Hyperlipidemias bile acid metabolism

T. A. Miettinen, Hyperlipidemia, bile acid metabolism and gallstones. Ital J Gastroenterol 10 Suppl 1 53 (1978). 

Hyperlipidemia is known to be one of the most potent factor associated with the premature development of atheromatous arterial disease. Thus an increased serum cholesterol level is frequently found in patients with ischemic heart disease and myocardial infarction, and hypercholesterolemic patients have a high incidence of coronary artery disease. Therefore, because cholesterol is partially eliminated from the body as bile acids (see Section VB), it would be important to know the role of bile acid metabolism in the development of different types of hypercholesterolemia. 

The significance of other hormones in bile acid metabolism is not known. Most of the obese and triglyceridemic patients presented in Table II had latent diabetes and, as obese patients in general, apparently a marked hyper-insulinemia. Since hyperinsulinemia markedly stimulates hepatic lipogenesis in man (166), it is logical to infer that insulin causes in these patients an augmented cholesterol production and an indirectly increased bile acid synthesis. The metabolism of bile acids in insulin-dependent diabetes and in hyperlipidemia of ketotic diabetes is not known. 

Clofibrate appears to have little general effect on bile acid metabolism, but, as Horlick et al. (25) have shown, it may affect bile acid excretion in certain types of hyperlipidemias. 

As described in the previous section, bile acids have evolved over the last years from regulators of bile acid homeostasis to general metabolic integrators. It is therefore not too surprizing that a number of bile acid-activated signaling pathways have become attractive targets for the treatment of gallstones and other metabolic diseases, such as obesity, type 2 diabetes, hyperlipidemia, and atherosclerosis. 

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