Hypertriglyceridemia

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Hypertriglyceridemia

hypertriglyceridemia denotes high blood

. triglycerideslevels

, atherosclerosisIt has been associated with

even in the absence of

. hypercholesterolemia

in excessive pancreatitisIt can also lead to

concentrations (i.e. when the triglyceride

concentration is greater, and often very

much greater, than 1000 mg/dl or

12 mmol/l).

Signs and symptoms

Modestly elevated triglyceride levels do not

lead to any physical symptoms.

lipemiaHigher levels are associated with

), retina(white appearance of the retinalis

(small lumps in the xanthomasEruptive

skin, sometimes itchy)

Causes:

A.Enzyme dependent

B.Non enzyme dependent ( other causes )

A. Enzyme dependent :

1. Lipoprotein lipase deficiency

2. Lysosomal acid lipase deficiency

Lipoprotein lipase deficiency

(known as chylomicronemia)

chylomicronemia and hyperlipoproteinemia type Ia is caused by a mutation in the gene which

. lipoprotein lipasecodes

Lipoprotein lipase (Lps):

gene family, which lipaseis a member of the , and hepatic lipase, pancreatic lipaseincludes

. endothelial lipase

It is a water soluble enzyme that hydrolyzes triglycerides in lipoproteins, such as those

density -very lowand chylomicronsfound in fatty acids(VLDL), into two free lipoproteins

molecule. monoacylglyceroland one

2.Lysosomal Acid Lipase Deficiency :

happens when the body does not produce

enough active LAL enzyme.

This enzyme plays an important role in breaking

and esterscholesteryldown fatty material (

) in the body. triglycerides

The lack of the LAL enzyme can lead to a

build-up of fatty material in a number of body

, in the gut, spleen, liverorgans including the

and other important blood vesselswall of

organs.

Abnormalities that a person may have

in(Cholesteryl Ester Storage Disease) include:

A high cholesterol and high triglyceride level

A high 'bad' cholesterol ( LDL)

A very low 'good' cholesterol (HDL)

(liver enlargement)hepatomegalyUnexplained

Elevated liver enzymes (a marker of liver

damage)

material in the liverlipidUnexplained fat or

that may be chronic liver diseaseUnexplained

getting worse over time

B. Other causes :

High carbohydrate diet

Idiopathic

Obesity

Diabetes mellitus and insulin resistance - it is

one of the defined components of metabolic

syndrome

Excess alcohol intake

renal failure, Nephrotic syndrome

Genetic predisposition; some forms of familial

hyperlipidemia such as familial combined

hyperlipidemia

Systemic Lupus Erythematosus Glycogen

storage disease type 1.

Treatment

Treatment of hypertriglyceridemia is by

dietrestriction of carbohydrates and fat in the

.

statinsand fibrates, niacinAs well as with

(three classes of drugs).

intake may substantially fish oilIncreased

lower an individual's triglycerides

Note:

Niacin (also known as vitamin B3, nicotinic

acid and vitamin PP) blocks the breakdown

of fats, it causes a decrease in free fatty acids

in the blood and, as a consequence,

decreases the secretion of VLDL and

cholesterol by the liver.

Fibrates are a class of amphipathic carboxylic

acids used in accessory therapy in many

forms of hypercholesterolemia, usually in

combination with statins

Statins (or HMG-CoA reductase inhibitors)

cholesterolused to lower drugsare a class of

CoA-HMGthe enzyme inhibitinglevels by

, which plays a central role in the reductase

. liverproduction of cholesterol in the

prevention

supplementation in the fatty acid3 -Omega

form of fish oil has been found to be effective

in decreasing levels of triglycerides and all

cardiovascular events by 19% to 45%