Diagnosis & Classification of Dyslipidemia Flashcards

A 42-year-old woman has LDL-C of 210 mg/dL, tendon xanthomas, and her father died of MI at age 48. The Dutch Lipid Clinic Network score would classify her as:

Answer: Definite FH

Tendon xanthomas alone yield 6 points, placing her at ≥8 points for definite FH in the Dutch Lipid Clinic Network scoring system.

Which finding on a fasting lipid panel best indicates the presence of chylomicrons?

Answer: Plasma that remains turbid after refrigeration

Chylomicrons float to form a creamy supernatant upon refrigeration overnight, distinguishing them from VLDL which keeps the infranatant turbid.

A patient with metabolic syndrome shows TG 200 mg/dL, HDL 38 mg/dL, and small dense LDL particles. This pattern is referred to as:

Answer: Atherogenic dyslipidemia triad

The atherogenic dyslipidemia triad—elevated TG, low HDL, and small dense LDL—is a hallmark of insulin resistance and metabolic syndrome.

Lp(a) levels are primarily determined by:

Answer: LPA gene copy number variation (kringle IV type 2 repeats)

Lp(a) concentrations are 70–90% genetically determined by the number of kringle IV type 2 repeats in the LPA gene, with shorter isoforms producing higher Lp(a) levels.

In the ACC/AHA 2018 guidelines, which LDL-C threshold triggers consideration of additional risk-enhancing factors for statin initiation in primary prevention?

Answer: ≥130 mg/dL

For intermediate-risk patients (7.5–20% 10-year ASCVD risk), an LDL-C ≥70 mg/dL is addressed, but primary prevention guidance focuses the 130 mg/dL threshold for discussion of risk enhancers.

Which lipoprotein is measured directly in the NMR-based advanced lipid panel that is NOT routinely captured in a standard fasting panel?

Answer: LDL particle number (LDL-P)

NMR spectroscopy directly quantifies LDL particle number (LDL-P), which can diverge from LDL-C and may better predict cardiovascular risk in certain patients.

A patient with sitosterolemia would most likely present with:

Answer: Markedly elevated plasma plant sterol levels with xanthomas despite normal LDL-C

Sitosterolemia (ABCG5/ABCG8 mutations) causes intestinal hyperabsorption of plant sterols, leading to xanthomas and atherosclerosis often with near-normal or mildly elevated LDL-C.