Metabolism is the complex set of chemical reactions that our
body uses to maintain life, including energy production.
Special enzymes break down food or certain chemicals so
our body can use them right away for fuel or store them.
When these chemical processes don't work properly due to a
hormone or enzyme deficiency, a metabolic disorder occurs.
Some metabolic disorders can be diagnosed by routine
screening tests done at birth.
Others are identified only after a child or adult shows
symptoms of a disorder.
HIGH BLOOD PRESSURE/ HYPERTENSION
Blood pressure is a measurement of the force against the walls of your
arteries as your heart pumps blood through your body.
Blood pressure readings are usually given as two numbers
The top number is called the systolic blood pressure. The bottom
number is called the diastolic blood pressure.
Hypertension (HTN) or high blood pressure, sometimes called arterial
hypertension, is a chronic medical condition in which the blood pressure
in the arteries is elevated.
CATEGORY BLOOD PRESSURE(mm/Hg)
HIGH B.P. ≥140/90
High blood pressure increases chance of having a stroke,
heart attack, heart failure, kidney disease, or early death.
‘Most of the time, no cause of high blood pressure is
found. This is called essential hypertension.’
Amount of water and salt in the body
The condition of kidneys, nervous system, or blood vessels
Age: Blood vessels become stiffer as you age and thus blood
pressure goes up.
Too much alcohol (more than one drink per day for women and
more than two drinks per day for men).
Too much salt in your diet
Family history of high blood pressure
„High blood pressure that is caused by another medical condition
or medication is called secondary hypertension.’
Secondary hypertension may be due to:
Chronic kidney disease
Disorders of the adrenal gland (such as Cushing syndrome)
Pregnancy or preeclampsia
Medications such as birth control pills, diet pills, some cold
medicines, and migraine medicines
Narrowed artery that supplies blood to the kidney (renal artery
Most of the time, there are no symptoms.
People can develop heart disease and kidney problems
without knowing they have high blood pressure.
If you have a severe headache, nausea or vomiting, bad
headache, confusion, changes in your vision, or nosebleeds
you may have a severe and dangerous form of high blood
pressure called malignant hypertension.
EXAMS AND TESTS
All adults should have their blood pressure checked
every 1 to 2 years if their blood pressure was less than
120/80 mmHg at their most recent reading.
If you have high blood pressure, diabetes, heart disease,
kidney problems, or certain other conditions, have your
blood pressure checked more often -- at least once every
Pre-hypertension: lifestyle changes to bring your blood pressure
down to a normal range.
Medicines are rarely used.
Eat a heart-healthy diet, including potassium and fiber, and drink
plenty of water.
Limit the amount of sodium (salt) -- aim for less than 1,500 mg per
Stay at a healthy body weight
When blood pressure is not well controlled, you are at risk
Bleeding from the aorta (the large blood vessel that
supplies blood to the abdomen, pelvis, and legs)
Chronic kidney disease
Heart attack and heart failure
Poor blood supply to the legs
Problems with your vision
Hyperlipidemia is a heterogeneous group of disorders
characterized by an excess of lipids in the bloodstream,
especially excess LDL-C and/or excess triglycerides.
These lipids include
Two better-known terms:
Based on density:
very low-density lipoproteins (VLDL)
intermediate-density lipoproteins (IDL)
low-density lipoproteins (LDL)
high-density lipoproteins (HDL)
Lipids are transported in the blood as large 'lipoproteins'
Most triglyceride is transported in chylomicrons or
VLDL, and most cholesterol is carried in LDL and HDL
Our bodies make and use a certain amount of cholesterol
every day, but sometimes that system gets out of whack, either
through genetics or diet.
The “good cholesterol” – known as high-density
lipoprotein, or HDL – helps coat the arteries like a
protective oil, helping to prevent blockages.
The “bad cholesterol,” low-density lipoprotein, or LDL –
can lead to blockages if there‟s too much in the body.
