Dyslipidemia

Digestion and
absorption of lipids
Lipid transport
METABOLISME
LIPID
 Exogenous Metabolism

• The fatty foods we eat consist of triglycerides and cholesterol. In

addition to cholesterol that comes from food, in the intestine
there is also cholesterol from the liver which is excreted with bile
into the small intestine. Both fat in the small intestine that comes
from food and comes from the liver is called exogenous fat
• These chylomicrons are then transported to the liver and adipose
tissue (Guyton, 2008). These chylomicrons will enter the lymph
channels and finally the thoracic duct will enter the bloodstream.
• Free fatty acids can be stored as triglycerides back in fat or
adipose tissue, but if they are present in large quantities some of
them will be taken up by the liver to become material for the
formation of liver triglycerides
 Endogenous Metabolism

• Triglycerides and cholesterol are synthesized in the liver and

secreted into the circulation as VLDL lipoproteins. In circulation,
the triglycerides in VLDL will undergo hydrolysis by lipoprotein
lipase enzymes, and VLDL will turn into IDL which will also
undergo hydrolysis into LDL. Some of the VLDL, IDL, and LDL will
transport ester cholesterol back to the liver. LDL is the
lipoprotein that contains the most cholesterol. Some of the
cholesterol in LDL will be carried to the liver and other
steroidogenic tissues such as the adrenal glands, testes and
ovaries which have receptors for LDL-cholesterol
 Reverse Cholestrol
Transport Metabolism

• Nascent HDL (low Ch and apoprotein A,C,E) ->

Take Ch from macrophages -> HDL mature (high
free Ch) -> Chest ester (Lecitin Cholestrol
Acytransperase) -> Taken to the liver
• VLDL and IDL give Tg to Chester while Chester
gives Ch to VLDL and IDL -> Back again to liver
PATHOFISIOOGI
DISLIPIDEMIA
 Pathophysiology
people who are obese and eat a diet high in fat (especially
animal fat)

Causing increased cholesterol synthesis in the liver

The concentration of LDL (which is rich in cholesterol) also

increases

LDL will bind to receptors intermediary collection of cholesterol

in macrophages, skin and blood vessels

causes accumulation of cholesterol in macrophage cells, skin and

blood vessels

Trigger the occurrence of atherosclerosis and coronary heart

disease
 Definition,
classification of
dyslipidemia
 Definition
Definition: a disorder of lipid metabolism
characterized by↑total cholesterol, LDL, TG,
and ↓HDL
 Classification
1 Primary dyslipidemia

Primary dyslipidemia is related to genes that

regulate enzymes and apoproteins involved
in lipoprotein metabolism and their
receptors. This disorder is usually caused by
a genetic mutation

2 secondary dyslipidemia

• Secondary dyslipidemia caused by

underlying disease or condition such as
diabetes mellitus, hypothyroidism,
metabolic syndrome and nephrotic
syndrome
Etiologi dan factor
risiko
 Etiology

genetic factor
Dietary habit Obesity

Age factor Smoking factor Sports factor

 Faktor risiko
• lipoprotein levels,especially cholesterol LDL,increase in line with increase age.In circum stances
normal,Men have which ratemore tall,but after menopause rate on woman start increase.
• Facto relse that cause height rate fat certain (for example VLDL and LDL) is:
History family with dyslipidemia
Obesity
Dietrichfat
Not enough To do sport
Use alcohol
Smoke
Diabetes which no controlled with good
Gland thyroid which not enough active
How to diagnose
 Anamnesis personal
 Anamnesis of MAIN complaint : Obesity
- neck and shoulder pain
- Asymptomatic
- generally dyslipidemia is asymptomatic and is usually
found at the time the patient performs (medical check
up)
1. Examination of vital signs

2. Anthropometric examination
(abdominal circumference and
body mass index)

BMI (kg/m2) =
weight(kg) /TB2(m)
 Supporting investigation
LIPID PROFILE

Method: total cholesterol, LDL, HDL no need to

fast. TG mustfasting 12-16 hours. LDL levels can
be calculated using the Friedewald formula

