heart Disease


Diet Obesity Diabetes

Lack of exercise
High blood cholesterol

Low HDL
Atherosclerosis

Hypertension

CV Disease
Genetic predisposition Being Male

Thrombosis(clots in blood vessels) Diet


Smoking

Aging

Dec 18, 2001

NCEP Classification for Cholesterol


< 200 mg/dl 200-239 mg/dl > 240 mg/dl

Desirable
Borderline High High

Enzymatic Measurement of Cholesterol


cholesterol oxidase

cholesterol

cholestene-4-ene-3-one

H2O2

HO

peroxidase

H2O2

reduced color indicator

2 H2O + oxidized color indicator (now colored)

Home Cholesterol Test


Contains peroxidase

Contains color indicator Cholesterol oxidase

2
Moves sample into place Opens buffer container

Reading the Result


Color indicator in the strip is oxidized by the H2O2 in the presence of peroxidase

Read the peak height from the scale on the plastic case

31.5

Electrophoresis of Lipoproteins
Origin
Direction of Migration
All Fractions

LDL VLDL HDL

Pre

Fasting Conditions

LDL VLDL HDL

HDL-C by Precipitation
Precipitate all lipoproproteins except HDL
MnCl2

Heparin

measure HDL chol. in supernatant

centrifuge

precipitate
HDL CHYLOMICRONS VLDL LDL

NCEP desirable: > 35 mg/dl

Measuring VLDL-C
Plastic tube

VLDL
Plasma

Centrifuge

Slice tube here

HDL & LDL

Flow Chart
Receipt of Sample

Beta-Estimate
TG < 250 mg/dl

TG Assay

Beta-Quant
TG > 250 mg/dl

TC Assay

Ultracentrifugation TC Assay

HDL Assay
Use the Friedewald Equation

Split tubes
VLDL fraction Assay

HDL Assay

Direct LDL-C
LDL HDL

LATEX BEAD

VLDL

NCEP Guidelines for LDL-C


< 130 mg/dl Desirable

130-159 mg/dl
> 160 mg/dl

Borderline High
High

IIa

IIb

III

IV

Non-lipid Tests for CVD Risk


Serum Homocysteine
Interferes with the formation of nitric oxide. Current Recommendation: Analyze only in patients considered at high risk due to cost. Increase intake of 3 vitamins: B6 B12 and folate

High-sensitivity C-reactive protein (hs-CRP)


A marker for systemic inflammation

Lecithin/Sphingomyelin Ratio
L/S
> 2/1

Indication
Lungs are mature

1.5-2/1 Transitional
(50% risk of RDS)

< 1.5/1 Immature lungs


(risk of RDS is great)

END