A 45-year-old man with a 20-year history of type 2 diabetes mellitus presents with fatigue and dyspnea on exertion. Vital signs: BP 152/88 mmHg, HR 92 bpm, RR 18/min, SpO2 98% on room air. Laboratory studies reveal fasting glucose 285 mg/dL, triglycerides 520 mg/dL, HDL cholesterol 26 mg/dL, and LDL cholesterol 145 mg/dL. He denies chest pain. Currently taking metformin monotherapy with poor glycemic control. Which biochemical mechanism best explains his lipid abnormality?
- A)Increased hepatic VLDL production from excess acetyl-CoA derived from hyperglycemiaGABARITO
- B)Reduced CETP activity leading to HDL accumulation
- C)Decreased lipoprotein lipase activity due to insulin deficiency
- D)Increased apolipoprotein B-48 synthesis in the intestine
- E)Impaired cholesterol esterification by LCAT
Explicação
In poorly controlled diabetes, hyperglycemia drives increased acetyl-CoA production through glycolysis, which fuels hepatic de novo lipogenesis. Excess triglycerides are packaged into VLDL particles for export, causing hypertriglyceridemia. Insulin resistance ... Ver explicação completa e trilha adaptativa →