This formula only applies if the TG level is

<400 mg/dl
 Pharmaco and non-
pharmaco management
 NON PHARMACO MANAGEMENT
1. Physical activity
• The recommended physical activity includes:exercise program
includes at least 30 minutesmoderate-intensity physical activity
(lowering4-7 kcal/min) 4 to 6 times a week, withSpending at least 200
kcal / day.
• Which activitySuggestions include brisk walking, stationary cycling,or
swimming.
• Daily physical activity goalscan be fulfilled in one session or several
sessionsthroughout the series in a day (minimum 10minute).
 NON PHARMACO MANAGEMENT
2. Medical Nutrition
• Therapy For adults, it is recommended to consume a low-calorie diet
consisting of fruits and vegetables (≥ 5 servings/day), whole grains (≥6
servings/day), fish, and lean meat.
• Intake of saturated fat, trans fat and cholesterol is a mustrestricted,
while macronutrients are loweredLDL-C levels should include plant
stanols/sterols (2g/day) and water-soluble fiber (10-25 g/day).
 PHARMACO MANAGEMENT
1. Statins
• The mechanism of action of statins is reducingcholesterol formation
in the liver by inhibitingcompetitive action of the HMG-CoA reductase
enzyme.
• Statins are generally taken once a dayat night.
• Currently available statin preparationson the market are: simvastatin
5-80 mg, atorvastatin 10-80 mg,rosuvastatin 5-40 mg, pravastatin 10-
80 mg, fluvastatin 20-40mg (80 mg extended release), lovastatin 10-
40 mg (10-60 mgextended release) and pitavastatin 1-4 mg
 PHARMACO MANAGEMENT
2. Bile Acid Sequestrants
• The mechanism of action of this drug is to lower cholesterol through
inhibition of absorption of bile acids in the enterohepatic circulation with
the result that the synthesis of bile acids by the liver will mostly come
from the liver's own cholesterol reserves. The process of cholesterol
catabolism by the liver will be compensated by an increase in LDL
receptor activity which will ultimately reduce LDL-K in the blood
circulation.
• There are three types of bile acid sequestrants namelycholestyramine,
colestipol with a dose of 2 doses 2-3 times a day and the newest class is
colsevelam 625 mg 2 times 3 tablets a day (3.8 grams/day).
 PHARMACO MANAGEMENT
3. Fibric Acid
There are four types, namely gemfibrozil, bezafibrat,ciprofibrate, and
fenofibrate.This drug lowers plasma triglycerides, in addition to
reducing triglyceride synthesis in the liver.
This drug works to activate the enzyme lipoprotein lipase which works
to break down triglycerides. In addition to lowering triglyceride levels,
this drug also increases HDL-cholesterol levels, presumably by
increasing the apoproteins A-I and A-I.
 PHARMACO MANAGEMENT
4. Nicotinic Acid (niacin)
• This drug is thought to work by inhibiting hormone enzymessensitive lipase
in adipose tissue, thus willreduce the amount of free fatty acids. It is known
that sourfree fat is in the blood some will be captured byliver and will be a
source of VLDL formation. Withdecreased VLDL synthesis in the liver, will
resultdecrease in triglyceride levels, and also LDL-cholesterol in plasma.
• Giving nicotinic acid was also found to increase KHDL levels.
• The most common side effect is flushingnamely the feeling of heat and
redness in the facial areaeven on the body.Niacin dosage varies between
500-750 mg to 1-2gram given at night in the form of extended realization.
Differential diagnosis
 6. Differential Diagnosis

Obesity

Obesity oftenti meoccur because calories which enter more many than which burned
through sport and activity normal obesity occur when index mass body some body is
30 or more big.Symptom main is fat body which excessive, which increase risk
emergence problem health which seriously. Handling mainly is change style life like
pattern eat and sport.
 Hypothyroidism
hypothyroid occur when sweat thyroid no capable produce hormonesin amount which
enough.Disturbance hormone this generally caused by:

 Disease autoimmune.Radiotherapy drugs certain use a number of type drug like

lithium,amiodarone andinterferons.
 Dietlow iodine,abnormality default disturbance hormone TSH.
 Easy tired and dizzy,constipation or difficult throw away water big,muscle feels weak,painful
and rigid,moresensitiv weather cold,skin dry,Rough,peeled off,and crunchy.Heavy body go on
without because which clear,face swollen,and voice Becomes hoarse,hair fall out andthin,
nailseasy fragile.
 Easy forget and difficult concentrating,tick heart slow(bradyadi).
 Chronic renal insufficiency

Fail kidney chronic caused by damage network kidney which triggered by disease period long.A
number of disease which can Becomes reason fail kidney is diabetes,pressure blood tall,and
disease sour tendon and the cause usually is disease kidney autoimmune,drugs
certain,dehydration heavy,obstruction channel urine,and disease systemic which no
controlled.Different withw hichI,fail kidney chronic could affect how much good function kidney
from time to time
 Metabolic syndrome

Some body said suffer syndrome metabolic if experience at least three from five condition,that is
hypertension (pressure blood tall), HDL levels low (dyslipidemia), TG level stall, rate sugar blood
tall or prediabetes,obesity with buil dup fatin stomach.
 Dm

kindly general,disease Diabetes Melitus (DM) occur consequence style life no healthy which
cause accumulation pile it upratesugar in blood and is atinon thres hold limit normal one
scharacteristic chronic and period long.

