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Secondary Causes of Lipid Disorders - Coggle Diagram
Secondary Causes of Lipid Disorders
Diseases
Type 2 Diabetes
Lipid Profile
Increase chylomicron, and Increase VLDL-C
Pathophysiology
Increase mobilization of FFA from peripheral tissues
Increased C3 activity -> Decreased LPL activity
Increased hepatic VLDL secretion and FFA synthesis
Leads to Increase TG rich lipoproteins leading to increase in CETP, and increase in LDL and decrease in ApoA1
Management
Optimize glycemic ocntrol (may need insulin)
Medical therapy (statin, fibrate, Niacin, Cholestyramine)
Obesity
Increase adipocyte mass -> Increase insulin Resistance
Increase FFA in the liver -> Increase VLDL-C production
Increase inflammatory state due to macrophages that infiltrate adipose tissue
Increased pro-inflammatory cytokines that reduce TG clearance
Decrease HDL Metabolism
Hypothyroidism
Mild increase in LDL and triglycerides
Decrease conversion of cholesterol to bile acids
Leads to downregulation of LDL-R and increase in LDL-C
Decrease in hepatic lipase leading to increase in triglycerides
Alcohol
Moderate intake increases HDL
Leads to decrease CETP
Less LDL production
Excessive Intake
Increase TG and increase risk of pancreatitis and atherosclerosis
Dysfunction can lead to decrease in HDL and Decrease in LCAT
CKD
Dyslipidemia will worsen with progressing CKD
Leads to increase in triglyceride and decreases LPL and clearance
Leads to small dense LDL-C and can make it more atherogenic than large LDL-C
Leads to decrease HDL-C and low Apo-A1, and downregulation of LCAT, impaired maturation, and no anti-oxidative
Nephrotic Syndrome
Albumin falls -> Increase total cholesterol, LDL, triglycerides
Normal or Low HDL-C renal loss of LCATm increased CETP
Liver Disease
Major formation and clearance of lipoproteins
Non-Alcoholic Fatty Liver Disease
Excess adiposity, insulin resistance, Lipolysis and FFA release, and Increase VLDL
Impaired VLDL excretion (steatosis, and hepatic TG accumulaton)
Progressing liver disease leads to Decreased total cholesterol and triglycerides due to less lipoprotein synthesis
Cholestasis/Primary Biliary Cholangitis
Commonly: Increases total cholesterol and LDL
Accumulation of lipoprotein-X and is not removed by LDL-R and decrease feedback on cholesterol synthesis
Progression of Liver disease
Increased total cholesterol and increased LDL with worsening liver disease
HDL in early stage increases and decreases in later stages
Glycogen Storage Disorders
Inability to mobilize hepatic glucose during fasting
Hypoinsulinemia and increase release of FFA from adiose tissue
Increase hepatic fatty acid synthesis
Increase VLDL secretion
Cushing's Syndrome
Cortisol mobilizes fuel and increases glucose and FFA
Leads to increase of VLDL and Mild LDL increase
Prolonged high cortisol leads to insulin resistance
Acromegaly
Increase in growth hormone
Insulin Resistance
Free fatty acid Mobilization from periphery
Leads to increase VLDL-C and mild increase in TG
Decrease in LPL activity
Anorexia Nervosa
Many have increase in LDL-C due to unclear mechanism
May be due to decreased excretion of bile acids and cholesterol
HIV
Lipid disorders are common
Antiviral medications can increase circulating TG
HIV infection can lead to mild increase in triglycerides, VLDL-C increase, decrease in LDL and HDL
Due to lower TG clearance and increase VLDL-C synthesis
Medications
Diuretics
high doses lead to increase in VLDL, LDL and tends to be temporary
Beta Blockers
Depends on receptor specificity
Non-selective beta blockers increase triglycerides and decrease HDL
beta 1 selective increases triglycerides
Alpha Blockers
Selective alpha 1 blockers cause decrease in total cholesterol, decrease in triglycerides and increase in HDL-C
Estrogens
Decrease in total cholesterol, Dcrease in LDL, and increase in VLDL and HDL, and increase in triglycerides
Progestins
Mild increase in LDL and decrease in HDL (typical of oral contraceptive pill)
Androgens
More effects on lipids if taken orally: HDL decrease, LDL increase and slight decrease in TG (VLDL, CM)
Corticosteroids
Mobilizes fuel to increase glucose, and FFA -> Increase in VLDL and triglycerides and increased LDL
HIV medications
Increase triglycerides and LDL and increase VLDL production due to protease ihibtiors
Others
Retinoids (increase VLDL, CM), Cyclosporine (Increase LDL), Carbamazepine (increase LDL)