Hyperlipidaemias secondary

Hyperlipidaemia may occur independently of, or as a result of, liver disease. When it occurs secondary to liver disease, it tends to manifest as hypercholesterolaemia [4-7]. There are three liver disorders in which it commonly occurs ... 

It is less likely in other forms of liver disease, such as acute hepatitis and cirrhosis. Cirrhosis may actually protect against atherosclerosis [5, 8, 9]. The reasons for this are not clear. Secondary hypercholesterolaemia frequently occurs in cholestatic conditions, but usually does not require treatment [10]. Other risk factors for hyperlipidaemia and cardiovascular disease should be assessed, as their presence may independently indicate a need for medical intervention [9]. In PBC, patients with severe, chronic disease do not appear to have an increased cardiovascular risk as a result of their hypercholesterolaemia this may be due to the presence of cirrhosis. In contrast, in less severe PBC... 

Secondary hyperlipidaemias results from liver and biliary disease, obesity, hypothyroidism, diabetes, diet, alcohol excess, renal disease (nephrotic syndrome) and drugs (including etretinate, HIV protease ir hibitors, thiazide diuretics, oral contraceptive steroids, glucorticosteroids, (3-adrenoceptor antagonists, ciclosporin). 

Investigation of hyperlipidaemia must be directed initially at excluding contributory causes, i.e. secondary hyperlipidaenaias (see above). None of these should be assumed to be the sole cause, even if present. Long-term decisions on management should be initiated only on the basis at least two fasting blood samples. 

Hyperlipidaemias are conditions where levels of LDL cholesterol are raised relative to HDL levels. They can be primary or secondary to other conditions such as diabetes or hypothyroidism. About 5% of cases are due to a hereditary condition where there is a deficiency of LDL receptors on cell membranes (familial hyperlipidaemia). 

Because the miinagemenl of primary and secondary hyperlipidaemia is fundamentally different, the two groups of conditions must be distinguished. The main secondary hyperlipidaemias are due to ... 

Though the plasma cholesterol level is not significantly altered in non-fasting blood samples, this woman s hypercholesterolaemia should be confirmed on a fasting plasma sample in which her triglyceride and HDL cholesterol should also be measured. Secondary causes of hyperlipidaemia such as hypothyroidism and diabetes mellitus should be excluded. If her plasma triglyceride is normal and she has primary hypercholesterolaemia, a likely diagnosis is familial hypercholesterolaemia (FH). 

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