ABSTRACT
Diversos estudios evidencian la asociación entre los niveles elevados del colesterol de LDL (cLDL) y el riesgo de desarrollar enfermedad cardiovascular aterosclerótica. Con el objetivo de comparar los valores de cLDL obtenidos mediante la medición directa y los valores estimados por las ecuaciones de Friedewald tradicional, modificada y de regresión, se valoró el cLDL de 4.621 pacientes mediante el ensayo directo en el autoanalizador ADVIA 1800. Dichos resultados se agruparon en los estados de normolipemia, hipercolesterolemia, hiperlipemia mixta e hipertrigliceridemia y se establecieron diferencias de estimación con las mencionadas fórmulas en el total de la muestra y en los niveles de decisión clínica para el cLDL. Las tres fórmulas presentaron correlación significativa con el método directo en la totalidad de la muestra; sin embargo, cuando los niveles de triglicéridos de las muestras superaron los 200 mg/dL, la diferencia entre la fórmula de Friedewald y el método directo resultó -11,94%, y llegó a -19,13% para el nivel de triglicéridos mayor de 400 mg/dL. Por otro lado, las ecuaciones de Friedewald modificada y de regresión se vieron afectadas en menor cuantía por el nivel de triglicéridos. Las fórmulas de regresión y de Friedewald modificada se constituyen como alternativas razonables para estimar el cLDL y presentan buena concordancia con el método directo, incluso en niveles altos de colesterol y triglicéridos.
Several studies show the association between high LDL cholesterol (LDLc) levels and the risk of developing atherosclerotic cardiovascular disease. In order to compare the LDLc values obtained by direct measurement and the values estimated by the traditional, modified and regression Friedewald equations, the LDLc of 4,621 patients was assessed by means of the direct test in the ADVIA 1800 autoanalyzer.These results were grouped into the states of normolipemia, hypercholesterolemia, mixed hyperlipemia and hypertriglyceridemia, establishing differences in estimation with the aforementioned formulas in the total sample and in clinical decision levels for LDLc. The three formulas showed a significant correlation with the direct method in the entire sample; however, when the triglyceride levels of the samples exceeded 200 mg/dL, the difference between Friedewald's formula and the direct method was -11.94% reaching -19,13% for the triglyceride level greater than 400 mg/dL, while the modified Friedewald and regression equations were affected to a lesser extent by the triglyceride level. Regression and modified Friedewald formulas are constituted as reasonable alternatives to estimate LDLc and have good agreement with the direct method, even at high cholesterol and triglyceride levels.
Varios estudos evidenciam a associacao entre niveis elevados do colesterol LDL (cLDL) e o risco de desenvolver doenca cardiovascular aterosclerotica. Visando comparar os valores de cLDL obtidos atraves da medicao direta e os valores estimados pelas equacoes de Friedewald tradicional, modificada e de regressao, o cLDL de 4.621 pacientes foi avaliado por meio do teste direto no analisador automatico ADVIA 1800. Tais resultados foram agrupados nos estados de normolipemia, hipercolesterolemia, hiperlipemia mista e hipertrigliceridemia, estabelecendo-se diferencas na estimativa com as formulas mencionadas no total da amostra e nos niveis de decisao clinica para cLDL. As tres formulas apresentaram correlacao significativa com o metodo direto em toda a amostra, no entanto, quando os niveis de triglicerideos das amostras excederam 200 mg/dL, a diferenca entre a formula de Friedewald e o metodo direto foi de -11,94% atingindo -19,13% para o nivel de triglicerideos superior a 400 mg/dL. Por outra parte, as equacoes de Friedewald modificada e de regressao foram afetadas em menor grau pelo nivel de triglicerideos. As formulas de regressao e de Friedewald modificada se constituem como alternativas razoaveis para estimar o cLDL, e apresentam boa concordancia com o metodo direto, mesmo em niveis elevados de colesterol e triglicerideos.
