ISSN 2398-2969      

Hyperlipidemia

icanis

Synonym(s): Hypercholesterolemia, Hypertriglyceridemia, Hyperlipoproteinemia

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Introduction

  • A raised blood concentration of lipid in the fasted (>12 hours) patient exceeding the upper range of normal.
  • Cause: primary idiopathic, or secondary to another disease process.
  • Signs: may be asymptomatic; vomiting, diarrhea, seizures, abdominal pain, distress, ocular involvement. Secondary hyperlipidemia signs of primary disease process.
  • Diagnosis: biochemistry - serum triglyceride, refrigeration test, lipid and cholesterol concentrations; lipoprotein electrophoresis.
  • Treatment: reduce dietary fat and/or treatment of primary disease process.
  • Prognosis: dependent upon response to treatment of primary disease process.

Pathogenesis

Etiology

Primary hyperlipidemia

  • Idiopathic hyperchylomicronemia:
  • Idiopathic hypercholesterolemia:
  • Post-prandial hypertriglyceridemia:
    • Normal physiological process.

Secondary hyperlipidemia

  • Same as primary causative disease process.

Pathophysiology

  • An increase in blood lipid concentrations in the fasted patient exceeding upper range of normal: primary idiopathic or secondary to another disease process.

Primary hyperlipidemia

  • Idiopathic hyperchylomicronemia:
    • ? Defective lipoprotein lipase (LPL) activity → hypertriglyceridemia + hyperchylomicronemia.
  • Idiopathic hypercholesterolemia:
    • Increased production of very low density lipoproteins (VLDL).
    • Reduced clearance of low density lipoprotein (LDL).
    • Reduced clearance of high density lipoprotein (HDL)
  • Post-prandial hyperlipidemia:
    • 30-60 min after ingestion of meal containing fat → gastrointestinal absorption of chylomicrons → increase in serum triglycerides for 3-10 hours.

Secondary hyperlipidemia

  • Pancreatitis Pancreatitis: acute :
    • Pancreatic inflammation may compromise pancreatic insulin production → reduced LPL activity → hyperlipidemia (hypertriglyceridemia, +/- moderate hypercholesterolemia).
  • Diabetes mellitus Diabetes mellitus :
    • Reduced LPL activity and production + increased very low-density lipoprotein (VLDL) production + increased cholesterol synthesis by the liver → hyperlipidemia ( hypertriglyceridemia, moderate hypercholesterolemia).
  • Hypothyroidism Hypothyroidism :
    • Reduced LPL activity + reduced general lipolytic activity + decreased hepatic degradation of cholesterol to bile acids → hyperlipidemia ( mild to marked hypercholesterolemia).
  • Hyperadrenocorticism Hyperadrenocorticism :
    • Reduced LPL activity + increased hepatic synthesis of VLDL → hypercholesterolemia + hypertriglyceridemia.
  • Nephrotic syndrome Nephrotic syndrome :
    • ? Low albumin and low oncotic pressure → increased hepatic cholesterol synthesis.
  • Liver disease Liver: chronic disease - overview /cholestasis:
    • Reduced cholesterol excretion in bile → hypercholesterolemia.
  • Obesity Obesity :
    • Increased hepatic VLDL synthesis → hyperlipidemia.

Ocular hyperlipidemia

  • High serum lipoproteins → anterior uveitis → normal blood aqueous barrier breakdown → lipids enter aqueous humor Lipid corneal dystrophy Cornea: lipidosis → cloudy eye + Lipemia retinalis may → blindness.
  • Seen with both primary and secondary hyperlipidemias.

Timecourse

  • Usually chronic (months).

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Li G, Kawasumi K, Okada Y, Ishikawa S, Yamamoto I, Arai T, Mori N (2014) Comparison of plasma lipoprotein profiles and malondialdehyde between hyperlipidemia dogswith/without treatment. BMC Vet Res​ 10 (67) PubMed.
  • Xenoulis P G, Suchodolski J S, Ruaux C G, Steiner J M (2010) Association between serum triglyceride and canine pancreatic lipase immunoreactivity concentrations in Miniature Schnauzers. JAAHA 46 (4), 229-234 PubMed.
  • Briand F, Serisier S, Krempf M, Siliart B, Magot T, Ouguerram K, Nguyen P (2006) Atorvastatin increases intestinal cholesterol absorption in dogs. J Nutr 136 (7 Suppl), 2034S-2036S PubMed.
  • Johnson M C (2005) Hyperlipidemia disorders in dogs. Compend Contin Educ Pract Vet 27 (5), 361-370 VetMedResource.
  • Halenda R M & Moore C P (1998) Presumed lipid retinopathy in a diabetic dog. Vet Ophthalmol (2/3), 171-174 PubMed.
  • Bauer J E (1997) New concepts of polyunsaturated fatty acids in dogs and cats. Vet Clin Nutrition (1), 29-33 VetMedResource.
  • Degner L & Shores A (1997) Hyperlipidemia associated with seizures in a dog. Vet Med 92 (5), 435-442.
  • Bauer J E (1995) Evaluation and dietary considerations in idiopathic hyperlipidemia in dogs. JAVMA 206 (11), 1684-1688 PubMed.
  • Whitney M S (1992) Evaluation of hyperlipidemias in dogs and cats. Semin Vet Med Surg (Small Anim) (4), 292-300 PubMed.
  • DeBowes L J (1987) Lipid metabolism and hyperlipoproteinemia in dogs. Comp Cont Ed Pract Vet 9 (7), 727-32 VetMedResource.
  • Rogers W A, Donovan E F & Kociba G J (1975) Lipids and lipoproteins in normal dogs and dogs with secondary hyperlipoproteinemia. JAVMA 166 (11), 1092-1100 PubMed.

Other sources of information

  • Bauer J E (2000) Hyperlipidemias. In: Textbook of Veterinary Internal Medicine. 5th edn. Ettinger S J & Feldman E C (eds). W B Saunders, Philadelphia. pp 283-292.

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