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Hyperlipidemia
Hyperlipidemia is defined as elevated levels of total cholesterol, LDL cholesterol, or triglycerides. It is a major risk factor for atherosclerosis and cardiovascular disease. LDL carries cholesterol to tissues while HDL removes cholesterol from tissues and returns it to the liver. Elevated LDL and reduced HDL promote atherosclerosis. Hyperlipidemia can be caused by genetic factors, obesity, diabetes, hypothyroidism, and certain drugs. It is investigated through a fasting lipid profile and classified using the Frederickson system. Treatment involves lifestyle modifications and medications like statins, fibrates, nicotinic acid, and bile acid sequestrants.
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Hyperlipidemia
- 1. HYPERLIPIDEMIA Hyperlipidemia is definedas 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 LDLcholesterol 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. Diabetesmellitus 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 accordingto Frederickson
- 6. 1. Xanthelasmas: nodularlipid 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 PalmarCrease Xanthomas Tendinous xanthomas Xanthomas : nodular lipid deposits in the skin and tendons
- 8. INVESTIGATION • A fastinglipoprotein 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 CholesterolEducation 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 NicotinicAcid 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
Editor's Notes
- #3 Chylomicrons transport fats from the intestinal mucosa to the liver 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. 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. Atherogenic cholesterol → LDL, VLDL, IDL
- #4 Chylomicrons transport fats from the intestinal mucosa to the liver 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. 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. Atherogenic cholesterol → LDL, VLDL, IDL
- #8 Extremely high levels of triglycerides and/or LDL result in extravasation of plasma lipoproteins and their deposition in tissue