Subject(s)
Triglycerides , Hypertriglyceridemia , Cholesterol , Hypercholesterolemia , Hyperlipidemias , Hyperlipoproteinemia Type V , Cholesterol, LDL , Cholesterol, LDL/blood , Patients , Association , Cardiovascular Diseases , Disease , Risk , Minors , MethodsABSTRACT
Hypertriglyceridemia-induced pancreatitis is a rare, but serious, complication of pregnancy. We report a case of acute pancreatitis associated with type V hyperlipoproteinemia in pregnancy. A 36-year-old primigravida was admitted at 16 weeks of gestation with severe abdominal pain. Chemical analysis showed high serum pancreatic enzymes and very high serum triglyceride. Abdominal magnetic resonance imaging (MRI) showed diffuse swelling of the pancreas and a peripancreatic fluid collection. A diagnosis of acute pancreatitis with type V hyperlipoproteinemia was made. She recovered from the acute pancreatitis with conservative management and the serum triglyceride decreased rapidly with dietary restriction of fat, insulin/glucose, fenofibrate, and omega-3. We review the management of hypertriglyceridemia-induced acute pancreatitis in pregnancy.
Subject(s)
Adult , Humans , Pregnancy , Abdominal Pain , Fenofibrate , Hyperlipoproteinemia Type V , Hypertriglyceridemia , Magnetic Resonance Imaging , Pancreas , PancreatitisABSTRACT
Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.
Subject(s)
Female , Humans , Middle Aged , Hypolipidemic Agents/therapeutic use , Diabetes Mellitus, Type 2/blood , Erythrocyte Aggregation , Hyperlipidemias/blood , Hyperlipoproteinemia Type V/blood , Hypoglycemic Agents/therapeutic use , Hypothyroidism/blood , Fenofibrate/therapeutic use , Skin Diseases/blood , Thyrotropin/blood , Thyroxine/blood , Treatment Outcome , Xanthomatosis/bloodABSTRACT
<p><b>OBJECTIVE</b>The aim of this study was to evaluate the efficacy and safety of combination therapy with simvastatin and fenofibrate in patients with combined hyperlipidemia.</p><p><b>METHODS</b>A total of 221 patients with combined hyperlipidemia were randomly assigned to receive 10 mg simvastatin (n = 72) or 200 mg fenofibrate (n = 68), or a combination of 10 mg simvastatin + 200 mg fenofibrate (n = 81) for 6 months. Lipid profiles, physical and laboratory investigations for adverse effects were assessed.</p><p><b>RESULTS</b>(1) Combination treatment were more effective in normalizing lipid profile than any monotherapy. Serum TC, LDL-C, and TG were reduced by 30%, 37% and 56% respectively, whilst HDL-C significantly increased by 24% (all P < 0.01). The improvement in TG and HDL-C achieved by combination treatment was superior to fenofibrate or simvastatin alone. (2) The success rate of TC, LDL-C and TG control in the combination therapy group were 51%, 55% and 61% respectively, with an overall success rate (all three together) of 45%, which was superior to either drug given as monotherapy. (3) All treatments were well tolerated with no increase in adverse events for combination therapy versus monotherapy.</p><p><b>CONCLUSION</b>The results of this study demonstrated that combination therapy with fenofibrate (200 mg/day) and low-dose simvastatin (10 mg/day) is more effective than monotherapy in patients with combined hyperlipidemia, and is generally safe and well tolerated.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Drug Therapy, Combination , Fenofibrate , Therapeutic Uses , Hyperlipoproteinemia Type V , Drug Therapy , Hypolipidemic Agents , Therapeutic Uses , Simvastatin , Therapeutic UsesABSTRACT
We report a case of type V hyperlipoproteinemia with xanthoma eruptivum in a 30-year-old male. He had diffuse erythematous yellowish papules on both extremities and the buttock. The laboratory findings showed the increased cholesterol and the triglyceride. Serum electrophoresis showed an increase in pre-beta and chylomicron, suggesting type V hyperlipoproteinemia. The biopsy specimen of an erythematous yellowish colored papule on the right knee showed many aggregates of foam cells without Touton giant cells.
