Dyslipidemias Causes Risk Factors Epidemiology Etiology

• It initiates atherosclerosis. It causes plaque formation. Alters endothelial functions.
• It enhances coagulability of blood.
• major classes of lipids are Chylomicrons
• Very low density lipoproteins (VLDL) Intermediate density lipoproteins (IDL) Low density lipoproteins (LDL)
• High density lipoproteins (HDL).
• Serum cholesterol >200 mg/dL (5.18 mmol/L):
  • Due mainly to lifestyle habits in Westernized countries; however, genetic and secondary causes should be considered.

Dyslipidemias Risk Factors

• Obesity (BMI >30 kg/m²)
• Physical inactivity
• Diet rich in saturated fat and cholesterol
• Heredity

Epidemiologyof Dyslipidemias

• Predominant age: Increases with age (female onset delayed by 10–15 years compared with males)
• Predominant sex: Male = Female

Hypercholesterolemia

• LDL (Low density lipoproteins) cholesterol is in­creased.
• Combined Hyperlipidemia Increased LDL and triglycerides.

hypertriglyceridemia

• increased Triglycerides.  
• any blockages can be cleared or stabilized by  Iowering drugs
• modification of serum lipid profile prevents and controls CAD.
• lipid levels are controlled, a patient of myo­cardial infarction does not develop reinfarction.
• ngina pectoris can be cured by lowering the lipids to normal.

Morbidity and Mortality due to Dyslipidemias

• number of deaths due to CAD and complications diabetes can be reduced by maintaining a normal lipid profile.
• morbidity due to CAD and diabetes is reduced the control of lipids by lifestyle changes and _ ugs.
• Lipoprotein subpopulations are commonly used to augment risk prediction, favoring the term dyslipidemia, which encompasses:
  • High-density lipoprotein fraction of cholesterol (HDL): Atheroprotective
  • Low-density lipoprotein (LDL): Atherogenic
  • Triglycerides
• Reduction in plasma LDL cholesterol causes re­gression of coronary atherosclerosis.

Etiology of Dyslipidemias

Fat intake increases plasma levels of factor VII and VIla – thus increasing coagulability.

• By reducing dietary fat intake thrombogenic risk in CAD is reduced quickly.
• A single high fat meal can impair endothelial func­tion and blood flow within 1 hour.
• A low fat diet improves blood flow and endothe­lial function.

Lipoproteins

• Proteins are large coml2.lexes that transport
• lipids through body flued

Physical Exam

• Few specific findings, most secondary to atherosclerotic disease
• Genetic familial hypercholesterolemia:
• Corneal arcus age <50 years
• Xanthomata

Pregnancy Considerationsfor Dyslipidemias

• Fetal nutritional demands may alter diet and drug treatment.
• Statins contraindicated in pregnancy – Class X
• Lactation: Possibly unsafe

Clinical Considerations for Dyslipidemias

• Though very low cholesterol readings have been associated with higher mortality (J-curve phenomenon),
• this epidemiologic finding is likely due to confounding disease processes associated with low cholesterol levels,
• such as cancer and liver disease, rather than a primary effect of low cholesterol itself. A lower limit of cardiovascular benefit has not been established.

Lipoproteins are essential for transport of :

• · Cholesterol
• · Triglycerides
• ·Fat soluble vitamins.

Transport of cholesterol:

• · Triglycerides, cholesterol and fat soluble vitamins are transported from liver to peripheral tissues.
• · Cholesterol is transported from peripheral tis­sues to liver.

Apolipoproteins

• Are required for assembly and structure of lipo­proteins.
• Activate enzymes for Lipoprotein metabolism. , Mediate binding of Lipoprotein to receptors.