LIPID METABOLISM

CASE STUDY – 01

A 30-year old man was admitted in a

cardiology ward after he complained chest
pain. His clinical and biochemical
investigations (ECG changes, is enzymes of
creatine phosphokinase etc.) indicated that
he suffered a mild myocardial infarction.
Timely intervention and appropriate
treatment saved him from death. The lipid
profile data of his man are given here.
 Parameter Subject Reference range

Serum total 450 150-200

cholesterol
LDL –cholesterol 380 <100

HDL – 40 40-60
cholesterol
VLDL – 30 20-40
cholesterol
Serum 150 75-150
triglycerides
Diagnosis – Familial hypercholesterolemia
(hyper lipoproteinemia type lla)
 CASE STUDY – 02

A 55-year old diabetic man had been on

treatment with oral hypoglycemic drugs for
over a decade. Despite the physician’s advice,
he could not give up his drinking habit. The
lipid profile data of his man are given below.
 Parameter Subject Reference range

Serum total 250 150-200

cholesterol
LDL -cholesterol 110 <100

HDL – 40 40-60
cholesterol
VLDL - 100 20-40
cholesterol
Serum 500 75-150
triglycerides
Diagnosis – Type V hyperlipoproteinemia
 CASE STUDY – 03

A 48-year-old male presents to the clinic because

of concerns about heart disease. He reports that
his father died from a heart attack at age 46, and
his older brother has also had a heart attack at age
46 but survived and is on medications for
elevated cholesterol. The patient reports chest
pain occasionally with ambulation around his
house and is not able to climb stairs without
significant chest pain and shortness of breath..
The physical examination is normal, and the physician
orders an electrocardiogram (ECG), exercise stress test,
and blood work. The patient’s cholesterol result comes
back as 350 mg/dL (normal 200). The physician
prescribes medication, which he states is directed at the
rate limiting step of cholesterol biosynthesis.
A.What is the rate-limiting step of cholesterol
metabolism?
B.What is the class of medication prescribed?
Diagnosis: Hypercholesterolemia
 Case History 04

• Despite strict dietary control, a 55-year-old man had

elevated serum cholesterol level. He started to take
simvastatin and 3 months later his cholesterol was normal.
• Questions
• a. Which enzyme of cholesterol biosynthesis is
inhibited by simvastatin?
• b. What is the role of that enzyme in cholesterol
biosynthesis?
• c. What is the normal serum cholesterol level?
• d. Name precursors of cholesterol synthesis.
 Case History 5

• A 50-year-old male, with history of chronic

alcoholism, had fatty liver.
• Questions
• a. What is fatty liver?
• b. What are the causes of fatty liver?
• c. What are lipotropic factors? Name any two.
• d. What is the nutritional therapy for fatty
liver?
 Case History 06

• A 19-year-old girl was referred to a medical

center because of poor exercise tolerance and
muscle weakness. After biochemical
investigations carnitine deficiency was
confirmed.
• Questions
• a. What is carnitine?
• b. What is the role of carnitine?
• c. What is cause of muscle weakness?
 Case History 7

• A 60-year-old woman was referred to a hospital. She

was noted to have hypertension. The plasma cholesterol
level was 390 mg/dL. An angiogram of the right carotid
artery demonstrated a narrowed lumen and the
concentration of LDL was elevated.
• Questions
• a. What is your probable diagnosis?
• b. What is the normal plasma cholesterol level?
• c. By which enzyme is cholesterol biosynthesis
regulated?
• d. Which lipoprotein has protective effect against the
disorder?
 Case History 8

• A 30-year-old woman was hospitalized, with an acute

myocardial infarction. Her plasma cholesterol and LDL
level were highly elevated. She was found to have
familial hypercholesterolemia.

• Questions
• a. How are LDL formed?
• b. What apoprotein does LDL contain?
• c. What is the function of LDL?
• d. Why LDL is called bad cholesterol?