Lipids

 

Dyslipidemia
TABLE 217-4   -- SECONDARY CAUSES OF LIPID DISORDERS
Condition/Medication Comments
Diabetes Common contributor to dyslipidemia. Abnormal lipids are seldom normalized by glycemic control alone.
Hypothyroidism Thyroid hormone regulates multiple steps in lipid metabolism including LDL receptor expression and LPL activity.
Alcohol Can cause hypertriglyceridemia in susceptible patients but mild intake linked to decreased risk of vascular disease.
Renal disease Increased LDL in nephrotic syndrome, hypertriglyceridemia in end-stage renal disease.
Obstructive liver disease Can be associated with very high cholesterol levels. Some evidence that diseases such as primary biliary cirrhosis not associated with increased vascular events despite dyslipidemia.
Diuretics Increased LDL with high doses. Current practice of using low doses of thiazides decreases vascular events and has minimal effect on lipids.
β-Adrenergic receptor blockers Increased triglycerides/decreased HDL probably by inhibiting LPL.
Anabolic steroids Can result in very low HDL (<10 mg/dL).
Estrogens Exacerbate hypertriglyceridemia when given orally. This effect is not seen with topical estrogen therapy.
Protease inhibitors Increased triglycerides/decreased HDL especially in setting of HIV-associated lipodystrophy.
Glucocorticoid excess Increased triglycerides/decreased HDL probably related to exacerbation of insulin resistance.
Antipsychotics Increased triglycerides/decreased HDL probably related to increased adiposity and insulin resistance.
Retinoids Increased triglycerides.
Systemic lupus erythematosus Chronic inflammation may increase risk of vascular disease independent of effects on lipid metabolism.
Acute intermittent porphyria Many agents used to treat lipid disorders reported to provoke episodes of abdominal pain.

HDL = high-density lipoprotein; HIV = human immunodeficiency virus; LDL = low-density lipoprotein; LPL = lipoprotein lipase;

L Goldman, D. A. (2008). Cecil Medicine, Saunders, an imprint of Elsevier Inc

McGill HC, C. M., EE Herderick, et al (2000). "Origin of atherosclerosis in childhood and adolescence." Am J Clin Nutr 72(suppl): 1307s-15s.