Frederick Classification of Hyperlipidemia

 Type I
- the name of the disease is hyperchylomicronaemia which is very rare compared to
the other classification. The serum cholesterol is normal but for the average of
overnight serum has a creamy top layer. Type I has two associated clinical disorders
which are apolipoprotein C-II deficiency or lipoprotein lipase deficiency. And for the
a child has type type I hyperlipidaemia (hyperchylomicronaemia) may develop a type
V hyperlipidaemia as become an adult. Other features include; recessive inheritance,
eruptive xanthomata, lipaemia retinalis and acute pancreatitis. For the lipoprotein
fraction of type I, the chylomicrons elevated, and for the lipid fraction, the
triglycerides elevated.

 Type IIa
- the name of the disease is familial hypercholesterolemia or hypercholesterolaemic
syndrome. For the average of overnight serum is clear and it is characterised by
autosomal dominant inheritance and has a gene frequency 1/500. Type IIa has five
associated clinical disorders; familial hypercholesterolemia, polygenic
hypercholesterolemia, nephrosis, hypothyroidism, and familial combined
hyperlipidemia. The presentation is with early onset ischaemic heart disease and
untreated life expectancy is 20 years. For the lipoprotein fraction of type IIa, the low-
density lipoprotein elevated, and for the lipid fraction, the cholesterol elevated.

 Type IIb
- the name of the disease is combined or mixed hyperlipidaemia. For the average of
overnight serum is clear . There is one associated clinical disorder for type IIb which
is the familial combined hyperlipidemia. Type IIb is inherited as an autosomal
recessive trait there is an increased risk of ischaemic heart disease. Also this condition
is characterised by raised triglyceride and cholesterol levels due to abnormally high
concentration of IDL and chylomicrons. For the lipoprotein fraction of type IIb, the
low-density lipoprotein and very low-density lipoprotein elevated, and for the lipid
fraction, the cholesterol and triglycerides elevated.

 Type III

- the name of the disease is dysbetalipoprotenemia which is also a rare condition. For
the average of overnight serum has the appearance of turbid. This type of condition or
disease may present in early adult life with possible other features such as obesity,
glucose intolerance and hyperuricaemia. And yellow palmar creases, palmer
xanthomas and tuberoeruptive xanthomas may be present. There is an increased risk
of coronary artery disease which may be found in approximately 3% of survivors of
myocardial infarctions and peripheral vascular disease. For the diagnosis of this
condition; the individual should be suspected in mixed hyperlipidaemia that has a
serum total cholesterol >8 mmol/l and serum triglyceride >5 mmol/l - though
generally lipid levels are markedly raised e.g. cholesterol 10-20mmol/L and
triglycerides 15-40 mmol/L. And possible features include; palmar striae and/or
tuberoeruptive xanthomata, remnant lipoprotein, or defective apo E isoforms. And for
the management includes; seek specialist advice, add fibrate or fish oil which is the
first - line treatment and there is generally a precipitant for the marked
dyslipidaemiaand this should be sought. Also there are pragmatic management of the
dyslipidaemia such as; seek specialist advice, identify if a metabolic insult that has led
to significant dyslipidaemia and manage accordingly, and check lipids and review
within two weeks. For the lipoprotein fraction of type III, the intermediate-density
lipoproteins, and for the lipid fraction, the cholesterol and triglycerides elevated.

 Type IV
- the name of the disease is Familial hypertriglyceridemia. For the average of
overnight serum has also the appearance of turbid. The associated clinical disorder are
the following; Familial hypertriglyceridemia, familial combined hyperlipidemia,
sporadic hypertriglyceridemia and diabetes. It is a condition wherein normal or
slightly raised plasma cholesterol and autosomal dominant inheritance. And condition
that there is an an overproduction of VLDL. For the lipoprotein fraction of type IV,
the very low-density lipoprotein elevated, and for the lipid fraction, the triglycerides
elevated.

 Type V
- the name of the disease is familial lipoprotein lipase deficiency which is also rare.
For the average of overnight serum the appearance is, creamy top and turbid bottom.
The clinical associated disorder are the following; diabetes, lipoprotein lipase and
apo-CII deficiency. It is normal or slightly raised plasma cholesterol. And it has
clinical features, these are; eruptive xanthoma, the characteristic of severe
hypertriglyceridaemia - yellow papules on the extensor surfaces of back, arms,
buttocks and legs; the hepatosplenomegaly may occur and lastly lipaemia retinalis
may occur which means that the retinal arteries and veins appearing white on
fundoscopy. For the lipoprotein fraction of type IV, the very low-density lipoprotein
and chylomicrons elevated, and for the lipid fraction, the triglycerides and cholesterol
elevated.

References:
1. WHO.(2018). WHO / Fredrickson classification of primary hyperlipidaemias.
Retrieved 24 October 2020, from https://gpnotebook.com/simplepage.cfm?
ID=x20020617063512021840
2. WHO.(2018). type 1 hyperlipidaemia. Retrieved 24 October 2020, from
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3. WHO.(2018). type 2A hyperlipidaemia. Retrieved 24 October 2020, from
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4. WHO.(2018). type 2B hyperlipidaemia. Retrieved 24 October 2020, from
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5. WHO.(2018). type 3 hyperlipidaemia. Retrieved 24 October 24, 2020, from
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6. WHO.(2018). type 4 hyperlipidaemia. Retrieved 24 October 2020, from
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7. WHO.(2018). type 5 hyperlipidaemia. Retrieved 24 October 2020, from
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