Classification of Hyperlipidemia

Question 1

Primary: cause

Answer 1

Result from single or multiple genetic mutations that result in increased plasma concentrations of cholesterol, triglycerides, or both and are the result of either increased synthesis or decreased clearance. HDL levels may be lower than normal, either from decreased synthesis or increased clearance

Question 2

Primary: symptoms

Answer 2

Early stages are asymptomatic. As disease progresses eruptive xanthomas, severe hypertriglyceridemia (>2000), lipemic plasma and lipemia retinalis

Question 3

Examples of primary hyperlipidemia

Answer 3

Familial hypercholesterolemia and familial defective Apo B-100. Familial hypertriglyceridemia, familial combined hyperlipidemia, familial chylomicronemia and familial dysbetalipoproteinemia

Question 4

Polygenic hypercholesterolemia (aka nonfamilial hypercholesterolemia)

Answer 4

Is the most common form of hyperlipidemia, with a prevalence of > 25% in the American population. Results from the combination of decreased activity of the LDL receptor and reduction of LDL clearance. This underlying genetic susceptibility becomes apparent with dietary intake of saturated fats, obesity, and sedentary lifestyle. 20% of these patients have Fhx of CHD. Present with mild-to high TC (250-350) and LDL (130-250). Treatment: LCs and lipid lowering drugs

Question 5

Familial hypercholesterolemia

Answer 5

An autosomal dominant disease responsible for defective LDL receptors that results in either reduction in receptor synthesis or inability of the receptor to bind and/or efficiently remove LDL. Pts typically present with tendon xanthomas, premature MI, elevated TC 275-500 in heterozygotes and 700-1200 in homozygotes; triglycerides 250-500 in heterozygotes and > 500 in homozygotes

Question 6

PH: treatment

Answer 6

Heterozygotes: TLC and drug tx that combines statins with other drugs that upregulate the LDL receptors (bile acid sequestrants, ezetimibe, or niacin). Due to the H risk of CHD and MI in homozygous patients, they should be treated in specialized medical centers that provide LDL apheresis and liver transplants

Question 7

Familial hypertriglyceridemia

Answer 7

Autosomal dominant disease characterized by high triglycerides (200-500) and normal LDL. Treated with lipid lowering drugs; combined with diet and weight loss

Question 8

Secondary Hyperlipdemias

Answer 8

Associated with primary underlying conditions (obesity HT/LHDL, diabetes HT,HTC, alcohol abuse HT/HHDL, chronic renal insufficiency HTC/HT, and hypothyroidism HTC)

Question 9

Atherogenic dyslipidemia

Answer 9

Found ~ 25% of patients with dyslipidemia and is usually diagnosed on patients with metabolic syndrome

Question 10

Atherogenic dyslipidemia: etiology

Answer 10

There is increased mobilization of triglycerides and cholesterol from adipose tissue to the circulation. This results in increased concentrations of triglycerides and VLDL rich in Apo C-III. Apo C-III inhibits lipoprotein lipase and prevents extraction of triglycerides from VLDL

Question 11

Atherogenic dyslipidemia: labs

Answer 11

Mod to high triglycerides (150-500) result from high fat intake and mobilization from adipose tissue and VLDL secretion by the liver

Question 12

Atherogenic dyslipidemia: treatment

Answer 12

Weight reduction; increased physical activity (stimulates lipoprotein lipase activity); statins to lower VLDL; fibrates to lower triglycerides; antioxidants

Question 13

Drug induced hyperlipidemia

Answer 13

Estrogen therapy: increased triglycerides and increased total cholesterol

Question 14

Drug induced hyperlipidemia

Answer 14

Atypical antipsychotics: increased triglycerides

Question 15

Drug inducred hyperlipdemia

Answer 15

Corticosteroids: increased total cholesterol

Question 16

Drug induced hyperlipidemia

Answer 16

Selective alpha blockers without intrinsic sympathetic activity or alpha-antagonism: increased total cholesterol and decreased HDL

Question 17

Drug induced hyperlipidemia: Thiazides

Answer 17

Modest increase in total cholesterol and LDL

Question 18

Secondary hyperlipidemia (elevated triglycerides) can be caused by

Answer 18

obesity, diabetes, alcohol abuse, HRT, atypical antipsychotic tx

Question 19

Secondary hyperlipidemia (elevated cholesterol) can be caused by

Answer 19

chronic renal failure, hypothyroidism, and typical beta blocker use