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Lipid disorders

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Lipid disorders

  1. 1. Lipid disorders Lipids = triglycerides & cholesterol
  2. 2. Basics  Fatty acids- triglycerides- dietary fat  Source & store of energy  Component of phospholipids in cell membrane  Cholesterol- derived from animal fat in diet  Synthesised in liver, excreted in bile & recycled from intestine  Component of cell membrane, bile acids, steroid hormones, fat-soluble vitamins-A,D,E,K  Transport- as lipoproteins  Chylomicrons- apoB48- diet-derived lipids to body cells  LDL- apoB100- carry cholesterol around the body  HDL- apoAI/II- carry cholesterol from cells to liver for excretion
  3. 3. Hyperlipidemia  Primary- familial  I- hyperchylomicronemia- deficiency of lipoprotein lipase- raised chylomicrons-TG- xanthomas, pacreatitis  II- hypercholesterolemia- LDL receptor defect- raised LDL ±TG- xanthelasma, tendon xanthoma, increased risk of CAD  III- dysbetalipoproteinemia- defect in apoE2 synthesis  IV- hypertriglyceridemia- impaired VLDL metabolism- TG increased  Secondary-  Diabetes mellitus, syndrome X  Hypothyroidism, nephrotic syndrome, alcohol intake  Drugs- diuretics, β-blockers, estrogens
  4. 4. Clinical  Raised cholesterol- increased risk of CVD, xanthelasma, tendon xanthoma, arcus senilis  Raised TG- xanthoma, pancreatitis, lipemic serum  Measurement- fasting, direct or derived  Screening- USPSTF  Men >35, women >45  Earlier in individuals with other risk factors of CAD
  5. 5. Target LDL <100 mg/dl, preferably <70
  6. 6. Treatment  Lifestyle changes-  Total fat intake- ~20-30% calories  Cholesterol intake- <200 mg/d  Quit smoking, weight control  Drugs-  Cholesterol/LDL- statins, fenofibrate, ezetimibe  Triglycerides- diet, fibrates, ω-3 fish oil  Low HDL-?- fibrate- after lifestyle changes
  7. 7. Treatment  Lifestyle changes-  Total fat intake- ~20-30% calories  Cholesterol intake- <200 mg/d  Quit smoking, weight control  Drugs-  Cholesterol/LDL- statins, fenofibrate, ezetimibe  Triglycerides- diet, fibrates, ω-3 fish oil  Low HDL-?- fibrate- after lifestyle changes

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