Lipids And Cardio Part 2
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Hyperchylomicronaemia Lipoprotein lipase deficient. Lipoprotein lipase needs insulin to work. Seen in “brittle” diabetes mellitus Pancreatitis Symptoms: Eruptive xanthomata Hepatomegaly Lipaemia retinalis Abdominal pain.
Serum triglyceride, fasting, increased, secondary causes: Obesity Carbohydrate diet Diabetes mellitus Hypothyroidism Renal disease Pancreatitis, acute. Drugs such as oral contraceptives, thiazides, betablockers
Hypertriglyceridaemia, treatments: Diet Drugs that activate Lipoprotein lipase LPL
Child, chronic abdominal pain, “pink” blood, “milky” serum. Sodium 100 mmol/L (135-147) is this real? Potassium 4 mmol/L (3.5-5) Chloride 70 mmol/L (95-108) Bicarbonate 20 mmol/L (22-30) Glucose 5 mmol/L (4-6) Urea 3 mmol/L (4-7) Osmolality 285 mmol/L(280-300) Amylase 2,000 U/L (40-150) Triglyceride > 50 mmol/L (<1.8).
Most Ischaemic Heart Disease (IHD) is acquired, risks: • • • • • • •
Family history Male Smoker Low exercise Obesity Hypertension Diabetes mellitus.
Controversies: Atherosclerosis is a degenerative disease. Ischaemic heart disease (IHD) is associated with serum cholesterol but IHD occurs at all levels of cholesterol IHD could be caused by atherosclerosis Not all myocardial infarctions (MI) are due to atherosclerosis.
atherogenesis
Controversies (2): Atheromas: calcification, ulceration, thrombosis, haemorrhage. Oxidized LDL Arteriosclerosis.
Management of IHD: Action in USA 5.2 mmol/L Canada and UK 6.2 (2006 in UK 4.0!) Treatment: Exercise 10% down Vegan diet 10% down Drugs for cholesterol: bile salt loss (cholestyramine) HMGCoA reductase inhibitor (statins) lowers by 20-30% but increases heart failure! [Nicotinic acid, Thyroxine].
49 year old bus driver Obese, alcoholic, smoker, no exercise, adopted, blood pressure 165/95. Serum cholesterol 7.6 mmol/L (<5.2) Serum triglyceride 4.7 mmol/L (<1.8) Serum HDL cholesterol 0.7 mmol/L (<2.0) Serum LDL cholesterol 4.5 mmol/L (<3.4) Are results valid? Should he be treated aggressively?
35 year old healthy woman Serum cholesterol is 8 mmol/L (“healthy” < 5.2) What next?
Serum triglyceride, fasting, increased, secondary causes: Obesity Carbohydrate diet Diabetes mellitus Hypothyroidism Renal disease Pancreatitis, acute. Drugs such as oral contraceptives, thiazides, betablockers
Hypertriglyceridaemia, treatments: Diet Drugs that activate Lipoprotein lipase LPL
Child, chronic abdominal pain, “pink” blood, “milky” serum. Sodium 100 mmol/L (135-147) is this real? Potassium 4 mmol/L (3.5-5) Chloride 70 mmol/L (95-108) Bicarbonate 20 mmol/L (22-30) Glucose 5 mmol/L (4-6) Urea 3 mmol/L (4-7) Osmolality 285 mmol/L(280-300) Amylase 2,000 U/L (40-150) Triglyceride > 50 mmol/L (<1.8).
Most Ischaemic Heart Disease (IHD) is acquired, risks: • • • • • • •
Family history Male Smoker Low exercise Obesity Hypertension Diabetes mellitus.
Controversies: Atherosclerosis is a degenerative disease. Ischaemic heart disease (IHD) is associated with serum cholesterol but IHD occurs at all levels of cholesterol IHD could be caused by atherosclerosis Not all myocardial infarctions (MI) are due to atherosclerosis.
atherogenesis
Controversies (2): Atheromas: calcification, ulceration, thrombosis, haemorrhage. Oxidized LDL Arteriosclerosis.
Management of IHD: Action in USA 5.2 mmol/L Canada and UK 6.2 (2006 in UK 4.0!) Treatment: Exercise 10% down Vegan diet 10% down Drugs for cholesterol: bile salt loss (cholestyramine) HMGCoA reductase inhibitor (statins) lowers by 20-30% but increases heart failure! [Nicotinic acid, Thyroxine].
49 year old bus driver Obese, alcoholic, smoker, no exercise, adopted, blood pressure 165/95. Serum cholesterol 7.6 mmol/L (<5.2) Serum triglyceride 4.7 mmol/L (<1.8) Serum HDL cholesterol 0.7 mmol/L (<2.0) Serum LDL cholesterol 4.5 mmol/L (<3.4) Are results valid? Should he be treated aggressively?
35 year old healthy woman Serum cholesterol is 8 mmol/L (“healthy” < 5.2) What next?
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