Dyslipidemia Modul 16 Modul 17 Modul 18 Metabolism of lipoprotein Diferentiation of lipoprotein metabolism Drug used in treatment of hyperlipoproteinemia FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY MALANG 2013 MODUL 16 : DYSLIPIDEMIA METABOLISM OF LIPOPROTEIN Overve! Lipoproteins are complexes of lipids and proteins that are essential for the transport of cholesterol, triglycerides, and fat-soluble vitamins. Lipoproteins are large macromolecular complexes that transport hydrophobic lipids (primarily triglycerides, cholesterol, and fat-soluble vitamins) through body fluids (plasma, interstitial fluid, and lymph) to and from tissues. Lipoproteins play an essential role in the absorption of dietary cholesterol, long-chain fatty acids, and fat-soluble vitamins; the transport of triglycerides, cholesterol, and fat-soluble vitamins from the liver to peripheral tissues; and the transport of cholesterol from peripheral tissues to the liver. G"#$ To understand the metabolism of lipoprotein and the clinical importance of lipoprotein disorders derives chiefly from the role of lipoproteins in atherogenesis. O%&e'(ve) After completion of this module, you should be able to !. "ention the characteristic of human serum lipoprotein. 2. #nderstand the metabolism of lipoprotein. Te#'*+, )(r#(e,e) Active learning $ith module tas%, group discussion, and expert lecture. S-,,e)(e. (/e Lecture ! hours Ev#$-#("+ "0 $e#r++, &xamination or assignment Re0ere+'e) ! . 'isorders of Lipoprotein "etabolism. (n )reenspan*s +asic , -linical &ndocrinology, . th &d. 'igital &dition (/001); -hapter /0. /. 'isorders of Lipoprotein "etabolism. (n 2arrison*s 3rinciples of (nternal "edicine, !1 th &d. 'igital &dition (/00.); -hapter 450. A'(v(1 1 #nderstanding the characteristic of human serum lipoprotein and the metabolism of lipoprotein. 12 C*#r#'(er)(' "0 *-/#+ )er-/ $3"3r"(e+ L3"3r"(e+ '$#)) De+)(1 "0 0$"(#("+4 ,5/L M#&"r $3. '"+)((-e+( TG : C*"$ r#(" S(e "0 )1+(*e)) Me'*#+)/6)7 "0 '#(#%"$)/ C*1$"/'r"+ #+. re/+#+() VLDL IDL LDL 8DL L36#7 22 W*#(9) (*e .00ere+( %e(!ee+ (*e e:",e+"-) #+. e+.",e+"-) $3"3r"(e+ /e(#%"$' 3#(*!#1) ; 32 E:3$#+ #%"-( (*e 3r"'e)) "0 #(*er",e+e))2 <2 W*1 ." )er-/ LDL '*"$e)(er"$ %e'"/e # (#r,e( (*er#31 ; MODUL 1= : DYSLIPIDEMIA D00ere+(#("+ "0 D)"r.er) "0 L3"3r"(e+ Me(#%"$)/ Overve! Lipoproteins are complexes of lipids and proteins that are essential for the transport of cholesterol, triglycerides, and fat-soluble vitamins. The clinical importance of lipoprotein disorders derives chiefly from the role of lipoproteins in atherogenesis. The greatly increased ris% of acute pancreatitis associated $ith severe hypertriglyceridemia is an additional indication for intervention. 'isordered lipid metabolism also underlies the syndrome of nonalcoholic steatohepatitis (6A72). -haracteri8ation of dyslipidemia is important for selection of appropriate treatment and may provide clues to underlying primary clinical disorders. G"#$ To define the clinical differentiation of abnormal patterns of plasma lipoproteins. O%&e'(ve) After completion of this module, you should be able to define the clinical differentiation of abnormal patterns of plasma lipoproteins and related diseases. Te#'*+, )(r#(e,e) Active learning $ith module tas%, group discussion, and expert lecture. S-,,e)(e. (/e Lecture ! hours Ev#$-#("+ "0 $e#r++, &xamination or assignment Re0ere+'e) ! . 'isorders of Lipoprotein "etabolism. (n )reenspan*s +asic , -linical &ndocrinology, . th &d. 'igital &dition (/001); -hapter /0. /. 'isorders of Lipoprotein "etabolism. (n 2arrison*s 3rinciples of (nternal "edicine, !1 th &d. 'igital &dition (/00.); -hapter 450. A'(v(1 2 !. 9hat is the primary causes of hyperlipoproteinemia : /. 9hat are some secondary causes of hyperlipidemia : 4. 9hat do you %no$ about atherogenic dyslipidemia : ;. A number of nonlipid ris% factors are associated $ith increased -2' (coronary heart disease) ris% and must be considered in preventive efforts. 9hat do you %no$ about nonlipid ris% factor and their correlation $ith -2' : MODUL 1> : DYSLIPIDEMIA: Tre#(/e+( "0 *13er$3"3r"(e+e/# Overve! -linical trials $ith effective cholesterol-lo$ering drugs have documented the safety and efficacy of cholesterol-lo$ering therapy in preventing -2'. 3atients benefit from lo$ering plasma cholesterol levels regardless of gender, age, or baseline lipid values $hether or not they have a prior history of vascular disease. Lifestyle change must be an integral part of ris% reduction therapy. G"#$ To understand essential component of therapeutic lifestyle changes (TL-) to treat disorders of lipid metabolism and to understand the development of safe, effective, and $ell-tolerated pharmacologic agents to treat disorders of lipid metabolism. O%&e'(ve) After completion of this module, you should be able to !. understand essential component of therapeutic lifestyle changes (TL-) to treat disorders of lipid metabolism /. understand the development of safe, effective, and $ell-tolerated pharmacologic agents to treat disorders of lipid metabolism. Te#'*+, )(r#(e,e) Active learning $ith module tas%, group discussion, and expert lecture. S-,,e)(e. (/e Lecture ! hours Ev#$-#("+ "0 $e#r++, &xamination or assignment Re0ere+'e) 'isorders of Lipoprotein "etabolism. (n )reenspan*s +asic , -linical &ndocrinology, . th &d. 