Download MBBS Hyperlipidemia Lecture PPT

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and/or lipoproteins in the blood but Plasma

cholesterol and triglyceride are clinically

important because they are major modifiable

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risk factors for cardiovascular disease, whilist

severe hypertriglyceridaemia also predisposes

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to acute pancreatitis.
the story of lipids.

? Chylomicrons---
? Transport fats from the intestinal

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mucosa to the liver.

? LDL---
? In the liver chylomicrons release triglycerides

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and some cholesterol and become low density

lipoprotein. Then carries fat and cholesterol the body's

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cells. Oxidized LDL cholesterol---Atheroma formation.

? HDL---Carry fat and cholesterol back to the liver for

excretion.

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? Atherogenic cholesterol---LDL, VLDL, IDL.
Type

Lipoprotein

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Cholesterol

Fraction

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level

elevated

TAG level

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Type I

Chylomicrons

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N

Type IIA

LDL

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N

Type IIB

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LDL and VLDL

Type III

Broad beta-

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VLDL and

Chylomicrons

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Type IV

VLDL

Type V

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VLDL

N

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Chylomicrons
Causes of Hyperlipidemia

v Diet
v Hypothyroidism

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v Nephrotic syndrome
v Anorexia nervosa
v Obstructive liver disease
v Obesity
v Diabetes mellitus

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v Pregnancy
? Diabetes Mellitus--Acetyl CoA pool is increased

and more molecules are channeled to

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cholesterol'

? Obstructive jaundice---
? Excretion of cholesterol

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through bile is blocked.

? Hypothyroidism--The receptor for HDL on liver

cells are decreased and so excretion is not

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effective.

? Nephrotic syndrome--ALBUMIN is lost through urine,

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( globulin and lipoprotein ) are increased as a

compensatory machanism.
? ATHERSCLEROSIS-The elevation of lipids in

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plasma leads to the deposition of cholesterol

on arterial wall.

? IHD and CVA--Thromboembolic episodes in

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coronary and cerebral vessels leads to

myocardial infarction and stroke.
Xanthelasma.

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? XANTHOMA-The deposition of lipid in

subcutaneouas tissue.

? CORNEAL ARCUS- Deposits of lipids in

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cornea, indicating hypercholestremia.

? Hyperlipidemia, in order to highest to lowest

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incidence are Type IIA, Type IIB, IV, I, III and V.

HYPOLIPOPROTEINSMIAS

Familial hypobetalipoproteinemia:

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It is an inherited disorder.

Due to an impairment in the synthesis of apo B.

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The plasma LDL concentration in the affected

individuals is between 10 to 50 of normal

values.

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This disorder is harmless & the individuals

have healthy and long life.
ABETALIPOPROTEINEMIA

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? This is a rare disorder due to a defect in the

synthesis of apoprotein B.

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? It is characterized by a total absence of B-

lipoprotein (LDL) in plasma.

? Triacylglycerols are not found in plasma, but

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they accumulate in liver & intestine.

? Serum cholesterol level is low.
? Impairment in physical growth & mental

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retardation.
FAMILIAL ALPHA-LIPOPROTEIN DEFICIENCY

(TANGIER DISEASE)

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The plasma HDL particles are almost absent.
The plasma TG are elevated.
Increased risk of atherosclerosis.
type ii a.( pimary Familial

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hypercholestremia)

? There is elevation of LDL.

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? Patients seldom survive the second decade of

life due to ischemic heart disease.

? The cause is LDL receptor defect.

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TYPE IIA(PRIMARY FAMILIAL HYPERCHOLESTREMIA).

? Receptor deficiency in liver and peripheral

tissues will result in the elevation of LDL levels

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in plasma, leading to hypercholesterolemia.

? The LDL receptor defect may be due to the

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following reasons.
1. LDL receptor deficiency.

2. Defective binding of B-100 to the LDL

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receptors.

? This defect is known as B-3500 or familial

defective apo B.

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3. Receptor-LDL complex is not internalized.

? Secondary type II hyperlipopteinemia is seen
in hypothyroidism, diabetes mellitus,

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nephrotic syndrome and cholestasis.
Goals of Lipids.

? LDL
? <100-------------optimal.

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? 100--129------Near optimal.
? 130---159------Borderline.
? 160--189--------High.
? 190--------------Very high.
? total cholesterol

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? <200----------Desirable.
? 200----239----Borderline.
? 240------------Very High.
? HDL
? <40------Low

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? 60----High
? serum Triglycerides
? < 150--Normal
? 150--199--Borderline.
? 200--499----High

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? 500? Very High.
Non-pharmacologic

Management of hyperlipidemia.

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Your Text Here
PREVENTIONSION OF

ATHEROSCLEROSIS.

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Reduce dietary cholesterol.

Vegetables oil and PUFA

Green leafy vegetables

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Exercise

Hypolipidemic drug.
Pharmacologic

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Treatment
Medication for Hyperlipidemia.

Drug class

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Agent

HMG COA Reductase

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LOVASTATIN.

inhibitor
Cholesterol absorption

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Ezetimibe

inhibitor
Nicotinic acid

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Fibric acid

Fenofibrate

Bile acid sequestrant

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Cholesttyramine.
Risk factor cardiovascular Disease.

modifiable

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Non-modifiable

Dyslipidemia--LOW HDL, High

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age

LDL, Triglycerides
smoking

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gender

Raised blood pressure.

Family history of CHD.

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Diabetes mellitus
Diet