Hypertriglyceridemia

1. Hypertriglyceridemia Made by : [email protected]

2. Hypertriglyceridemia hypertriglyceridemia denotes high blood levels triglycerides . It has been associated with atherosclerosis , even in the absence of hypercholesterolemia . It can also lead to pancreatitis in excessive concentrations (i.e. when the triglyceride concentration is greater, and often very much greater, than 1000 mg/dl or 12  mmol /l).

3. Signs and symptoms Modestly elevated triglyceride levels do not lead to any physical symptoms.  Higher levels are associated with lipemia retinalis (white appearance of the retina ), Eruptive xanthomas (small lumps in the skin, sometimes itchy)

4. Causes: A.Enzyme dependent B.Non enzyme dependent ( other causes ) A. Enzyme dependent : 1. Lipoprotein lipase deficiency 2. Lysosomal acid lipase deficiency

5. Lipoprotein lipase deficiency ( known as chylomicronemia ) chylomicronemia and hyperlipoproteinemia type Ia is caused by a mutation in the gene which codes lipoprotein lipase . Lipoprotein lipase ( Lps ): is a member of the lipase gene family, which includes pancreatic lipase , hepatic lipase , and endothelial lipase . It is a water soluble enzyme that hydrolyzes triglycerides in lipoproteins, such as those found in chylomicrons and very low-density lipoproteins (VLDL), into two free fatty acids and one monoacylglycerol molecule.

6. 2.Lysosomal Acid Lipase Deficiency :  happens when the body does not produce enough active LAL enzyme. This enzyme plays an important role in breaking down fatty material ( cholesteryl esters and triglycerides ) in the body.  The lack of the LAL enzyme can lead to a build-up of fatty material in a number of body organs including the liver , spleen , gut , in the wall of blood vessels and other important organs.

7. 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) Unexplained hepatomegaly (liver enlargement) Elevated liver enzymes (a marker of liver damage) Unexplained fat or lipid material in the liver Unexplained chronic liver disease that may be getting worse over time

8. 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

9.  renal failure, Nephrotic syndrome  Genetic predisposition; some forms of familial hyperlipidemia such as familial combined hyperlipidemia  Systemic Lupus Erythematosus Glycogen storage disease type 1.

10. Treatment Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the diet . As well as with niacin , fibrates and statins (three classes of drugs). Increased fish oil intake may substantially lower an individual's triglycerides

11. Note: Niacin (also known as vitamin B 3 , 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

12. Statins (or HMG- CoA reductase inhibitors ) are a class of drugs used to lower cholesterol levels by inhibiting the enzyme HMG- CoA reductase , which plays a central role in the production of cholesterol in the liver . prevention Omega-3 fatty acid supplementation in the form of fish oil has been found to be effective in decreasing levels of triglycerides and all cardiovascular events by 19% to 45%