Hyperlipidemia

Presented by VARUN SUNIL

Under the guidance of DR GNANAMANI Sir
Important Terms
• 1. Hypercholesterolemia: Increased serum level of
total cholesterol (TC). Lo
density lipoprotein (LDL), and low-density
lipoprotein-cholesterol (LDL-C).
• Hypertriglyceridemia: Increased serum level of
very-low-density lipoproteins
(VLDL) and triglycerides (TG).
• Combined hyperlipidemia: Increased TC, LDL, VLDL,
LDL-C, and TG.
 HYPERLIPIDEMIA
• Hyperlipidemia is abnormally elevated levels of any
or all lipids (fats, cholesterol, or triglycerides) or
lipoproteins in the blood.
Hyperlipidemias may basically be classified as either familial also called
primary) caused by specific genetic abnormalities, or acquired (also
called secondary) when resulting from another underlying disorder that
leads to alterations in plasma lipid and lipoprotein metabolism.
Etiology of Hyperlipidemia

• Primary causes include familial

hypercholesterolemia which is a genetic disorder
Secondary causes include:
• Smoking.
Drinking a lot of alcohol.
Eating foods that have a lot of saturated fats
or trans fats.
Sitting too much instead of being active
Being stressed.
Being overweight.
Hypothyroidism
Risk Factors of Hyperlipidemia
• Poor diet. Eating too much saturated fat or trans fats can result in unhealthy
cholesterol levels. Saturated fats are found in fatty cuts of meat and full-fat dairy
products. Trans fats are often found in packaged snacks or desserts.
• Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high
cholesterol.
• Lack of exercise. Exercise helps boost your body's HDL, the "good," cholesterol.
• Smoking. Cigarette smoking may lower your level of HDL, the "good,"
cholesterol.
• Alcohol. Drinking too much alcohol can increase your total cholesterol level.
• Age. Even young children can have unhealthy cholesterol, but it's much more
common in people over 40. As you age, your liver becomes less able to
remove LDL cholesterol.
Fredrikcson classification of
Hyperlipidemia
Clinical features
• Most people don't have symptoms when their
cholesterol is high.
• People who have a genetic problem with
cholesterol clearance that causes very high
cholesterol levels may get xanthomas (waxy, fatty
plaques on the skin or corneal arcus (cholesterol
rings around the iris of the eye).
Xanthomas
Corneal Arcus
• Cholesterol rings around iris of eye
• Due to deposition of phospholipids and cholesterol in peripheral
stroma
• Usually bilateral
• Mostly asymptomatic and does not affect visual acquits
Cholesterol levels
Different types of cholesterol
Treatment
• Non pharmacological treatment
• Pharmacological treatment
Non pharmacological Treatment
• Quit smoking
• Lower intake of saturated fats
• Lower intake of alcohol
• Loose excess body weight
• Low salt diet
• Diet rich in fruits vegetables and whole gram
Pharmacological Treatment
• 1. HMG-COA reductase inhibitors

• 2.Fibric acid derivatives

• 3. Niacin

• 4. Bile acid binding resins

• 5. Sterol absorption inhibitors

• 1. HMG-COA reductase inhibitors:
• Atorvastatin , Lovastatin ,pravastatin ,simvastatin
• Moa : HMG-CoA reductase is an essential enzyme in the cholesterol
synthesis pathway. By inhibiting this enzyme, HMG-CoA reductase
inhibitors decrease cholesterol levels.
• Side effects : elevated Transaminase ,Myopathy
• Most commonly used in treatment is statins
 Fibric Acid Derivatives

• Fenofibrate , Gemfibrozil
• Moa : Fibrates stimulate cellular fatty acid uptake, conversion to acyl-CoA deriva
catabolism by the beta-oxidation pathways, which, combined with a reduction in
and triglyceride synthesis, results in a decrease in VLDL production.
• Side effects : Rashes , GIT UPSET , elevated transaminase , Myopathy
Niacin
• Vitamin B 3
• Moa• The mechanism of action of niacin to raise
HDL is by decreasing the fractional catabolic
rate of HDL-apo AI without affecting the
synthetic rates. Additionally, niacin
selectively increases the plasma levels of Lp-
AI (HDL subfraction without apo AII), a
cardioprotective subfraction of HDL in
patients with low HDL.
Side effects : The most common side effect is flushing
secondary to skin vasodilation.
This effect is mediated by prostaglandins and can be decreased
by taking concurrent aspirin.
Bile acid binding resins
• Bile acid binding resins
• Bile acid binding resins are colestipol, cholestyramine, and
colesevelam,
• Moa : binding to bile acids, increasing their excretion
• They are useful for decreasing LDL cholesterol.
• Side effects : The most common side effects include bloating and
diarrhea.
Sterol absorbtion inhibitors
• Sterol absorption inhibitors
• Inhibitors of intestinal sterol absorption, such as ezetimibe,
• MOA :
• function by decreasing the absorption of cholesterol in the Gl tract
by targeting NPC1L1, a transport protein in the gastrointestinal
wall. This results in decreased LDL cholesterol
Screening • Adults 20 years and older should have the
cholesterol checked every four to six years.
• Serum level of Low Density Lipoproteins
(LDL)cholesterol, High Density Lipoproteins
(HDL)Cholesterol, and triglycerides are
commonly tested in primary care setting using
a lipid panel.
• Stratification models Quantitative levels of
lipoproteins and triglycerides contribute toward
cardiovascular disease riskstratification via
models such as
• .Framingham Risk Score,
• .ACC/AHA
• .Atherosclerotic Cardiovascular Disease
Risk Estimator,
• .Reynolds Risk Scores.
Regular Screening Frequency
• Regular screening should be done for those with known CHD or risk-
equivalent conditions
• Acute Coronary Syndrome,
• history of heart attacks,
• Stable or Unstable angina,
• Transient ischemic attacks,
• Peripheral arterial disease of atherosclerotic origins.
4-ml sample of hyperlipidemic blood in a vacutainer with
EDTA. Left to settle for four hours without centrifugation,
the lipids separated into the top fraction.
two bags of thawed fresh frozen plasma: The bag on the left
was obtained from a donor with hypercholesterolemia, and
contains altered serum lipid levels, while the bag obtained
from a normal donor contains regular serum lipid levels.
Complications of Hyperlipidemia
• Macrovascular complications:
• Unstable Angina (chest pain)
• Myocardial Infarction (heart attack)
• Ischemic Cerebrovascular Disease (stroke)
• Coronary Artery Disease (heart disease)

