A 51-year-old man with type 2 diabetes mellitus and metabolic syndrome presents with BP 148/92 mmHg, HR 88/min, and denies chest pain. Fasting laboratory studies show triglycerides 280 mg/dL, HDL cholesterol 32 mg/dL, and LDL cholesterol 156 mg/dL. Apolipoprotein B is elevated. VLDL particles are small and dense on lipid analysis. He takes metformin but denies statin use. Which metabolic disturbance in lipid metabolism best explains these findings?
- A)Increased hepatic apoB-100 synthesis with reduced clearance of VLDL particlesGABARITO
- B)Defective hepatic cholesterol esterification
- C)Decreased intestinal absorption of dietary triglycerides
- D)Impaired hydrolysis of triglycerides by adipose tissue lipoprotein lipase
- E)Primary deficiency of hepatic triglyceride lipase
Explicação
In metabolic syndrome and type 2 diabetes, hyperinsulinemia and insulin resistance drive increased hepatic apoB-100 synthesis, leading to overproduction of VLDL particles. Simultaneously, reduced clearance of VLDL particles (due to insulin resistance affecting... Ver explicação completa e trilha adaptativa →