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Lipid Associated Disorders PowerPoint Presentation

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This medical talks about lipid-associated disorders, a group of medical conditions that are caused by abnormal levels of lipids, or fats, in the blood. These disorders can affect the heart, blood vessels, and other organs, and are a major risk factor for heart disease and stroke. Some of the most common lipid-associated disorders include Hyperlipidemia, Atherosclerosis, Familial hypercholesterolemia, Hypertriglyceridemia, Lipoprotein(a) excess, and Mixed hyperlipidemia, etc.

Tags : lipid-associated disorders, Hyperlipidemia, Atherosclerosis, Familial hypercholesterolemia, Hypertriglyceridemia, Lipoprotein excess, Mixed hyperlipidemia, endocrinology, endocrinology

Published on : Apr 21, 2023 | Views : 638 | Downloads : 2

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Slide 1-

Lipid Associated DisordersOR Lipid Related Clinical Problems
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Obesity- Metabolic Syndrome Dyslipoproteinemias/Dyslipidemias Fatty Liver Atherosclerosis Coronary Heart Diseases Myocardial Infarction Stroke
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Causes of Lipid Associated Disorders Diseases associated with abnormal lipid concentrations may be due to: Nutritional Imbalances Lifestyle habits Genetic abnormalities Secondary causes as a consequence of other disease
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Disorders Of LipoproteinsDyslipoproteinemias/Dyslipidemias
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Types Of Lipoprotein DisordersHyperlipoproteinemiasAndHypolipoproteinemias
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Dyslipoproteinemias/ Dyslipidemias Dyslipoproteinemias can be subdivided into two major categories Hyperlipoproteinemias Hypercholesterolemia Hypertriglyceridemia Combined Hyperlipoproteinemia Hypolipoproteinemias
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Hyperlipoproteinemia Hyperlipoproteinemia is an abnormal condition With an increased abnormal levels of circulating Lipoproteins in blood.
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Dyslipidemias Dyslipidemias are due to defect in Lipoprotein metabolism May include both excess and deficiency of Lipoproteins. Associated mostly in increase of one or more Lipid forms in blood circulation.
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Classification Of Dyslipidemias Based On Number Of Gene Involvement
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Primary Hyperlipoproteinemia Monogenic defect Polygenic Defect
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Monogenic Disorders Familial Hypercholesterolemia Homozygous or Heterozygous Defect: inactive LDL receptor Familial Lipoprotein Lipase deficiency Defect: inactive lipoprotein lipase Familial combined Hyperlipidemia Defect: Unknown
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Polygenic/Multifactorial These are commonly encountered Hypercholesterolemia Hypertriglyceridemia
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Causes Of Dyslipoproteinemias/ Dyslipidemias Dyslipidemias are generally caused by impaired Lipoprotein metabolism : Biosynthesis (Increased) Transformation and Transport (Improper ) Uptake and Utilization (Decreased)
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Causes of Hyperlipoproteinemia Increased formation of Lipoprotein Reduced clearance of LP from circulation Factors Causing These Excessive dietary intake of Carbs and Lipids Biochemical defects in LP metabolism Deficient Protein to form Apoproteins Defect in Enzymes and Proteins Associated to LP Defect in Receptors for LP Use of drugs that perturb LP formation or catabolism
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Secondary Causes Of Dyslipidemias
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Types of Hyperlipoproteinemias
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Fredrickson Classification of Hyperlipoproteinemia
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Deficiency Of Lipoprotein Lipase Leads To Familial Type I Hyperlipoproteinemia
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Defect in Lipoprotein Lipase activity Does not clear circulating Chylomicrons and VLDL; Increases levels of circulating Chylomicrons and VLDL Associated Hypertriglyceridemia This is termed as Familial Type I Hyperlipoproteinemia.
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Type I Hyperlipoproteinemias Shows a dramatic accumulation (≥1000 mg/dl) of Chylomicrons and VLDL in plasma
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Usually associated with acute abdomen pain due to acute pancreatitis  plasma TAG even in the fasted state
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Type III Hyperlipoproteinemia Familial dysbetalipoproteinemia Due to Apo E deficiency Associated with Hypercholesterolemia & premature Atherosclerosis
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Hypolipoproteinemias
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Hypolipoproteinemias Hypolipoproteinemias are abnormal conditions With decreased levels of circulating Lipoproteins in blood.
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Conditions Of Hypolipoproteinemias Decreased synthesis of Lipoproteins Deficiency of Lipotropic factors required for Lipoprotein biosynthesis.
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Types Of Hypolipoproteinemias
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Familial Hypobetalipoproteinemia Impairment in synthesis of Apo B Characterized with low LDL levels.
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Abeta Lipoproteinemia Rare disorder No synthesis of Apo B (Total Absence) Absence of LDL (Beta Lipoprotein) in blood circulation Defect in TAG-transfer protein Accumulation of TAG in liver
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Familial Alpha Lipoprotein DeficiencyTangiers Disease Absence of HDL (Alpha Lipoprotein) in blood Affects severely Reverse transport of Cholesterol Hypercholesterolemia Increased risk of Atherosclerosis and its Complications.
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Combined Hyperlipoproteinemia Presence of elevated levels of both serum Total Cholesterol and Triacylglycerols. Genetic form of this condition Familial Combined Hyperlipoproteinemia (FCH) Type V Hyperlipoproteinemia An accumulation of Cholesterol-rich VLDL and Chylomicron remnants as a result of defective catabolism of those particles 38
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Diagnosis And Therapeutic Strategy Of Dyslipidemias
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Identify patients at risk 1. Routine screening of Serum Lipid profile 2. Assessment of contributing risk factors Non-Pharmacologic therapy 1. Diet modification 2. Lifestyle modification C. Pharmacologic therapy
Slide 41-

