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Disease of Lipoprotein Metabolism and Lipidemia, Obesity
By… Krairat Komdee, MD.
Department of Internal Medicine, Phayao Hospital
Dietary cholesterol ~ 300-700mg/day
Biliary cholesterol ~ 1000mg/day
Adapted from Champe PC, Harvey RA. Biochemistry. 2nd ed. Philadelphia: Lippincott Raven, 1994; Glew RH. In Textbook of Biochemistry with Clinical Correlations. 5th ed. New York: Wiley-Liss, 2002:728-777; Ginsberg HN, Goldberg IJ. In Harrison’s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill, 1998:2138-2149; Shepherd J Eur Heart J Suppl 2001;3(suppl E):E2-E5; Hopfer U. In Textbook of Biochemistry with Clinical Correlations. 5th ed. New York: Wiley-Liss, 2002:1082-1150.
Physiologic role of cholesterolNormal biologic function
Component of cell membranes
Precursor of other steroids
Cortisol, progesterone, estrogen, testosterone, bile acids
Excess cholesterol
CHD
XanthomasAdapted from Saladin KS. Anatomy and Physiology. 2nd ed. Boston: McGraw-Hill, 2001; Jones PH et al. In Hurst’ s The Heart. Arteries and Veins. 9th ed. New York: McGraw-Hill, 1998:1553-1581; Ginsberg HN, Goldberg IJ. In Harrison’s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill, 1998:2138-2149.
Fredrickson Classification of Dyslipidemias
PhenotypeLipoprotein
elevated
SerumCholesterol
Level
SerumTriglyceride
LevelAtherogenicity
I Chylomicrons Normal to None seen
IIa LDL Normal +++
IIb LDL and VLDL +++
III IDL +++
IV VLDL Normal to +
V VLDL and chylomicrons
Notmal to +
Types of Dyslipidemia1. Hypertriglyceridemia
2. Hypercholesterolemia
3. Hyperalphalipoproteinemia
4. Hypoalphalipoproteinemia
5. Hypobetalipoproteinemia
Common genetic dyslipidemiaFamilial hypercholesterolemia
CHD risk based on risk factors other than LDL level
Positive risk factors
Male more than 45 years
Female more than 55 years or postmenopausal without estrogen replacement therapy
FH of premature CHD (definite MI or sudden death before age 55 in father or other male first-degree relative or before age 65 in mother or other female first-degree relative)