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MODULE FOR STUDENTS

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.