A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 57-year-old woman comes to the physician for a routine examination. She takes no medications. She swims 3 times weekly and jogs several miles with her dog on most mornings. Her diet consists primarily of vegetables, fish, and whole grains; she avoids processed foods and carbohydrates. She drinks one glass of red wine with dinner on most evenings. There is no family history of serious medical illness or cardiovascular disease. Physical examination shows no abnormalities. This patient is most likely to have an increase in which of the following laboratory markers?
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A
Very low density lipoproteinIncorrect. VLDL is the triglyceride-rich lipoprotein produced by the liver; it is increased by refined carbohydrates and alcohol excess, and decreased by exercise and a low-carbohydrate diet.
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B
High density lipoproteinCorrect. aerobic exercise, Mediterranean diet, and moderate red wine all raise HDL, the cardioprotective 'good' cholesterol involved in reverse cholesterol transport.
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C
Apolipoprotein B-100Incorrect. ApoB-100 is the structural apoprotein on LDL/VLDL/IDL; its level reflects total atherogenic particle number and is decreased — not increased — by this lifestyle.
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D
Low density lipoproteinIncorrect. LDL transports cholesterol to peripheral tissues and is atherogenic; her diet (low saturated fat, high fiber) and exercise would decrease LDL.
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E
Lipoprotein(a)Incorrect. Lp(a) is a genetically determined atherogenic lipoprotein largely UNAFFECTED by lifestyle modifications; her healthy habits would not increase this marker.
↑ Tap an answer to reveal the reasoning
Answer: B. This patient's lifestyle is a textbook cardioprotective profile: regular aerobic exercise (swimming and jogging), Mediterranean-style diet (vegetables, fish, whole grains), avoidance of processed carbohydrates, and moderate red wine intake. Each of these independently raises HDL cholesterol.
HDL is the 'reverse cholesterol transport' lipoprotein — it returns peripheral cholesterol to the liver for excretion. Aerobic exercise increases lipoprotein lipase activity and apolipoprotein A-I synthesis, both of which raise HDL. Monounsaturated fats (olive oil, fish) and moderate alcohol (1 drink/day) further raise HDL by 5-15%. The atheroprotective threshold is HDL >60 mg/dL.
In contrast, LDL, VLDL, and apoB-100 (the structural apoprotein of LDL, VLDL, and IDL) are all atherogenic and are LOWERED — not raised — by this lifestyle. The clinical pearl: when counseling patients, the lifestyle interventions that most reliably raise HDL are aerobic exercise (30+ min, 5x/week), smoking cessation, and weight loss; dietary changes have smaller effects on HDL than on LDL.
**Why each option:**
**A.** VLDL is the triglyceride-rich lipoprotein produced by the liver; it is increased by refined carbohydrates and alcohol excess, and decreased by exercise and a low-carbohydrate diet.
**B.** Correct — aerobic exercise, Mediterranean diet, and moderate red wine all raise HDL, the cardioprotective 'good' cholesterol involved in reverse cholesterol transport.
**C.** ApoB-100 is the structural apoprotein on LDL/VLDL/IDL; its level reflects total atherogenic particle number and is decreased — not increased — by this lifestyle.
**D.** LDL transports cholesterol to peripheral tissues and is atherogenic; her diet (low saturated fat, high fiber) and exercise would decrease LDL.