Lipids and lipoproteins are important indicators of CHD risk, This is major reason for their measurement in research, as well as in clinical practice.
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Lipid Profile and Lipoprotein Analyses
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Estimation Of Lipid Profile Serum Triacylglycerol Serum Total Cholesterol Serum VLDL Serum LDL Cholesterol Serum HDL Cholesterol
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Hypertriglyceridemia Serum Triacylglycerol Borderline = 150-200 mg/ dl High 200-500 mg/dl Very High > 500 mg/dl Familial Hypertriglyceridemia Genetic Secondary Hypertriglyceridemia Hormonal imbalances Imbalance between synthesis and clearance of VLDL 44
Slide 45-

Hypertriglyceridemia Generally caused by deficiency of LPL or LPL cofactor. LPL hydrolyzes TAG in Chylomicrons and VLDL Deficiency of LPL prevents processing and clearing of Lipoproteins. Elevated even with fasting condition. 45
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Hypercholesterolemia Familial Hypercholesterolemia (FH) Homozygous rare 1/million Total cholesterol 800-1000 mg/dl Heart attack as early as teenage years Heterozygous cholesterols 300-600 mg/dl Heart attacks 20-50 years
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Hypercholesterolemia Familial hypercholesterolemia (FH) Primarily LDL elevations Synthesis is normal but decrease or lack LDL receptors Therefore LDL builds-up in serum Since cells cannot acquire from LDL increase internal synthesis
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LDL Methods Friedewald Calculation VLDL is estimated as TAG/5 LDL = Total Cholesterol – HDL – TAG/5
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Lipoprotein Assay Methods Separate Lipoprotein Fractions By: Electrophoresis – Agarose or Polyacrylamide Chromatographic Precipitation Ultracentrifugation Immunochemical
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Serum Triglycerides
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Serum Total Cholesterol 200-239 mg/dL
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HDL Cholesterol
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LDL Cholesterol
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Cholesterol Levels of: Healthy person = < 200 mg/dl Heterozygous individuals = 300 mg/dl Homozygous individuals = 680 mg/dl
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Consequences Of Dyslipoprotein Metabolism
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Fish Eye Disease Fatty Liver Atherosclerosis and its Complications
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Fish Eye Disease
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Fatty Liver
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Role Of Liver In Lipid Metabolism
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Liver is the Biochemical Factory of Human Body. Liver plays an important role in Lipid metabolism. Major pathways of Lipid metabolism are efficiently carried out in Liver.
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Lipid Metabolism At LiverIn Well Fed Condition
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Liver in well fed condition efficiently carries out various metabolic pathways of Lipid Metabolism. De Novo biosynthesis of Fatty acids Triacylglycerol Biosynthesis Cholesterol Biosynthesis Phospholipid Biosynthesis Glycolipid Biosynthesis VLDL Biosynthesis
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Lipid Metabolism At LiverIn Emergency Condition
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Liver in emergency condition carries following metabolic pathways of Lipid metabolism efficiently: Beta Oxidation of Fatty acids Ketogenesis Bile Acid and Bile Salt Formation
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Though Liver is predominant site for Lipid biosynthesis. Liver is not the storage organ for Lipids.
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Normally 3-5% of Lipids are present in Hepatocytes.
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Endogenously biosynthesized Lipids in Liver are Mobilized out in the form of VLDL molecule.
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Efficient formation of VLDL in Liver Does not allow the excess of Lipids to remain in Liver tissue.
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Fatty Liver/ Fatty Liver Disease/Hepatosteatosis
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What Is Fatty Liver? Fatty Liver is an abnormal condition Where there is more than 5% of Lipids retained in Hepatocytes.