• genetically based, but the genetic defects are
known for only a minority of patientsPrimary
• may result from diseases such as diabetes, thyroid
disease, renal disorders, liver disorders, and
Cushing's syndrome, as well as obesity, alcohol
consumption, estrogen administration, and other
drug-associated changes in lipid metabolism
• is a major, modifiable risk factor for atherosclerosis
and cardiovascular disease, including coronary
• COMMON CAUSE
Familial combined hypercholesterolemia is the most common primary
lipid disorder, characterized by moderate elevation of plasma
triglycerides & cholesterol and reduced plasma HDL-C
Contributory or predisposing factors
Insulin-dependent diabetes mellitus
Non-insulin dependent diabetes mellitus
Renal failure and nephrotic syndrome
Fat intake per total calories greater than 40%
Saturated fat intake per total calories greater than 10%
Cholesterol intake greater than 300 mg per day
Habitual excessive alcohol use
• Lifestyle contributing factors include:
Habitual excessive alcohol use
Lack of exercise
Treatment will vary based on which type of lipids that
are too high.
Making healthy diet choices and increasing exercise are
important first steps in lowering your high cholesterol.
Avoid fatty foods and lower your overall daily calorie
Medication is also an effective tool
For people with high triglycerides, alcohol can be
Those with high cholesterol, a daily glass of wine or
other alcohol, along with healthy eating and exercise,
may actually help.
1% reduction in the level of LDL-C, there is a 1-1.5%
reduction in the risk of major cardiovascular events. 18
Read food labels and choose foods with low cholesterol and saturated fat
Keeping daily cholesterol intake between 250 and 300 milligrams and make
sure to limit saturated fat intake.
Limit your intake of red meat and eggs to reduce your saturate fat and
Choose skim milk, low fat or fat-free dairy products.
Limit fried food, and use healthy oils in cooking, such as vegetable oil.
Increase the amount of fiber you eat.
A diet high in fiber can help lower cholesterol levels by as much as 10
Lose extra weight.
A weight loss of 10 percent can go a long way to reversing, or lowering
your risk of hyperlipidemia
Check your family history of high cholesterol
Atherosclerosis is a potentially serious condition where arteries
become clogged up by fatty substances, such as cholesterol. These
substances are called plaques or atheromas.
It is characterized by irregularly distributed lipid deposits in the
intima of large and medium-sized arteries, causing narrowing of
arterial lumens and proceeding eventually to fibrosis and
The plaques cause affected arteries to harden and narrow which is
potentially dangerous for two reasons:
restricted blood flow can damage organs and stop them
if a plaque ruptures, it can cause a blood clot that blocks the
blood supply to the heart – triggering a heart attack, or the brain
– triggering a stroke .
WHAT CAUSES ATHEROSCLEROSIS?
Arteries are blood vessels that carry blood from the heart throughout
Two particularly important arteries are:
coronary arteries – which provide blood to the heart
carotid arteries – which supply blood to the brain
The blood passes into tiny blood vessels, known as
capillaries, where the oxygen in the blood is transferred into the cells
of your body's tissues and organs. The blood then returns to the heart
through the veins.
If a blood clot occurs in the coronary artery it can trigger a heart
attack. Similarly a blood clot in the carotid artery can trigger a
The endothelium layer works to keep the inside of arteries toned and
smooth, which keeps blood flowing.
"Atherosclerosis starts when high blood pressure, smoking, or high
cholesterol damage the endothelium, At that point, cholesterol
plaque formation begins."
Cholesterol invasion. Bad cholesterol, or LDL, crosses damaged
endothelium. The cholesterol enters the wall of the artery.
Plaque formation. White blood cells stream in to digest the LDL
cholesterol. Over years, the accumulating mess of cholesterol and
cells becomes a plaque in the wall of the artery.
ATHEROSCLEROSIS AND PLAQUE ATTACKS
Plaques from atherosclerosis can behave in different
They can stay within the artery wall.