Subject(s)
Adult , Humans , Male , Biopsy , Buttocks , Cholesterol , Electrophoresis , Extremities , Foam Cells , Giant Cells , Hyperlipoproteinemia Type V , Knee , Triglycerides , XanthomatosisABSTRACT
We report a case of type V hyperlipoproteinemia with xanthoma eruptivum associated with diabetes mellitus. An 18-year-old female patient presented with multiple, erythematous papules on the trunk, buttocks, and both extremities and multiple orange-yellow colored, conglomerated nodules on the elbows and knees. Laboratory examination showed increased serum blood glucose, cholesterol and triglyceride. Lipoprotein electrophoresis showed increased pre-beta and chylomicron bands. Analysis of lipoprotein revealed increase of very low density lipoprotein (VLDL) and triglyceride levels in the plasma. A skin biopsy from the papule on the trunk revealed a xanthoma. We diagnosed the patient as type V hyperlipoproteinemia. After 10 months of treatment with insulin and gemfibrozil, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions showed marked improvement without scar.
Subject(s)
Adolescent , Female , Humans , Biopsy , Blood Glucose , Buttocks , Cholesterol , Cicatrix , Diabetes Mellitus , Elbow , Electrophoresis , Extremities , Gemfibrozil , Hyperlipoproteinemia Type V , Insulin , Knee , Lipoproteins , Plasma , Skin , Triglycerides , XanthomatosisABSTRACT
We report two cases of type V hyperlipoproteinemia and eruptive xanthomas associated with diabetes mellitus in a 44-year-old woman and a 25-year-old woman. They had asymptomatic, diffuse, erythematous yellowish papules on the extremities and buttocks. The laboratory studies showed increased serum blood glucose, total cholesterol, triglyceride, increasing pre-β and chylomicron bands on electrophoresis of lipoprotein. Histopathologic findings of erythematous yellowish papules on the thigh and buttock revealed aggregation of foam cells in the dermis. They have been treated with diet control, hypoglycemic agent (gliclazide) and hypolipidemic drug (gemfibrozil), and are under continued supervision.
Subject(s)
Adult , Female , Humans , Blood Glucose , Buttocks , Cholesterol , Dermis , Diabetes Mellitus , Diet , Electrophoresis , Extremities , Foam Cells , Hyperlipoproteinemia Type V , Lipoproteins , Organization and Administration , Thigh , Triglycerides , XanthomatosisABSTRACT
We report a case of type V hyperlipoproteinemia and xanthoma eruptivum associated with diabetes mellitus in a 12-year-old female. She had diffuse erythematous yellowish papules on the extremities and trunk with itching. The laboratory findings showed increased serum blood glucose, cholesterol and triglyceride, increasing pre- and chylomicron bands on electrophoresis of lipoprotein. The biopsy specimen of an erythematous yellowish colored papule on the trunk showed characteristic findings of xanthoma.
Subject(s)
Child , Female , Humans , Biopsy , Blood Glucose , Cholesterol , Diabetes Mellitus , Electrophoresis , Extremities , Hyperlipoproteinemia Type V , Lipoproteins , Pruritus , Triglycerides , XanthomatosisABSTRACT
Se presenta una revisión sobre los xantomas cutáneos enfatizando su importancia como marcadores de padecimientos sistémicos principalmente de la hiperlipoproteinemias primarias y secundarias. Existe una estrecha relación entre el trastorno metabólico y tipo de lípido sérico elevado con las diferentes variedades de xantomas. Se destaca la necesidad del diagnóstico temprano de la dislipidemias por el riesgo de la enfermedad coronaria aterosclerosa en pacientes jóvenes
Subject(s)
Adult , Middle Aged , Humans , Female , Male , Coronary Disease/metabolism , Coronary Disease/prevention & control , Hyperlipoproteinemia Type V/metabolism , Hyperlipoproteinemia Type V/physiopathology , Lipidoses/metabolism , Lipidoses/physiopathology , Xanthomatosis/diagnosis , Xanthomatosis/physiopathologyABSTRACT
Type V hyperlipoproteinemia result from the accumulation of trglyceride(TG)-rich lipoproteins, very low density lipoprotein(VLDL), and chylomicrons. A 53-year old woman has showed asmptomatic, yellowish patches on tie palms and eyelids and papules on the knees with various types of xanthoma including xanthelasma palpebraum, xanthoma striatum palmare, anrl nonspecific papular xanthoma. The blood chemistry revealed a marked elevation of cholesterol and TG, and lipoprotein electrophoresis showed fasting chylomicronemia, prep-b and b-band, On histologic studies, typical foam cells were shown.
