Background of Study

Case:

A 56 year old man comes in for a routine health maintenance visit.
He is new to your practice and has no spesific complaint today. He has
hypertension for which he takes hydroclorothiazide, and he occasionally
takes an aspirin because someone told him that it was good for him. He has
no other significant medical history. He does not smoke cigarettes,
occasionally drink alcohol, and does not exercise. His father died of a heart
attack at age 60 years and his mother died at age 72 years of cancer. He has
two younger sister who are in good health. On examination, his blood
pressure is 130/80 mmHg and his pulse is 75 bpm. He is 6 ft tall and weighs
200 lb. His complete physical examination is normal. You order a fasting
lipid panel, which subsequently returns with the following reselts: total
cholestrol 242 mg/dL ; triglycerides 138 mg/dL ; high-density lipoprotein
(HDL) cholesterol 48 mg/dL ; and low-density lipoprotein (LDL) cholesterol
155mg/dL.













Definition / theory
Hyperlipidemia = Hyperlipoproteinemia is high in saturated fat (cholesterol ,
triglycerides or both) in the blood.
Fat (also called lipid ) Is the energy-rich substances, which serves as the primary
energy source for the body's metabolic processes. Fats obtained from food or
formed in the body, especially in the liver and can be stored in fat cells for future
use. Fat cells also protects the body from the cold and helps protect the body
against injury. Fat is an important component of cell membranes, nerve sheaths
that wrap around nerve cells and bile
Kinds of Hyperlipidemia:
1. Primer Hyperlipidemia
Many caused by genetic abnormalities. This disorder is usually discovered during
laboratory tests by chance. In general, no complaints, except in circumstances
which seem a bit heavy presence of xanthomas (a buildup of fat tissue under the
skin).

2. Secondary Hyperlipidemia
In this type, the increase in blood lipid levels caused by a particular disease, eg
diabetes mellitus, thyroid disorders, liver disease, and kidney disease. Secondary
hyperlipidemia is reversible (recurring).
There are also drugs that cause fat metabolism disorders, such as - blockers,
diuretics, oral contraceptives (estrogen, gestagen)

Analisys / discussion
3.1 Etiologi / Cause
Lipoprotein levels, especially LDL cholesterol, increases with age. Under normal
circumstances, men have higher levels, but the levels after menopause in women
begins to rise.
Primer Hyperlipidemia: genetic
Secondary Hyperlipidemia:
- Obesity
- foods containing saturated fatty acids, such as: butter, margarine, whole
milk, ice cream, cheese, meat
- Less exercise
- Use of alcohol
- Smoking
- Diabetes is not well controlled
- Renal failure
- Underactive thyroid gland
- Certain drugs can interfere with fat metabolism such as estrogen, pills
KB, corticosteroids, thiazide diuretics (in certain circumstances)




3. 2 symptom
Usually high fat content does not cause symptoms. Sometimes, if the level is
very high, fatty deposits will form a growth called xanthomas in the tendons
(tendonitis) and in the skin.
Triglyceride levels are very high (up to 800 mg / dl or more) can cause an
enlarged liver and spleen and symptoms of pancreatitis (eg, severe abdominal
pain).

3.3 Risk factor

- Atherosclerosis
- Coronary heart disease
- Pancreatitis (inflammation of the pancreas organ)
- Diabetes mellitus
- Thyroid Disorders
- Diseases of the liver and kidney disease
- Heart disease





3.4 Diagnostic
Do blood tests to measure levels of total cholesterol. To measure the levels of
LDL cholesterol, HDL, and triglycerides fasting patient should first dive at least
12 hours.


3.5 Treatment
NON MEDICAL PHARMACOLOGY
Diets low in cholesterol and low in saturated fat will reduce levels of LDL
exercise can help reduce LDL levels. Exercise can help reduce LDL cholesterol
levels and increase HDL cholesterol levels.
Usually the best treatment fatherly people who have high cholesterol or
triglyceride levels are:
- Lose weight if they are overweight
- Stop smoking
- Reduce the amount of fat and cholesterol in the diet.
- Adding exercise portion
- Consumming lipid-lowering medications (if needed)
If very high blood fat levels or do not respond to the above measures, then
sought specific cause by doing a special blood test that could be given special
treatment.












Pharmacology treatment

The drugs are used for lowering blood fat level
Drug type example mechanism
Bile Acid Absorber

Kolestiramin
Kolestipol
Binds bile acids in the intestine
Improving the disposal of LDL
from the bloodstream
Lipoprotein synthesis
inhibitors
Niasin Reduce speed VLDL formation
(a precursor of LDL)
Coenzyme A reductase
inhibitors
-Adrenalin,
Fluvastin
-Lovastatin
-Pravastatin
-Simvastatin
Inhibit the formation of
cholesterol
Improving the disposal of LDL
from the bloodstream
Fibrate acid derivatives Klofibrat
Fenofibrat
Gemfibrosil
Not yet known, possibly
increasing the breakdown of
fat.

Goal for therapy
- The decrease in total and LDL cholesterol Reduce the risk of first / recurrent of
myocardial infarction, angina heart failure, stro ischemia or other events in
peripheral arterial disease such as carotid stenosis or abdominal artery aneurysm.
- For every 1% decrease in LDL, then there is a reduced risk of coronary heart
disease as much as 1%.
- For every 1% of HDL, the decline in coronary heart disease risk by 2 %.

combination therapy
- Fibric acid derivatives + bile acid binding resin
- HMG-CoA reductase inhibitors + bile acid binding resin
- Niacin + bile acid binding resin
- Niacin + reductase inhibitors


Beneficial Effects of Statins:
Angiogenic role
Promote formation of new blood vessels
Reduction in mortality independent of effect on cholesterol
concentration
Activates protein kinase Akt
Leads to NO production
Promotes endothelial cell survival
Enhances revascularization of ischemic tissue
? Inhibits cell apoptosis rather than stimulation of vessel growth

Individuals of 50 years and older who were prescribed statins had a
substantially lowered risk of developing dementia, independent of the
presence or absence of untreated hyperlipidemia, or exposure to non statin
LLAs. The available data do not distinguish between Alzheimers disease
and other forms of dementia. Adjusted relative risk for those prescribed
statins was 0.29 (0.13-0.63; p=0.002)
Nested case-control study (UK)
(Jick, et al, Lancet 2000; 356: 1627-31)
Reduction in plasma viscosity
Decrease in platelet aggregation and thrombin formation
Reduction in inflammation
Decrease in CRP
Reduction in fractures










Conclution
Hyperlipidemia is a condition characterized by elevated levels of lipids / fat blood
past the normal limit.
By type, hyperlipidemia were divided into 2, namely:
1. Primer Hyperlipidemia
2. Secondary Hyperlipidemia
Usually high fat content does not cause symptoms. Sometimes, if the level is very
high, fatty deposits will form a growth called xanthomas in the tendons
(tendonitis) and in the skin.
Diets low in cholesterol and low in saturated fat will reduce levels of LDL
exercise can help reduce LDL levels. Exercise can help reduce LDL cholesterol
levels and increase HDL cholesterol levels.










Reference:
IPD Jilid 3
Scribd.com / hyperlipidemia
http://wailineal.blogspot.com/2011/06/normal-0-false-false-false-in-x-none-
x_20.html