Lipid Biochemistry USMLE Step 1 Practice Question
A 72-year-old man with chronic kidney disease (stage 4) presents with LDL cholesterol of 95 mg/dL on atorvastatin, but persistent hypertriglyceridemia (320 mg/dL) and very low HDL (28 mg/dL). His urinary protein is 2.5 g/day. Which of the following metabolic abnormalities best accounts for his atherogenic dyslipidemia despite LDL-lowering therapy?
Answer choices
- AIncreased lipoprotein lipase activity in adipose tissue
- BSelective impairment of hepatic cholesterol esterification
- CReduced hepatic clearance of apoB-containing lipoproteins and impaired reverse cholesterol transportCorrect answer
- DEnhanced VLDL synthesis due to increased apoB availability
- EStatin-induced inhibition of apoA-I synthesis
- FIncreased peripheral tissue uptake of HDL cholesterol via enhanced SR-BI expression
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