• Diabetes Melitus type 1or often known also with diabetes type1 is condition in where body
no can produce insulin with enough because exists damage on cell pancreas.Type diabetes
this is abnormality autoimmune and often suffered by children and teenager.
• On diabetes type 2,body no produce enough insulin,or reject insulin.Symptom form
flavorthirsty increase,often throw away water small,hungry,tired,and vision blurry.On a
number of case,no there is symptoms. Treatment formdiet,sport,drug,and therapy insulin.
Complications and
prognosis
ARTERIOSKLEROSIS
• is the thickening and loss
of elasticity of the artery
walls
• arteriosclerosis
complications
1. coronary heart disease
2. cerebral vascular
disorders
3. Peripheral vascular
disorders
 Prognosis

• One tool that clinicians can use to calculate the prognosis of a patient
with dyslipidemia is 10-year atherosclerotic cardiovascular disease
risk. This calculator is a risk factor for patients based on lipid levels as
well as age, race, tobacco use, diabetes, sex, and history of
hypertension. This calculation will give a percentage of risk that a
cardiovascular event will occur in 10 years. Also, a percentage of risk if
risk factors were optimal.
Education
 EDUCATION ABOUT

• THE POSSIBLE CAUSE

• STEPS ASSOCIATED WITH THERAPY (DRUG SIDE
EFFECTS)
• RELATED TO HEALTHY LIFESTYLE THERAPY (EATING
ARRANGEMENTS AND PHYSICAL ACTIVITIES)
- diet low in saturated fatty acids and high in unsaturated
fatty acids
- high fiber intake and avoid consuming excess sugar and
alcohol
- Stop smoking habit
 Suggestions in Islam

Maintain a healthy body by consuming halal food and drink thoyyib is an obligation for
every Muslim.In accordance with the word of Allah SWT:"O people! Eat from (food) that is
lawful and good that is found on earth…”(QS. Al Baqarah, 2:168). The provisions for eating
and drinking enough are also explained in the Qur'an Surah Al A'raf verse 31: "…eat and
drink and do not be extravagant. Verily, Allah does not like those who exaggerate...” means
eating and drinking enough, explained not to overdo it.
God said, “And He has created livestock (camels, cows, buffaloes, sheep, goats) for
you; there is (fur) that warms and various benefits, and so on you eat "(QS. An Nahl:
5). In order for the body to be healthy, consume meat foods that are rich in animal
protein. The fat contained in it contains iron, phosphorus, vitamins B, C, the liver is
rich in vitamin A and iron.

Allah said,And it is He, Allah who subjected the sea (to you), so that you may eat from
it fresh meat (fish), ...” (QS. An Nahl: 14). Fish is the best food for humans. The
advantage is that it contains high levels of protein, fish oil is rich in vitamins A & B, fish
is the best source of calcium.
"From Ibnu umar said, the Messenger of Allah said:Every
intoxicant is khamr, and every intoxicant is unlawful.” arouse
enmity and hatred among you in intoxi cants and gambling, and
prevent you from remembering Allah and praying.
• Alcohol Increaselevels of body fat called triglycerides which can contribute
to the accumulation of fat in blood vessels indirectly by increasing
levelsTriglyceride Rich Lipoproteinsin blood.
• Increasing blood pressure through several mechanisms, one of which is
by increasing the activity of the system Renin-Angiotensin-Aldosterone
which causes blood vessels to narrow and fluid to be retained in the body.
• Damages the heart muscle due to the toxic effects of ethanol and their
metabolism. This disorder is called Cardiomyopathy and can lead to heart
failure in the long run long.
• Causeobesity and increases the risk of obesity-related diseases such as
diabetes because alcohol can be a source of additional calories outside of
the food we consume. One glass beer or wine can contain around 100-150
calories!
 REFERENCE
• Perkumpulan Endokrinologi Indonesia. Panduan Pengelolaan Dislipidemia di Indonesia.
Indonesia:PERKENI; 2021
• Ikatan Dokter Indonesia. Panduan Praktik Klinis bagi Dokter di Fasilitas Pelayanan
Kesehatan Primer. 2nd ed. Jakarta: Ikatan Dokter Indonesia; 2014.
• https://openoregon.pressbooks.pub/nutritionscience/chapter/5e-lipid-transport-storage-util/
• Jim EL. Metabolisme Lipoprotein. J Biomedik. 2014;5(3).
• Adam J. Dislipidemia : Buku Ajar Ilmu Penyakit Dalam Jilid II Edisi 6. 2014;
• Kotapati HK, Bates PD. (14)C-Tracing of Lipid Metabolism. Methods Mol Biol.
2021;2295:59–80.
• Perkumpulan Endokrinologi Indonesia. Panduan Pengelolaan Dislipidemia di Indonesia.
Indonesia:PERKENI; 2021
• Pappan N, Rehman A. Dyslipidemia. [Updated 2022 Jul 11]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK560891/
• Dislipidemia, Definisi. 2009. “Hubungan Perilaku ..., Nico Gandha, FK UI., 2009 5.” : 5–19
Terima Kasih
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