Metabolic Syndrome
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How can effects of metabolic syndrome be reversed?
by losing 5-10% of body weight
What are the 5 medical conditions that metabolic syndrome is a combination of?
• central/abdominal obesity • high serum TGs • low HDL levels • elevated BP • elevated fasting plasma glucose
What is apoB?
a protein in the blood that helps transport cholesterol and other fats
Why is HDL cholesterol ‘good’?
it helps remove other forms of cholesterol from the bloodstream
What are consequences of metabolic syndrome?
increased risk of developing type 2 diabetes, CVD and stroke
What are the main causes of metabolic syndrome?
obesity, physical inactivity, endocrine factors, ageing and insulin resistance
What is insulin resistance?
the inability to respond to insulin, which can lead to hyperglycaemia
How do anti-hyperlipidaemic drugs reduce the level of lipids in the body?
• decreasing LDL cholesterol • increasing HDL cholesterol • decreasing TG levels
What are the 3 main types of anti-hyperlipidaemic drugs?
bile acid sequestrants, statins and ezetimibe
Why are statins prescribed?
to decrease LDL cholesterol to decrease the incidence of CVD
What is plaque?
a buildup of LDL cholesterol, other fats, and dead immune cells, covered by a cap of smooth muscle cells
What is the most important step of the cholesterol synthesis pathway?
the formation of mevalonate from HMG-CoA
How do statins work?
they bind to HMG-CoA reductase which prevents the formation of mevalonate
How do statins lower CDV risk?
they reduce cholesterol synthesis in the liver, prompting it to absorb LDL from the blood, which decreases CVD risk
What is ezetimibe?
a cholesterol absorption inhibitor
How does ezetimibe work?
• reduce the absorption of dietary and biliary cholesterol via the intestine • decrease delivery of intestinal cholesterol in the liver • increase hepatic LDL receptor activity • increase clearance of LDL
How do bile acid sequestrants work?
• they prevent bile acids from being reabsorbed into the bloodstream and force them out of the body in faeces. • the liver then makes more bile acids from LDL cholesterol in the blood, which reduces its levels in the blood • the depletion of cholesterol increases LDL receptor activity, which also reduces its levels in the blood
How does niacin (vitamin B3) work?
it inhibits the synthesis of cholesterol and TGs to reduce the risk of heart attack
How do fibrates work?
• they activate peroxisome proliferator-activated receptor α, which activates lipoprotein lipase • they decrease levels of VLDL cholesterol which is normally converted to LDL cholesterol and TGs
What is PCSK9?
an enzyme that regulates cholesterol levels in the blood produced in the liver, kidneys, and small intestine
How do PCSK9 inhibitors result in?
more LDL receptors to remove LDL i.e. decrease LDL levels in the blood
What do anti-hypertensive drugs do?
reduce blood pressure and prevent stroke and myocardial infarction
What do diuretics do?
target different parts of the nephron to reduce sodium reabsorption, which in turn pulls water into the urine
What are the first line of treatment for hypertension?
diuretics or calcium channel blockers