Subject(s)
Female , Humans , Middle Aged , Chemistry , Cholesterol , Chylomicrons , Electrophoresis , Eyelids , Fasting , Foam Cells , Hyperlipoproteinemia Type V , Knee , Lipoproteins , XanthomatosisABSTRACT
The hyperlipoproteinemias are the disturbance of lipid transport resulted from accelerated synthesis or retarded degradation of lipoproteins that transport cholesterol and trigycerides through plasma. These diseases are classified as type I, type IIa, type IIb, type III, type IV, type V, and hyper- -lipoproteinemia by lipoprotein phenotype. Type V hyperlipoproteinemia is uncommon in childhood and characterized by elevation of triglyceride levels due to increases in both VLDL and chylomicrons and lipoprotein electrophoresis shows increased pre- , , and chylomicron bands. We experienced a case of hyperlipoproteinemia type V in a 12 year old male who presented no specific signs and symptoms. So, we report a case of hyperlipoproteinemia type V with brief review of the literatures.
Subject(s)
Child , Humans , Male , Cholesterol , Chylomicrons , Electrophoresis , Hyperlipoproteinemia Type V , Hyperlipoproteinemias , Lipoproteins , Phenotype , Plasma , TriglyceridesABSTRACT
Los perfiles de los tipos clásicos mencionados pueden encontrarse en forma aislada o en diversas combinaciones. Muchas veces el perfil resulta limítrofe entre dos clasificaciones, siendo difícil incluirlo en uno de los dos tipos. Este problema se presenta en el 10%de las muestras
Subject(s)
Humans , Clinical Laboratory Techniques , Electrophoresis, Agar Gel , Hyperlipoproteinemias/blood , Hyperlipoproteinemias/diagnosis , Lipoproteins/analysis , Hyperlipoproteinemia Type III/blood , Hyperlipoproteinemia Type III/therapy , Hyperlipoproteinemia Type II/blood , Hyperlipoproteinemia Type II/therapy , Hyperlipoproteinemia Type IV/blood , Hyperlipoproteinemia Type IV/therapy , Hyperlipoproteinemia Type V/blood , Hyperlipoproteinemia Type V/therapyABSTRACT
Se presenta la historia de un caso de hiperlipoproteinemia tipo V en la infancia, primer reporte en Venezuela, diagnosticado desde los primeros días de vida. Después de descartadas todas las causas secundarias de esta enfermedad, se concluyó en un origen primario; fue imposible realizar estudio de la familia. El paciente ha presentado xantomas eruptivas, hepatoesplenomegalia, dolor abdominal que ameritó laparatomía exploradora, con extracción de líquido lechoso del abdomen; lipemia retinalis. Después de comenzado el tratamiento dietético específico para esta enfermedad se logró una disminución importante de los triglicéridos, aunque éstos se mantienen aún elevados. El paciente no ha presentado más complicaciones y se conserva asintomático con un crecimiento y desarrollo normal
Subject(s)
Infant, Newborn , Humans , Male , Hyperlipoproteinemia Type V/epidemiology , VenezuelaABSTRACT
Se presenta el caso de una paciente, en la cual un cuadro de abdomen agudo motivo repetidos internamientos en uno de los hospitales de la Caja Costarricense de Seguro Social. El diagnostico fue inicialmente de colis espastica y luego de pancreatitis aguda recidivante. Sin embargo, en el cuarto internamiento, el analisis de las lipoproteinas sericas dio un patron semejante al de la hiperlipoproteinemia tipo V, mientras que el analisis de la orina dio un patron de excrecion de profirinas y precursores sugestivo de profiria aguda intermitente. Ambos trastornos pueden producir un cuadro semejante al de la paciente y hasta donde los autores saben, esta podria ser la primera vez que se reportan juntos en un mismo paciente