CLS CLS Triglyceride Disorders & Management 2 — Questions and Answers
Question 1: Which dietary modification has the greatest impact on reducing severely elevated triglyceride levels?
- Restricting total dietary fat intake (Correct answer)
- Reducing dietary cholesterol
- Increasing saturated fat
- Eliminating dietary fiber
Correct answer: Restricting total dietary fat intake
In severe hypertriglyceridemia, reducing total dietary fat (especially in chylomicronemia syndrome) is the most effective dietary intervention.
Question 2: What is the Friedewald equation limitation regarding triglycerides when calculating LDL-C?
- It is inaccurate when triglycerides exceed 400 mg/dL (Correct answer)
- It overestimates LDL when triglycerides are below 100 mg/dL
- It cannot be used in fasting samples
- It requires direct HDL measurement only
Correct answer: It is inaccurate when triglycerides exceed 400 mg/dL
The Friedewald equation (LDL = TC − HDL − TG/5) becomes unreliable when triglycerides exceed 400 mg/dL because the VLDL estimate is inaccurate.
Question 3: Which genetic disorder is characterized by the accumulation of IDL and causes both hypercholesterolemia and hypertriglyceridemia with palmar xanthomas?
- Type III hyperlipoproteinemia (familial dysbetalipoproteinemia) (Correct answer)
- Familial hypercholesterolemia
- Familial hypertriglyceridemia
- Tangier disease
Correct answer: Type III hyperlipoproteinemia (familial dysbetalipoproteinemia)
Type III hyperlipoproteinemia (familial dysbetalipoproteinemia) involves ApoE2 homozygosity causing IDL accumulation and characteristic palmar xanthomas.
Question 4: Which medication class is generally contraindicated in patients with triglycerides >500 mg/dL due to risk of worsening hypertriglyceridemia?
- Estrogen-containing oral contraceptives (Correct answer)
- ACE inhibitors
- Beta-blockers at standard doses
- Calcium channel blockers
Correct answer: Estrogen-containing oral contraceptives
Estrogen-containing oral contraceptives stimulate hepatic VLDL production and can dramatically worsen hypertriglyceridemia.
Question 5: In the REDUCE-IT trial, icosapentaenoic acid (EPA) 4 g/day reduced major cardiovascular events by approximately what percentage in statin-treated patients with elevated triglycerides?
- 25% (Correct answer)
- 10%
- 40%
- 5%
Correct answer: 25%
REDUCE-IT demonstrated a 25% relative risk reduction in major adverse cardiovascular events with 4 g/day EPA in statin-treated patients with TG 135–499 mg/dL.
Question 6: Non-HDL cholesterol is considered a better predictor of cardiovascular risk than LDL-C in patients with elevated triglycerides because it includes which additional atherogenic particles?
- VLDL-C, IDL-C, and Lp(a) (Correct answer)
- HDL2 and HDL3 subfractions
- Chylomicron remnants only
- ApoA-I containing particles
Correct answer: VLDL-C, IDL-C, and Lp(a)
Non-HDL cholesterol captures all atherogenic apoB-containing particles including VLDL-C, IDL-C, and Lp(a), making it more comprehensive in hypertriglyceridemia.
CLS CLS Triglyceride Disorders & Management 2
Which dietary modification has the greatest impact on reducing severely elevated triglyceride levels?