• Microvascular complications:
• Retinopathy (vision loss)
• Nephropathy (kidney disease)
• Neuropathy (loss of sensation in the feet and legs )
Hyperlipidemia and predisposition to
Atherosclerosis
• . Atherosclerosis is the accumulation of lipids, cholesterol, calcium,
fibrous plaques within the walls of arteries.
• This accumulation narrows the blood vessel and reduces blood flow
and oxygen to muscles of the heart.
• Over time fatty deposits can build up, hardening and narrowing the
arteries until organs and tissues don't receive enough blood to properly
function.
• If arteries that supply the heart with blood are affected, a person might
have angina (chest pain).
• Complete blockage of the artery causes infarction of the myocardial
cells, also known as heart attack / myocardial infarction
• Fatty buildup in the arteries can also lead to stroke, if a blood clot
blocks blood flow to the brain.
 National programme for prevention and control
of Non Communicable Disease
Non-Communicable Diseases
are estimated to account for around 60% of all deaths. . Losses due to
premature deaths related to heart diseases, stroke and Diabetes are also
projected to increase over the years.

In order to prevent and control major NCDs, the National Programme for
Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and
Stroke (NPCDCS) was launched in 2010 with focus on strengthening
infrastructure, human resource development, health promotion, early
diagnosis, management and referral

NCD Cells are being established at National, State and District levels for
programme management, and NCD Clinics are being set up at District and
CHC levels, to provide services for early diagnosis, treatment and follow-
up for common NCDs.

• Cardiac Care Units (CCU) are also being set up in identified districts for
providing facilities for emergency Cardiac Care. Day Care Centres at
the identified districts are setup to provide facilities for Cancer care.
Modified strategies under NP-NCD
• Health promotion through behavior change with involvement of community,
civil society, community based organizations, media etc.
• Outreach Camps are run for opportunistic screening at all levels in the
health care delivery system from sub-centre level and above
• Management of chronic Non-Communicable diseases, especially Cancer,
Diabetes, CVDs and Stroke through early diagnosis, treatment and follow
up through setting up of NCD clinics.
• Provide support for diagnosis and cost effective treatment at primary,
secondary and tertiary levels of health care.
• Provide support for development of database of NCDs through a
Surveillance System and to monitor NCD morbidity, mortality and risk factors.
 INITIATIVES UNDER NP-NCD
• Inclusion of guidelines for prevention and management of Chronic Obstructive Pulmonary Disease
(COPD) and Chronic Kidney Disease (CKD) under NP-NCD
• For early detection “Population-based Screening of common NCDs” utilising the services of the
Frontline-workers and Health-workers under the existing Primary Healthcare System.
• Pilot project on ‘Integration of AYUSH with NP-NCD’ has been initiated in six districts in the country.
Wherein the practice of Yoga is an integral part of the intervention.
• Pilot intervention has been initiated for the prevention and control of Rheumatic Fever and
Rheumatic Heart Disease under the platforms of NP-NCD and RBSK (Rashtriya Bal Swasthya
Karyakram), in three select districts (Gaya - Bihar, Firozabad - Uttar Pradesh and Hoshangabad - Madhya
Pradesh).
• Another initiative is the integration of NTEP with NP-NCD, wherein the “National Framework for Joint
Tuberculosis-Diabetes collaborative activities” has been developed to articulate a national strategy for ‘bi-
directional screening’, early detection and better management of Tuberculosis and Diabetes
comorbidities in India
Reference

• nhm.gov.in

• pib.gov.in

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485409/

• Park's Textbook of Preventive and Social Medicine

• Pharmacology For Medical Graduates By Tara V Shanbhag