jean robert
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A?
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| Idlehands
Forum Newbie
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E - Deficient levels of LDL receptors
E. Decreased lipoprotein(a)
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| Tiff
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answer is A
Edited by Tiff on 01/13/08 - 01:47 PM
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| new_n_lost
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E. Decreased lipoprotein(a)
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| SILVER
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A
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| GoodGirl
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Definitely E, Apo A - activator of LCAT
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| Misrati
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 its E.
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| Tiff
Forum Guru
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Ok. For those who answered E, can you possibly explain to me why on earth decreased levels of lipoprotein (a) will cause coronary heart disease? That really doesn't make any sense to me. 
Increased levels of lipoprotein (a) should contribute to increased risk of coronary disease. I still go with choice A.
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| paheli
It'sAllAboutGoodKarma
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I'llgo with A.
What's the answer, hero?
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| pr20
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I will go with A.
Increased LDL(LDL>160 mg/dL) and decreased HDL (HDL<35mg/dL) are clear risk factors for coronary artery disease.
Other risk factors are increasing age(men>40yrs,post menopausal women as estrogen offers protection),hypertension,smoking,family history,and diabetes mellitus.
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| new_n_lost
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Tiff wrote:Ok. For those who answered E, can you possibly explain to me why on earth decreased levels of lipoprotein (a) will cause coronary heart disease? That really doesn't make any sense to me. Increased levels of lipoprotein (a) should contribute to increased risk of coronary disease. I still go with choice A.
Lol i will but let me find the right city in Earth
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| hero
Forum Guru
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ans is A. Sorry, don't remember source, can't put original answer.
But i found reference for apo-? battle.
http://findarticles.com/p/articles/mi_m3225/is_6_...
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| pr20
Forum Senior
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It is important to remember that all patients with coronary disease of any kind should receive lipid lowering drug therapy and HMG COA reductase inhibitors(Statins)are therecommended initial drugs.
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| new_n_lost
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Guys remember that in layman terms we sometimes explain to our friends and relatives that its the HDL value which has to be good rather the LDL value. Even if your LDL value is high but your HDL value is also high then u are at a lower risk for CHD than person who has a lower value of HDL
Remember Good Cholesterol and Bad Cholesterol terms.
Well look if your LDL values are high you are a risk for CHD but if a question also says that choose between which has the more DEFINITE risk for CHD in the following
1. a person with high LDL
or
2. a person with low lipoprotein a
who would you choose ??
Remember Lipoprotein A is the main apolipoprotein for HDL. And also high HDL values are positively associated with decreased risk of CHD. or in other words if a person has a greater value of HDL it automatically negates the risk for CHD even though the LDL is elevated.
Now you have a patient whose lipoprotein A is decreased therefore he will have decreased production of HDL which would lead to increase levels of LDL and VLDL cos the reverse cholesterol transport system is down. So who will develop CHD faster ??
"HDL serves as a chemical shuttle that transports excess cholesterol from peripheral tissues to the liver. This pathway is called the reverse cholesterol transport system. In this system, plasma HDL takes up cholesterol from the peripheral tissues, such as fibroblasts and macrophages. Cholesterol undergoes esterification by lecithin-cholesterol acyltransferase (LCAT) to produce cholesteryl ester, which results in the production of the mature spherical HDL."
"High-density lipoprotein (HDL) is positively associated with a decreased risk of coronary heart disease (CHD). As defined by the US National Cholesterol Education Program Adult Treatment Panel III guidelines, HDL cholesterol (HDL-C) level of 60 mg/dL or greater is a negative (protective) risk factor. "
Ref Harrison's , Emedicine and NEJM
PS the above conclusion is what i have read from these books and articles. so this is only my opinion and i would like to discuss with you guys. so let the discussion begin.
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| hero
Forum Guru
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ok, found it
The correct answer is A
Educational Objectives
Recognize atherogenic lipoprotein abnormalities.
Critique
Increased LDL cholesterol is the lipoprotein abnormality that confers the greatest and most consistent risk for coronary heart disease. An increased total cholesterol does not allow the prediction of risk because multiple lipoprotein abnormalities may contribute to an elevated total cholesterol, including an increased HDL cholesterol. An increased HDL cholesterol lowers the risk for coronary heart disease. Although an elevated chylomicron triglyceride level may contribute to the development of pancreatitis, it is not predictive of coronary heart disease.
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| Misrati
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Dears , I'm still going with E , you know why ? B/c you won't get such a question in the exam since I had a look on many articles about Apo A , B , ...still negotiable ??
many of them still show coronary artery disease more specifically associated with low apo A, and/orhigh apo B rather than LDL itself ...as a result of many american and international cohort studies , you can check NEJM and many others ...
the more apo A you have the more HDL you get , how ? apo A's used to form HDL
A-1 especially activates LCAT (which catalyzes esterification of cholesterol )
Remember : High Apo B , low apo A and increased risk of heart disease .
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| Tiff
Forum Guru
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Misrati... NNL...
Lipoprotein (a) and apoA cannot be used interchangeably. They are not the same exact thing. Here's an excerpt from an article http://www.medscape.com/viewarticle/451762_4
Lipoprotein(a) [Lp(a)] is another lipoprotein particle which in structure is very similar to LDL with the addition of apolipoprotein(a). Lp(a) links lipid metabolism with blood coagulation,[13] and because of the structural similarities of the Lp(a) particle to both LDL and plasminogen, it is thought that this particle has both atherogenic and thrombogenic potential.[14] Lp(a) may inhibit thrombolysis and elevated levels are linked to increased risk for coronary heart disease[15]; this risk appears greater in the presence of elevated LDL cholesterol levels.
Also here's a chart showing how each apolipoprotein correlates with each class of lipoproteins:
Table I.
Hope this helps.
Edited by Tiff on 01/17/08 - 10:00 AM
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| SmokyWaters
Forum Elite
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EXACTLY.. tiff is right...
lp a is SMALL a :P
and Lipoprotein A is somethin with BIG A
the small lipoprotein a protein is similar to plasminogen and it is thrombogenic..it competes with plasminogen and decreases fibrinolysis...
so its a known risk factor for CAD
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| new_n_lost
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Yes have to agree Tiff is right on the mark Sorry confused with both,
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