Cholesterol_in_the_Body_

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Cholesterol in the Body 1
📌
Cholesterol in the Body 
Dates
Topic
Type 📌 Assignment
Montoya Corral José Luis 
How does it work? 
Ingestion of triglycerides - fats are degraded by enzimatic processes. Lipases, after this cholecystokinin creates a reaction 
to stimulate pancreatic lipase which stimulates bile release 
After this proccess triglycerides are cleaved off to fatty acids, these fatty acids are wrapped up into chylomicrons to be 
transported from the digestive system to the adipose tissue
Finally chylomicrons become rich of cholesterol that is 
transported to the liver 
VLDL
Deliver triglycerides to adipose tissue, these can turn to LDL with high presence of cholesterol 
"Made" in the liver 
@September 8, 2021
Cholesterol in the Body 2
LDL
Used to move cholesterol to perioheral tissue and to the liver 
Important part of the processing if cholesterol using lysosomes 
These incorporate to the cell membrane
HDL
Known as good cholesterol
It acquires cholesterol from tissues to move it to the liver 
Cardioprotectors
It is believed that they protect us from AMI and ischemic cardiomyopathy 
Where can we find lipids? 
Vitamin A, D, E and K 
Omega 3
Fish
Omega 6
Linoleic acid 
Cholesterol in the Body 3
Butter
Cream
Bacon 
Beef fat
Walnuts
Triglycerides: Triglycerides store unused calories and provide your body with energy
Aid in the absorption and transport of fat-soluble vitamins
Lipoproteins: Transport of cholesterol to organs and tissues. There are five different types of lipoproteins in the blood, 
and they are commonly classified according to their density. The main types of lipoproteins that are analyzed in a lipid 
panel include very low-density lipoproteins (VLDS), low-density lipoproteins (LDL), and high-density lipoproteins (HDL).
Used in formation of membranes and are closely related to atherosclerotic plaques 
Statins
HMG-CoA reductase inhibitors are atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin,and 
simvastatin.
Indications:
They are used to reduce blood cholesterol levels in persons with hypercholesterolemia (goals- 30% to 40% 
reduction in LDL-C levels).
Atorvastatin and rosuvastatin also have the greatest effect on triglyceride levels and can be useful in treating 
patients with mixed hyperlipidemia.
Fibric acid derivates 
Indications:
Treatment of very high triglyceride levels (higher than 1,500 mg/dL) to prevent pancreatitis when dietary therapy 
has failed to lower these levels.
Patients who have a triad of elevated LDL-C, low HDL-C, and elevated triglycerides, and whose lipidemia has not 
responded to lifestyle changes or other pharmacologic agents.
Side effects:
Gastrointestinal side effects, allergic reactions, blood cell deficiencies, myopathy and rhabdomyolysis.
Resins 
Indications:
The resins are indicated for the treatment of hypercholesterolemia.
Patients who cannot tolerate other drugs and for younger patients who may need to have drug therapy for many 
years.
The resins have also been used to treat chronic diarrhea due to bile acid malabsorption.
Side effects:
They can cause constipation, fecal impaction, and other gastrointestinal side effects
Occasionally, they cause irritation of the perianal area and a skin rash.
Niacin 
Indications:
Hypertriglyceridemia: reduce LDL-C and triglyceride levels
To increase HDL-C levels in persons with abnormally low levels of this lipoprotein.
Patients with primary hyperlipidemia and mixed dyslipidemia.
Cholesterol in the Body 4
To reduce the risk of pancreatitis in patients with very high triglyceride levels.
Side effects:
Vasodilation, flushing, and pruritus; gastric irritation; glucose intolerance; myopathy
In a small percentage of patients, it can elevate serum transaminase levels and cause hepatitis.
It can also cause gastric distress and may aggravate a peptic ulcer.
It can increase blood glucose and aggravate diabetes.
Hyperuricemia and gout
NPC1L1 inhibitors 
Indications:
It can be used alone or in combination with a statin to treat hypercholesterolemia. A fixed-dose combination of 
ezetimibe and simvastatin (Vytorin), and ezetimibe with atorvastatin (Liptruzet) are available for this purpose. This 
may permit the use of lower doses of statins to obtain desired LDL-C levels with correspondingly less risk of statin 
toxicity (effective in treating persons with homozygous familial hypercholesterolemia).
Side effects:
Headache, myalgia
It can increase serum hepatic transaminase levels
PCSK9 inhibitors
Indications:
Alirocumab for adult patients:
To reduce the risk of myocardial infarction, stroke, and unstable angina requiring hospitalization in adults with 
established cardiovascular disease.
As an adjunct to diet, alone or in combination with other lipid-lowering therapies (e.g., statins, ezetimibe), for the 
treatment of adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) to reduce 
LDL-cholesterol
Evolocumab for adult patients:
To reduce the risk of myocardial infarction, stroke, and coronary revascularization in adults with established 
cardiovascular disease.
As an adjunct to diet, alone or in combination with other lipid-lowering therapies (e.g., statins, ezetimibe), for 
treatment of adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) to reduce 
LDL-cholesterol
As an adjunct to diet and other LDL-lowering therapies (e.g., statins, ezetimibe, LDL apheresis) in patients with 
homozygous familial hypercholesterolemia who require additional lowering of LDL-C
Side effects:
Rash, pruritus, and urticaria, rarely including nummular eczema, severe urticaria, nasopharyngitis and 
hypersensitivity vasculitis and neurocognitive toxicity.
References
Pokhrel, B., Yuet, W., & Levine, S. (2021). PCSK9 Inhibitors. Obtenido de Statpearls: 
https://www.ncbi.nlm.nih.gov/books/NBK448100/
Brenner, G., & Stevens, C. (2018). Pharmacology . Philadelphia: ELSEVIER.
Stroes, E., Stiekema, L. C. A., & Rosenson, R. S. (2021). PCSK9 inhibitors: Pharmacology, adverse effects, and 
use. UpToDate. https://www.uptodate.com/contents/pcsk9-inhibitors-pharmacology-adverse-effects-and-use