Hyperlipidemia

1. HYPERLIPIDEMIA
Hyperlipidemia is defined as elevated total cholesterol, LDL cholesterol, or
triglycerides; a low HDL cholesterol; or a combination of these abnormalities.
Abnormalities of plasma lipids can result in a predisposition to coronary,
cerebrovascular, and peripheral vascular arterial disease.
Hyperlipidemia is a major risk factor for atherosclerotic cardiovascular
disease!

2. In the liver, the chylomicrons release triglycerides and some cholesterol and
become low-density lipoproteins (LDL).
LDL then carries fat and cholesterol to the body’s cells.
High-density lipoproteins (HDL) carry fat and cholesterol back to the liver for
excretion

3. When oxidized LDL cholesterol gets high, atheroma formation in the walls of arteries
occurs, which causes atherosclerosis.
HDL cholesterol is able to go and remove cholesterol from the atheroma.
Elevated LDL and reduced HDL → promote atherosclerosis → increased risk of
cardiovascular events

4. 1. Obesity
2. Diabetes mellitus
3. Physical inactivity
4. Alcoholism
5. Hypothyroidism
6. Nephrotic syndrome
7. Cholestatic liver disease
8. Cushing's disease
9. Drugs: oral contraceptive pill, high
dose diuretic use, metoprolol
Congenital (less common)
1. Hyperchylomicronemia
2. Familial hypercholesterolemia
3. Familial hyperlipidemia
4. Familial hypertriglyceridemia
Acquired (more common)
HYPERLIPIDEMIA

5. Dyslipidemia classification according to Frederickson

6. 1. Xanthelasmas: nodular lipid deposits around the eyelids
2. Typically bilateral, yellow, flat plaques on the upper eyelids (nasal side)
3. Occurrence: primary or hypercholesterolemia (e.g., primary biliary cholangitis),
hyperapobetalipoproteinemia, ↑ LDL level

7. Eruptive Xanthomas Palmar Crease Xanthomas
Tendinous xanthomas
Xanthomas : nodular lipid deposits
in the skin and tendons

8. INVESTIGATION
• A fasting lipoprotein profile including total cholesterol, LDL, HDL,
and triglycerides should be measured in all adults 20 years of age or
older at least once every 5 years.
• Measurement of plasma cholesterol , triglyceride, and HDL levels
after a 12-hour or longer fast is important, because triglycerides
may be elevated in nonfasted individuals; total cholesterol is only
modestly affected by fasting.

9. The National Cholesterol Education Program Adult
Treatment Panel III (NCEP ATP III)

10. Treatment ofHyperlipidemia
Lifestyle modification
1. Low-cholesterol diet
2. Exercise
1. Inducing a weight loss of 10% should be
discussed with patients who are
overweight.
2. In general, physical activity of moderate
intensity 30 minutes a day for most days
of the week should be encouraged

11. Medications forHyperlipidemia
Agents
Lovastatin
Pravastatin
Ezetimibe
Side Effects
Myopathy, increased liver
enzymes
Headache, GI distress
Drug Class
HMG CoA reductase
inhibitors
Cholesterol
absorption inhibitor
Nicotinic Acid
Effects (% change)
 LDL (18-55), HDL(5-15)
 Triglycerides (7-30)
 LDL( 14-18),  HDL (1-3)
Triglyceride (2)
LDL (15-30),  HDL(15-35)
 Triglyceride(20-50)
Fibric Acids Gemfibrozil
Fenofibrate
LDL (5-20), HDL (10-20)
 Triglyceride(20-50)
Flushing, Hyperglycemia,
Hyperuricemia, GI distress,
hepatotoxicity
Dyspepsia, gallstones,
myopathy
Bile Acid
sequestrants
Cholestyramine  LDL
 HDL
No change in triglycerides
GI distress, constipation,
decreased absorption of
other drugs

12. Bile Acid Resins
Nicotinic Acid
Fibric Acid
Statin
Cholestrol
Absorption
inhibitor

13. Refrences
• Rosenson RS, JP Kastelein JJP. Hypertriglyceridemia.
• Le T, Bhushan V. First Aid for the USMLE Step 1 2015.
McGraw-Hill Education; 2014: p. 256.
• Jenkins B, McInnis M, Lewis C. Step-Up to USMLE
Step 2 CK. Lippincott Williams & Wilkins; 2015: p. 5