Hyperlipidaemia
Serum lipoprotein by electrophoresis
Chylomicrons:
Which transport dietary (exogenous) triglycerides from intestine to blood.
VLDL:
Transports endogenous triglycerides from the liver to blood. It also contains cholesterol.
IDL:
Transports 60% of plasma cholesterol from liver to tissue.
HDL:
Trasports 40% of plasma cholesterol from tissue to liver.
I. Classification of 1ry Hyperlipidaemia
Type 1 (
­ Chylomicrons)

Creamy plasma.
Due to
¯ lipoprotein lipase.
Triglycerides
­® pancreatitis.
ttt by
¯ fat in diet.

Type II (
­ LDL)

It is a familial hypercholesterolemia.
Due to
¯¯ LDL receptors.
Liable to I.H.D.
ttt by educing cholesterol rich diet & by drugs e.g. cholestyramine & HMG COA reductase inhibitors (stations)
HMG COA i.e. (hydroxymethyl Glutaryl coenzyme A).

Type III (
­ LDL, ­ VLDL)

Familial hypercholesterolemia & triglyceridemia.
Liable to I.H.D.
TTT by
¯ cholesterol in diet & by bezafibrate.

Type IV (endogenous Hyperlipemia)
­
VLDL, ­ triglycerides.
I.H.D & pancreatitis.
TTT
¯¯ fat, CHO in diet & nicotonic. A.

5- Type V (
­ Chylomicrons & VLDL)

Plasma triglycerides
­® pancreatitis.
Associated with obesity.
Liable to pancreatitis.
TTT by fat, CHO, Wt reduction & nicotinic acid (triglycerides lowering agent).

II. Causes of 2ry Hyperlipidaemia
D.M.
®­ VLDL, IDL, triglycerides.
Alcohol excess
®­ VLDL, triglycerides.
Chronic renal failure
®­ VLDL, ¯ HDL, ­triglycerides.
Thiazides
®­ VLDL, ­ triglycerides.
Non selective BB
®­ VLDL, ­ triglycerides.
Hypothyroidism
® LDL ­, ­ cholesterol.
Nephrotic $ LDL
­, ­ cholesterol.


Drugs used in the management of hyperlipidaemia
Fibrates e.g. bezafibcate ciprofibrate. Their action mainly is lowering triglycesides and increase HDL.
Statins e.g. fluvastatin, Atorastin. Their main action is lowering of LDL cholesterol.
Resins, they are cholesterol binding drugs and lower LDL .
Nicotinic acid, it reduces LDL and triglycerides.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)