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What Is Fatty Liver Disease? Fatty Liver disease (FLD), is a reversible condition of Liver Wherein large vacuoles of Lipids accumulate in Liver cells Via the process of Steatosis (Abnormal retention of Lipids within a cell)
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What Is Steatohepatitis ? Progressive inflammation of Liver (Hepatitis), Due to abnormal accumulation of Lipids(Steatosis) is termed as Hepatosteatosis/Steatohepatitis.
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Causes Of Fatty Liver
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Clinical Conditions Leading To Fatty LiverORRisks For Developing Fatty Liver
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Defect in Hepatic Biosynthesis of Lipids No Mobilization of Endogenously biosynthesized Lipids in Liver Accumulates Lipids in Liver
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Increased biosynthesis of Lipids than the mobilization capacity ,due to increased Carbohydrates. Decreased mobilization of Lipids from Liver cells due to decreased VLDL formation.
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Deficiency of Lipotropic factors affects The VLDL formation and mobilization of Lipids out of Hepatocytes.
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Conditions Leading To Fatty Liver
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Metabolic Syndrome Obesity Hypertension Dyslipidemias Diabetes mellitus Alcoholism Malnutrition (Deficiency of Lipotropic Factors)
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Wilsons Disease Hepatitis A Hepatitis C Hepatotoxic Drugs : MTX, VA, Acetaminophen, TC, Tamoxifen, Nefidepine, Amiodarone, CCl4 etc
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Lipotropic Factors and Their Role
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Adequate Presence of Lipotropic factor Prevents Retention of Lipids in LiverThere by preventing Fatty Liver.
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Lipotropic Factors are chemical substances which helps in formation of Phospholipids. This in turn helps in proper formation and mobilization of VLDL out from Liver.
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Names Of Lipotropic Factors Lipotropic Factors are chemicals involved in biosynthesis of Phospholipids: Choline Betaine forms Choline Inositol
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Amino Acids As Lipotropic Agents Glycine Serine Methionine
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Vitamins As Lipotropic Factors Vitamin B 12 Folic Acid
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Types Of Fatty Liver
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4 Types Of Fatty Liver Alcoholic Fatty Liver Non Alcoholic Fatty Liver Disease (NAFLD) Non Alcoholic Steatohepatitis (NASH) Acute Fatty Liver of Pregnancy
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Consequences Of Fatty Liver
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Fatty liver is a reversible condition and usually goes away on its own. Generally Fatty liver often has no symptoms and Does not cause any permanent damage.
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Consequences Of Fatty Liver
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Constant accumulation of abnormal excess amount of Lipids in Hepatocytes Affects the normal Liver functions Leads to Parenchymal damage to Liver Tissues Causes Liver Cirrhosis.
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Excess of Lipids deposition in Hepatocytes Interferes the biochemical functions Brings inflammation of Liver (Hepatitis) Changes the cytological features Damages the cell components Causes Liver Fibrosis Leads to Liver Cirrhosis Liver Carcinoma
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Natural History of Fatty Liver DiseaseFatty liver Steatohepatitis Steatohepatitis + Fibrosis (First Stage of Scar) Steatohepatitis + CirrhosisCryptogenic Cirrhosis
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When there is repeated damage to the LiverPermanent scarring of Hepatocytes takes place This is called Liver Cirrhosis
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Diagnostic Features OF Fatty Liver Disease
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Laboratory Abnormalities In Fatty Liver Disease 2 - 4 fold  ALT & AST AST: ALT Ratio < 1 ALP slight  in 1/3 Dyslipidemia -  TAG FBG and PPBG  BUN & Creatinine - N Normal Albumin. PT Low ANA + < 1 in 320  Serum Ferritin  Iron saturation AST: ALT Ratio > 1 if Cirrhosis sets in
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Fatty liver Normal liver