ISSN 2398-2950      

Hyperlipidemia

ffelis

Synonym(s): Hypercholesterolemia, Hypertriglyceridemia, Hyperlipoproteinemia


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 causative 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.
  • Genetic predisposition in Himalayan cats - autosomal recessive gene.
  • Post-prandial hypertriglyceridemia.
  • Normal physiological process.

Secondary hyperlipidemia

  • Same as primary causative disease process.

Specific

  • Obesity Obesity.
  • High dietary intake of fats.
  • Hyperchylomicronemia - genetic predisposition in Himalayan breed.

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.
  • Post-prandial hyperlipidemia.
  • 30-60 minutes after ingestion of meal containing fat   →   gastrointestinal absorption of chylomicrons   →   increase in serum triglycerides for 3-10 hours.

Secondary hyperlipidemia

  • Pancreatitis Pancreatitis:
    • Pancreatic inflammation may compromise pancreatic insulin production   →   reduced LPL activity   →   hyperlipidemia (hypertriglyceridemia, +/- moderate hypercholesterolemia).
  • Diabetes mellitus Diabetes mellitus:
    • Reduced LPL activity + increased very low-density lipoprotein (VLDL) production   →   hyperlipidemia ( hypertriglyceridemia, moderate hypercholesterolemia).
  • Hyperadrenocorticism Hyperadrenocorticism:
    • Rare in cats. Most often associated with diabetes mellitus which may account for hyperlipidemia.
    • 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/cholestasis:
    • Reduced cholesterol excretion in bile   →   hypercholesterolemia.
  • Obesity:
    • Increased hepatic VLDL synthesis   →   hyperlipidemia.

Ocular hyperlipidemia

  • High serum lipoproteins   →   anterior uveitis   →   normal blood aqueous barrier breakdown   →   lipids enter aqueous humor    →   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.
  • Hatano Y, Mori N, Asada M et al (2010) Hypertriglyceridemia with increased plasma insulin concentrations in cats. Res Vet Sci 88 (3), 458-460 PubMed.
  • Kluger E K, Caslake M, Baral R M et al (2010) Preliminary post-prandial studies of Burmese cats with elevated triglyceride concentrations and/or presumed lipid aqueous. J Feline Med Surg 12 (8), 621-630 PubMed.
  • Chanut F, Colle M A, Deschamps J Y et al (2005) Systemic xanthomatosis associated with hyperchylomicronaemia in a cat. J Vet Med A Physiol Pathol Clin Med 52 (6), 272-274 PubMed.
  • Bauer J E (1997) New concepts of polyunsaturated fatty acids in dogs and cats. Vet Clin Nutrition (1), 29-33 VetMedResource.
  • Whitney M S (1992) Evaluation of hyperlipidemias in dogs and cats. Semin Vet Med Surg Small Anim (4), 292-300 PubMed.

Other sources of information

  • Winterowd T (2007) Hyperlipidemia and lipid flare in a 3-year-old-cat. Veterinary Forum 24 (1).
  • 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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