Dyslipidemia Pocket Guide: Full Illustrated

Introduction
Dyslipidemia is a group of disorders characterized by changes in plasma lipid or lipoprotein quantity or quality (Marais, 2013). Dyslipidemias may be genetically acquired, or arise from other medical conditions or external factors. They range from common, mild disorders to extremely rare and severe forms of disease. Dyslipidemia is a known risk factor of cardiovascular disease (CVD). Understanding the genetic and environmental factors that mediate dyslipidemia pathophysiology facilitates diagnosis and management, while reducing the risk of developing CVD.
Lipid overview
Lipids are fat molecules that are soluble in non-polar organic solvents and insoluble in water. In humans, they are a diverse group of molecules that provide energy storage and structure, and activate enzymes. In addition, lipids are required to absorb other dietary lipids and metabolize fat-soluble vitamins such as vitamins A, D, E, and K. They are classified in to eight categories by the Lipid Metabolites and Pathways Strategy (Lipid MAPS). These categories are: the fatty acyls, glycerolipids, glycerolphospholipids, sphingolipids, sterol lipids, prenol lipids, saccharolipids, and polyketides (Fahy et al., 2009).
Lipids are functionally distinct and several are crucial for mammalian cell and human body function. Lipids that are directly or indirectly associated with dyslipidemia include fatty acids, cholesterol, phospholipids, triglycerides, and plant sterols. Dyslipidemia diagnosis is often made when plasma cholesterol or triglyceride levels, or both, are measured outside the normal range.
Fatty acids are fatty acyls. They are considered the building blocks of more complex lipid molecules. The fatty acid molecular structure comprises a carboxylic acid group accompanied by long hydrocarbon chains, varying from 4-30 hydrocarbons (Figure 1.1). The hydrocarbon chain renders fatty acids non-polar and hydrophilic, and the numerous carbon-hydrogen bonds are considered energy-rich. The structure of a simple fatty acid is shown in Figure 1.1.

Table of Contents
ABBREVIATIONS AND ACRONYMS 12
CHAPTER 1: AN INTRODUCTION TO DYSLIPIDEMIA 14
Introduction 14
Lipid overview 14
Fatty acids 14
Cholesterol 15
Phospholipids 16
Triglycerides 17
Plant sterols 17
Lipoprotein overview 18
Chylomicrons 18
HDL 19
IDL 19
LDL 19
VLDL 19
Apolipoproteins and lipoproteins 20
Dyslipidemia and cardiovascular disease 20
Conclusion 21
CHAPTER 2: NORMAL LIPID METABOLISM AND FUNCTION 22
Lipid metabolism 22
Dietary lipid uptake 22
Lipogenesis 22
Lipolysis 23
Triglyceride metabolism 24
Cholesterol metabolism 25
De novo cholesterol biosynthesis 26
De novo cholesterol biosynthesis regulation 27
Cholesterol uptake 27
Lipid function overview 29
Energy storage 30
Lipid membranes and structural support 30
Cholesterol functions 31
Cholesterol and bile salt synthesis 31
Cholesterol and steroid hormones 32
Cholesterol and oxysterols 33
Cholesterol and vitamin D 34
Lipids and the brain 35
Lipid signaling 36
Other functions 36
Conclusion 36
CHAPTER 3: DYSLIPIDEMIA PATHOPHYSIOLOGY 38
Dyslipidemia overview 38
Primary hyperlipidemias 38
Chylomicronemia 39
Familial hypercholesterolemia 39
Hypercholesterolemia, atherosclerosis, and CVD 39
Familial combined hyperlipidemia 41
Dysbetalipoproteinemia 41
Familial hypertriglyceridemia 41
Hypertriglyceridemia, atherosclerosis, and CVD 41
Familial mixed hyperlipidemia 42
Hyperalphalipoproteinemia 42
Sitosterolemia 42
Hypocholesterolemia 43
Hypoalphalipoproteinemia 43
Cholesterol transport diseases 43
TD 43
CESD 44
Wolman disease 44
Secondary dyslipidemias 44
Secondary hypertriglyceridemia 45
Conclusion 46
CHAPTER 4: DIAGNOSIS AND MANAGEMENT OF HYPERLIPIDEMIAS 47
Guidelines 47
Familial hyperlipidemias 48
Chylomicronemia 48
Epidemiology 48
Symptoms 48
Diagnosis 49
Management 49
Prognosis 49
Special concerns 49
Hypercholesterolemia 50
Epidemiology 50
Symptoms 50
Diagnosis 51
Mana