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Disorders of lipid metabolism

Posted by iskanbasal on March 27, 2009

Or disorders of lipoprotein metabolism. I studied for this subject some chapters from important textbooks of medicine:

1. Chapter 350 from the Harrison’s principles of internal medicine. Clinically is the most comprehensive on the subject, either the description of  diseases of lipid metabolism or the approach to treatment.

2. Chapter 217 from Cecil medicine. Same as the above particularly when telling the physiopathology and the role of nuclear factors such as the PPARalpha, PPAR?, and PPARd in the regulation of lipids in the human body.

3. Chapter 21 “hyperlipidemias” from the Lippincott’s illustrated reviews: pharmacology 4th ed. a good rapid and concise review on the drugs used here.

4. Chapter 5 Tests of lipid metabolism from the Wallach interpretation of diagnostic tests. Excellent tables on this subject from the Adult Treatment Panel III guidelines.

One of the most useful paragraphs on the subject is that where the Harrison’s describes the diagnostic process. Now I should consider the lab results and divide them in categories. The critical first step in managing a lipid disorder is to determine the class or classes of lipoproteins that are increased or decreased in the patient. I might have Lab results showing only increased levels of tryglicerides or only increased levels of LDL-cholesterol and think about the differential diagnosis in each situation. But the most common error in the diagnosis and treatment of lipid disorders occurs in patients with a mixed hyperlipidemia without chylomicronemia. This occurs with increased levels of both cholesterol and tryglyceride which may indicate TypeIII (increased IDL levels) or Type IIb( increased LDL and VLDL) or TypeIV ( increased VLDL levels). Analysis of lab tests is very important to distinguish between the different situations. I also considered the secondary causes of lipid disorders: obesity, Diabetes mellitus, thyroid diseases, renal diseases, liver disorders, alcohol, and endocrine disorders but particularly the role of hyperlipidemia as a major risk for Coronary heart disease. Actually the tests of lipid metabolism ( my initial interest in this subject) has two important objectives:

1. to assess risk of atherosclerosis, especially Coronary heart disease

2. to classify hyperlipidemias.

I reviewed all the other risk factors for coronary heart disease(CHD) and understood the importance in calculating the atherogenic risk in a general practice setting. What I’m doing is to try to build the good and necessary clinical knowledge (CK) that one needs.

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