Hyperlipidemia Hypertriglyceridemia

It is indicated as an adjunct to diet to reduce elevated total cholesterol, LDL-cholesterol and TG levels in patients with primary hypercholesterolemia, diabetic dyslipidaemia or mixed hyperlipidemia, hypertriglyceridemia, dysbetalipo-proteinemia and familial hypercholesterolemia. 

The principal use of niacin is for mixed hyperlipidemia or as a second-line agent in combination therapy for hypercholesterolemia. It is a first-line agent or alternative for the treatment of hypertriglyceridemia and diabetic dyslipidemia. 

Excess lipid in the blood can result from primary genetic deficiencies, most of which are rare, or as a secondary consequence of another disease. Two primary hyperlipidemias, type I hypertriglyceridemia and type IIA hypercholesterolemia, are summarized in Table 1-15-2. 

Diabetes, alcoholism, and glucose 6-phosphatase deficiency all can produce less severe hypertriglyceridemia with an increase in VLDL and chylomicrons. Factors contributing to the hyperlipidemia are ... 

Hypertriglyceridemia Hypertriglyceridemia in adult patients (Types IV and V hyperlipidemia) who present a risk of pancreatitis and who do not respond to diet. Consider therapy for those with triglyceride elevations between 1000 and 2000 mg/dL, and who have a history of pancreatitis or of recurrent abdominal pain typical of pancreatitis. 

Hypertriglyceridemia A6 unct /e therapy to diet for treatment of adult patients with hypertriglyceridemia (Fredrickson types IV and V hyperlipidemia). 

The fibrates are mainly used to treat two hyperlipi-demias, familial hypertriglyceridemia (type IV) and dysbetalipoproteinemia (type III). They are also useful in the treatment of hypertriglyceridemia associated with type II diabetes (secondary hyperlipidemia). The fibrates are the drugs of choice in treating hypertriglyceridemias, particularly those associated with low levels of HDL cholesterol. The fibrates additionally appear to... 

Is an indigenous drug obtained from gum guggul used for treatment of hyperlipidemia, hypercholesterolemia and hypertriglyceridemia. 

Monogenic dyslipoproteinemias can generally be grouped into five categories (1) hypertriglyceridemia with an increase in chylomicrons and the clinical sign of pancreatitis, (2) mixed hyperlipidemia with an increase in chylomicron and VLDL remnants and an increased risk of premature atherosclerosis, (3) hypercholesterolemia with an increase in LDL and an increased risk for premature atherosclerosis, (4) hypoalphalipoproteinemia with low HLD and an increased risk for premature atherosclerosis, and (5) hypolipoproteinemia with a decrease in VLDL and LDL, which may lead to neurological disease. 

Yeshurun D, Hamood H, Morad N, Naschitz J. [Acipimox (Olbetam) as a secondary hypolipemic agent in combined hypertriglyceridemia and hyperlipidemia.JHarefuah 2000 138(8) 650-3710. 

Acipimox had to be withdrawn in 10 of 32 patients with hypertriglyceridemia, excessive hypertriglyceridemia, and combined hyperlipidemia because of adverse effects or absence of clinical response (15). The other 22 completed... 

Hyperlipidemia associated with antipsychotic drugs has been reviewed (SEDA-29, 64). Haloperidol and the atypical antipsychotic drugs ziprasidone, risperidone, and aripiprazole would be associated with lower risks of hyperlipidemia, whereas chlorpromazine, thioridazine, and the atypical drugs quetiapine, olanzapine, and clozapine would be associated with higher risks. However, severe clozapine-induced hypercholesterolemia and hypertriglyceridemia has been reported in a patient taking clozapine (55). 

Hypertriglyceridemia due to sirolimus often does not respond to dosage reduction or hypolipidemic drugs. After liver transplantation (n — 6), significant hyperlipidemia improved after withdrawal of sirolimus (1070). The incidence of sirolimus-associated hyperlipidemia is up to 44%. After liver transplantation, there was hypercholesterolemia in 15% and hypertriglyceridemia in 10% of recipients. Sirolimus in combination with tacrolimus... 

The consequences of hypertriglyceridemia are not well understood, but there may be an increased risk of cardiovascular disease and pancreatitis (SEDA-13, 123). Patients with an increased tendency to develop hypertriglyceridemia include those with diabetes mellitus, obesity, increased alcohol intake, and a positive family history. With a short course (16 weeks) of isotretinoin it is sufficient to ensure there is no hyperlipidemia before the start of therapy, and to determine the triglyceride response to therapy on one occasion after 4 weeks (1207). 

In the pathogenesis of nephrotic hyperlipidemia, both increased production and impaired catabolism of lipoproteins were demonstrated to play a role. Pathogenic mechanisms may be different in nephrotic patients with isolated hypercholesterolemia and in patients with combined hypercholesterolemia and hypertriglyceridemia (V6). 

Acipimox had to be withdrawn in 10 of 32 patients with hypertriglyceridemia, excessive hypertriglyceridemia, and combined hyperlipidemia because of adverse effects or absence of chnical response (14). The other 22 completed 6 months of treatment with no adverse effects. The authors claimed that acipimox is much better tolerated than nicotinic acid, that it has fewer adverse effects, and can therefore be used as a second-line drug. 

In rats with diet-induced hyperlipidemia, triglycerides were lower in rats treated with the extract at doses of 1.2 g/kg (p < 0.05) and 3 g/kg (p < 0.01) than in untreated rats. Weight was not affected. In genetically hyperlipidemic Yoshida rats, and in rats with alcohol-induced hypertriglyceridemia, triglycerides were 31.8% (p < 0.05) and 61.5% (p < 0.01) lower, respectively, in bilberry-treated rats than in untreated rats (1). 

Familial Combined Hyperlipidemia About 10% to 15% of patients with premature CHD actually have familial combined hyperlipidemia (FCHL). This disorder is recognized as a distinct phenotype by studying family members of survivors of myocardial infarction. Patients with FCHL can have increased plasma concentrations of total and LDL cholesterol (type Ila), or triglyceride (type IV), or both (type lib). In all cases, apo B-lOO concentrations are increased. The presentation of lipoprotein patterns can vary in an individual with time. Furthermore, patients with hypertriglyceridemia with normal partners tend to have offspring with hypercholesterolemia, and vice versa. 

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