The nurse is teaching a client about reducing the risk for coronary artery disease. An elevation in which laboratory value is most directly associated with atherosclerosis, leading to coronary artery disease?
1. Total cholesterol
2. Very low-density lipoprotein (VLDL)
3. Low-density lipoprotein (LDL)
4. High-density lipoprotein (HDL)
Correct Answer: 3
Rationale 1: Total cholesterol represents the sum of all types of cholesterol. An elevation in total cholesterol is not the most direct predictor of atherosclerosis risk.
Rationale 2: Very low-density lipoprotein (VLDL) is a precursor of LDL and thus does not have the most direct relationship with initiation of atherosclerosis.
Rationale 3: The strength of the association between LDL cholesterol and atherosclerosis is demonstrated by the direct relationship between reduction in LDL cholesterol and acute coronary syndrome risk. LDL cholesterol contains lipoprotein (a), which is highly associated with atherosclerotic plaque.
Rationale 4: High-density lipoprotein (HDL) carries cholesterol from the peripheral tissues to the liver for metabolism and excretion, so an elevation rather than a decrease in HDL is associated with lowered atherosclerosis risk.
Global Rationale: The strength of the association between LDL cholesterol and atherosclerosis is demonstrated by the direct relationship between reduction in LDL cholesterol and acute coronary syndrome risk. LDL cholesterol contains lipoprotein (a), which is highly associated with atherosclerotic plaque. Total cholesterol represents the sum of all types of cholesterol. An elevation in total cholesterol is not the most direct predictor of atherosclerosis risk. Very low-density lipoprotein (VLDL) is a precursor of LDL and thus does not have the most direct relationship with initiation of atherosclerosis. High-density lipoprotein (HDL) carries cholesterol from the peripheral tissues to the liver for metabolism and excretion, so an elevation rather than a decrease in HDL is associated with lowered atherosclerosis risk.
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