They can grow in a slow, controlled way into the path of
blood flow. Eventually, they cause significant blockages.
Pain on exertion (in the chest or legs) is the usual
The worst-case scenario: plaques can suddenly rupture,
allowing blood to clot inside an artery. In the brain, this
causes a stroke; in the heart, a heart attack.
The development of arterial atherosclerosis may occur when deposits of
cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the
deposits harden and occlude the arterial lumen, blood flow to distant tissues
decreases and a clot may become lodged, completely blocking the artery.
FIGURE A REPRESENTS A HEALTHY ARTERY. FIGURE B SHOWS AN
ARTERY WITH PLAQUE BUILD-UP
Cardiovascular disease caused by plaques of
Coronary artery disease:
• Stable plaques in the heart's arteries
cause angina (chest pain on
• Sudden plaque rupture and clotting
causes heart muscle to die.
• This is a heart attack, or myocardial
• Ruptured plaques in the brain's
arteries causes strokes, with the
potential for permanent brain
• Temporary blockages in an artery can
also cause transient ischemic attacks
(TIAs),however, there is no brain
Peripheral artery disease:
• Narrowing in the arteries of the legs caused by plaque.
• Peripheral artery disease causes poor circulation.
• This causes pain on walking and poor wound healing.
Severe disease may lead to amputations 26
WHAT IS THE DIFFERENCE BETWEEN
ARTERIOSCLEROSIS AND ATHEROSCLEROSIS?
Arteriosclerosis is the stiffening or hardening of the
Atherosclerosis is the narrowing of the artery because of
All patients with atherosclerosis have arteriosclerosis,
but those with arteriosclerosis might not necessarily have
SIGNS AND SYMPTOMS:
The first signs of atherosclerosis can begin to develop during adolescence,
with streaks of white blood cells appearing on the artery wall.
Carotid Arteries - these arteries provide blood to the brain, when the
blood supply is limited patients can suffer stroke and may experience:
Coronary Arteries - these arteries provide blood to the heart, when the
blood supply to the heart is limited it can cause angina and heart
attack, symptoms include:
Renal Arteries- these supply blood to the kidneys; if the blood supply
becomes limited, there is a serious risk of developing chronic kidney
disease, and the patient may experience:
Loss of appetite
Swelling of the hands and feet
Peripheral arterial disease - the arteries to the limbs, usually the legs, are
The most common symptom is leg pain, either in one or both legs, usually
in the calves, thighs or hips.
The pain may be described as one of heaviness, cramp, or dullness in the leg
Other symptoms may include:
Hair loss on legs or feet
Male impotence (erectile dysfunction)
Numbness in the legs
The color of the skin on the legs change
The toenails get thicker
Weakness in the legs
a high-fat diet
a lack of exercise
being overweight or obese
having either type 1 or type 2 diabetes
having high blood pressure (hypertension)
having high cholesterol
Air pollution - exposure to diesel exhaust particles in air
pollution leads to a higher risk of bad cholesterol build-up in
the arteries.(in 2007, researchers from the University of
California in Los Angeles) 31
To prevent the build up of plaque or to help prevent blood clots
Other medications such as statins may be prescribed to lower
cholesterol, and Angiotensin-converting enzyme (ACE) inhibitors to
lower blood pressure.
Surgery - Severe cases of atherosclerosis may be treated by surgical
procedures, such as angioplasty or coronary artery bypass grafting (CABG).
Angioplasty involves expanding the artery and opening the blockage, so
that the blood can flow through properly again.
CABG is another form of surgery that can improve blood flow to the
heart by using arteries from other parts of the body to bypass a narrowed
Avoid saturated fats, they increase bad cholesterols level .
Exercise will improve fitness level and lowers blood pressure.
Flu vaccine - Flu vaccination may reduce the risk of heart attack by 50% in
middle-aged individuals with narrowed arteries.