Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Hyperlipidemia Lecture PPT
Hyperlipidemia.
? abnormally elevated levels of any or all lipids
and/or lipoproteins in the blood but Plasma
cholesterol and triglyceride are clinically
important because they are major modifiable
risk factors for cardiovascular disease, whilist
severe hypertriglyceridaemia also predisposes
to acute pancreatitis.
the story of lipids.
? Chylomicrons---
? Transport fats from the intestinal
mucosa to the liver.
? LDL---
? In the liver chylomicrons release triglycerides
and some cholesterol and become low density
lipoprotein. Then carries fat and cholesterol the body's
cells. Oxidized LDL cholesterol---Atheroma formation.
? HDL---Carry fat and cholesterol back to the liver for
excretion.
? Atherogenic cholesterol---LDL, VLDL, IDL.
Type
Lipoprotein
Cholesterol
Fraction
level
elevated
TAG level
Type I
Chylomicrons
N
Type IIA
LDL
N
Type IIB
LDL and VLDL
Type III
Broad beta-
VLDL and
Chylomicrons
Type IV
VLDL
Type V
VLDL
N
Chylomicrons
Causes of Hyperlipidemia
v Diet
v Hypothyroidism
v Nephrotic syndrome
v Anorexia nervosa
v Obstructive liver disease
v Obesity
v Diabetes mellitus
v Pregnancy
? Diabetes Mellitus--Acetyl CoA pool is increased
and more molecules are channeled to
cholesterol'
? Obstructive jaundice---
? Excretion of cholesterol
through bile is blocked.
? Hypothyroidism--The receptor for HDL on liver
cells are decreased and so excretion is not
effective.
? Nephrotic syndrome--ALBUMIN is lost through urine,
( globulin and lipoprotein ) are increased as a
compensatory machanism.
? ATHERSCLEROSIS-The elevation of lipids in
plasma leads to the deposition of cholesterol
on arterial wall.
? IHD and CVA--Thromboembolic episodes in
coronary and cerebral vessels leads to
myocardial infarction and stroke.
Xanthelasma.
? XANTHOMA-The deposition of lipid in
subcutaneouas tissue.
? CORNEAL ARCUS- Deposits of lipids in
cornea, indicating hypercholestremia.
? Hyperlipidemia, in order to highest to lowest
incidence are Type IIA, Type IIB, IV, I, III and V.
HYPOLIPOPROTEINSMIAS
Familial hypobetalipoproteinemia:
It is an inherited disorder.
Due to an impairment in the synthesis of apo B.
The plasma LDL concentration in the affected
individuals is between 10 to 50 of normal
values.
This disorder is harmless & the individuals
have healthy and long life.
ABETALIPOPROTEINEMIA
? This is a rare disorder due to a defect in the
synthesis of apoprotein B.
? It is characterized by a total absence of B-
lipoprotein (LDL) in plasma.
? Triacylglycerols are not found in plasma, but
they accumulate in liver & intestine.
? Serum cholesterol level is low.
? Impairment in physical growth & mental
retardation.
FAMILIAL ALPHA-LIPOPROTEIN DEFICIENCY
(TANGIER DISEASE)
The plasma HDL particles are almost absent.
The plasma TG are elevated.
Increased risk of atherosclerosis.
type ii a.( pimary Familial
hypercholestremia)
? There is elevation of LDL.
? Patients seldom survive the second decade of
life due to ischemic heart disease.
? The cause is LDL receptor defect.
TYPE IIA(PRIMARY FAMILIAL HYPERCHOLESTREMIA).
? Receptor deficiency in liver and peripheral
tissues will result in the elevation of LDL levels
in plasma, leading to hypercholesterolemia.
? The LDL receptor defect may be due to the
following reasons.
1. LDL receptor deficiency.
2. Defective binding of B-100 to the LDL
receptors.
? This defect is known as B-3500 or familial
defective apo B.
3. Receptor-LDL complex is not internalized.
? Secondary type II hyperlipopteinemia is seen
in hypothyroidism, diabetes mellitus,
nephrotic syndrome and cholestasis.
Goals of Lipids.
? LDL
? <100-------------optimal.
? 100--129------Near optimal.
? 130---159------Borderline.
? 160--189--------High.
? 190--------------Very high.
? total cholesterol
? <200----------Desirable.
? 200----239----Borderline.
? 240------------Very High.
? HDL
? <40------Low
? 60----High
? serum Triglycerides
? < 150--Normal
? 150--199--Borderline.
? 200--499----High
? 500? Very High.
Non-pharmacologic
Management of hyperlipidemia.
Your Text Here
PREVENTIONSION OF
ATHEROSCLEROSIS.
Reduce dietary cholesterol.
Vegetables oil and PUFA
Green leafy vegetables
Exercise
Hypolipidemic drug.
Pharmacologic
Treatment
Medication for Hyperlipidemia.
Drug class
Agent
HMG COA Reductase
LOVASTATIN.
inhibitor
Cholesterol absorption
Ezetimibe
inhibitor
Nicotinic acid
Fibric acid
Fenofibrate
Bile acid sequestrant
Cholesttyramine.
Risk factor cardiovascular Disease.
modifiable
Non-modifiable
Dyslipidemia--LOW HDL, High
age
LDL, Triglycerides
smoking
gender
Raised blood pressure.
Family history of CHD.
Diabetes mellitus
Diet
This post was last modified on 30 November 2021