A 45-year-old man with a 20-year history of type 2 diabetes presents with tendon xanthomas and eruptive skin xanthomas. Vital signs: BP 148/92 mmHg, HR 88 bpm, RR 16, temp 37°C. Laboratory findings reveal serum triglycerides 850 mg/dL, LDL cholesterol 320 mg/dL despite atorvastatin 80 mg daily, elevated apolipoprotein B levels, and normal TSH. He denies alcohol use. Which pathophysiologic mechanism best explains his severe dyslipidemia?
- A)Impaired lipolysis due to lipoprotein lipase deficiency
- B)Defective LDL receptor with complete loss of function
- C)Hepatic lipase deficiency leading to HDL accumulation
- D)Increased VLDL production and impaired remnant clearanceGABARITO
- E)Familial LCAT deficiency with impaired cholesteryl ester formation
Explicação
Type 2 diabetes causes insulin resistance, leading to increased hepatic VLDL synthesis and impaired catabolism of VLDL remnants. The elevated apoB indicates multiple atherogenic particles, consistent with VLDL overproduction and defective clearance mechanisms. Ver explicação completa e trilha adaptativa →