'igital &dition (/001); -hapter /0. 'isorders of Lipoprotein "etabolism. (n 2arrison*s 3rinciples of (nternal "edicine, !1 th &d. 'igital &dition (/00.); -hapter 450. 'rug Therapy for 2ypercholesterolemia and 'yslipidemia. (n )oodman , )ilman*s The 3harmacological +asis of Therapeutics. 'igital &dition (/00.); 7ection <<<=. Third >eport of the 6ational -holesterol &ducation 3rogram (6-&3) &xpert 3anel on 'etection, &valuation, and Treatment of 2igh +lood -holesterol in Adults (Adult Treatment 3anel (((), /00/ A'(v(1 321 Aim to understand the essential component of therapeutic lifestyle changes (TL-) to treat disorders of lipid metabolism. According to the NCEP-ATP III, what is the essential component of therapeutic lifestyles changes (TLC to lower L!L cholesterol and reduce C"! ris# $ %ention a&out the ATP III L!L-C 'oals and cutpoints for TLC and drug therapy in different ris# categories( A'(v(1 322 Aim to understand the development of safe, effective, and $ell-tolerated pharmacologic agents to treat disorders of lipid metabolism. )hat #ind of drugs can &e used to treat disorders of lipid meta&olism $ A'(v(1 323 This activity $ill help you to identification the differentiation and management of disorders of lipoprotein metabolism by a case study. CASE 1 A 44-year old $hite male has a long standing history of type / '" treated $ith glibenclamide !0 mg. 2e complaints of fre?uent attac%s of abdominal pain and also hyperpigmentation and hyper%eratosis in the s%in folds (nec% and axilla). 2bA!- $as !0@, total cholesterol .A. mgBdl; fasting plasma glucose !;1 mgBdl. Appearance of the plasma after overnight refrigeration sho$s a CcreamD layer at the top of the tube $ith a turbid, opa?ue infranatant. 3hysical examination demonstrates an obese male, !1/ cm, !!0 %g, blood pressure !..BA/ mm2g, pulse rate .0 xBmin. !. 9hat physical findings is illustrated in this man*s axilla : /. &ffective treatment of this man*s hyperlipidemia $ould include (true or false) a. gemfibro8il b. cholestyramine c. insulin d. nicotinic acid e. probucol f. lovastatin g. fish oil capsules from the health-food store T$o months later, he comes to the emergency room $ith acute abdominal pain locali8ed to the midepigastic area. 7erum lipase is !040 (#BL (normal ;-/;), amylase is 515 (#BL (normal /-/0), and triglycerides are 5;4/ mgBdl (normal !50-/00). 3lain film of the abdomen is unremar%able; gallbladder ultrasound sho$ no gallstones. 4. 9hat is $rong $ith this man no$ : CASE 2, A /0-year-old $hite male has a history of hypercholesterolemia dating bac% to age !/, $hen total cholesterol $as 4!5 mgBdL, triglycerides E;. This $as discovered after screening, since his mother has a history of hypercholesterolemia. 2is L'L cholesterol has been consistently $ell over /50 mgBdl in the past. 2e $as started on cholestyramine, but he has ad relatively poor compliance and therefore has not had much improvement. 2e has seen a dietician and appears to follo$ a fairly reasonable diet. 2is mother $as found to have cholesterol over ;00 mgBdL at age /4 and $as placed on medication. 7he is currently on cholestyramine and pravastatin, but $ith L'L cholesterol consistently over /00. 'espite being 55 years of age, she has no history of cardiac disease. 2is father is %no$n to have normal cholesterol. 2is younger brother has elevated cholesterol to a milder degree. 3hysical examination demonstrates a thin male, height !.5 cm, $eight 1/ %g4 blood pressure !!.B1; mm2g, pulse E.xBmin. There are no xanthomas, corneal arcus, or xanthelasmas. The examination is completely normal. !. 9hat type of hyperlipidemia does this man probably have : /. (s it li%ely to respond to diet : 4. 9hy does his mother not have significant cardiovascular disease : ;. A recent lipid profile sho$s L'L cholesterol /!4 mgBdL. Triglycerides are normal,and 2'L is lo$ at 4/ mgBdL. 9hat therapy $ould you recommend : CASE 3 A ;4 year old man has hetero8ygous familial hyperlipidemia. 2is serum concentration of total cholesterol and L'L are mar%edly elevated. 2is serum concentration of 2'L cholesterol, =L'L cholesterol and triglyceride are normal or slightly elevated. This patient*s mother and older brother died of myocardial infarctions before the age of 50. This patient has recently experienced mild chest pain $hen $al%ing up stairs and has been diagnosed as having angina of effort. The patient is some$hat over$eight. 2e drin%s alcohol most evenings and smo%es about one pac% of cigarettes per $ee%. !. (f the patient has a history of gout, $hat drugs is most li%ely to exacerbate this condition: 'escribe your reason. /. &xplain the mechanism $hy alcohol drin%ing is associated $ith cholesterol changes in serum lipid concentration.
