Ive posted the two threads I need to reply to. I need 2 replies of at least 250 words for EACH thread.
3 scholarly citations in AMA format for each topic. Each reply must incorporate at least 1 scholarly citation in AMA format. Any sources cited must have been published within the last five years. Acceptable sources include Peer-reviewed journal articles and textbooks.
We are discussing Disorders of Lipoprotein Metabolism, this person wrote;
Thread #1. “One of the most common disturbances of lipid metabolism and increased lipid level in blood is hyperlipidemia. (1,3) This disorder is incredibly common, primarily in the western hemisphere. (1) It is a chronic and progressive disease which can last an entire lifetime. (1) Many pathways are involved in normal lipid metabolism. (3) If any of these are disturbed, it could lead to one fo the types of hyperlipidemia. (3) Hyperlipidemia is categorized by increased low density lipoprotein (LDL), total cholesterol, triglyceride levels, or lipoprotein levels which are greater than the 90th percentile. (1) It can also be detected by high density lipoprotein (HDL) levels which are less than the tenth percentile. (1) Lipids categorized for diagnosis include cholesterol level, lipoprotein, chylomicrons, very low density lipoprotein, low density lipoprotein, apoldprotein, and high density lipoprotein. (1,3) Main categories of hyperlipidemia include primary and secondary. (1) Primary is mainly familial meaning it is genetics based. (1) Secondary type is acquired which has to do with underlying etiology such as diet or medication. (1) There are three subtypes of hyperlipidemia. (2) The first includes primary hyperlipidemia which is primarily genetic. (2) This type comprises about ninety eight percent of cases. (2) The next two are called hypercholesteremia and combined dysplidemia which are both due to excessive fat. (2) These two types also elevate the risk of atherosclerosis. (2) Children have the ability to be diagnosed with hyperlipidemia if they are underweight or obese and less than type years of age. (1) They would primarily be at risk for the acquired or secondary type of hyperlipidemia. (1) Any of these three type can be helped by increasing physical exercise. (2) Tissue factor and increased platelets are primary indicators of coagulation. (1) These can lead to increased risk of plaque rupture and thrombosis. (1) Because there are several environmental and genetic factors at play in terms of pathogenesis, it becomes very complex to treat and diagnose specific subtypes of hyperlipidemia. (3) More findings of the different pathways of lipoprotein metabolism in the body as well as related genes will aid in further research and development of treatment for hyperlipidemia in the future. (3) Initial treatment of hyperlipidemia includes lifestyle modifications such as exercise or dietary changes. (1) Dietary changes could include a lower fat and lower carb diet. (1) Sometimes a lipid lowering medication is prescribed if it is felt necessary. (1) There is still more to be discovered given the vast variety of subtypes and mechanisms of action of this disorder going forward. References
1. Hill MF, Bordoni B. Hyperlipidemia. [Updated 2022 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559182/
2. Pedersen BK. Physical exercise in chronic diseases. Nutrition and Skeletal Muscle. 2019:217-266. doi:10.1016/b978-0-12-810422-4.00014-2
3. Taghizadeh E, Mardani R, Rostami D, Taghizadeh H, Bazireh H, Hayat SM. Molecular mechanisms, prevalence, and molecular methods for familial combined hyperlipidemia disease: A Review. Journal of Cellular Biochemistry. 2018;120(6):8891-8898. doi:10.1002/jcb.28311”
THREAD 2
The lipoprotein metabolism disease I have chosen to look at is hypertriglyceridemia (HTG). Hypertriglyceridemia is a disorder in which someone has an increased fasting plasma triglyceride level about the 95th percentile for their age and sex1. It is possible to fluctuate between hypertriglyceridemic states, although a normal triglyceride level in adults is below 150 milligrams per deciliter (mg/dL)2. Elevated plasma triglyceride levels contribute to an increased risk of cardiovascular disease1. This increased risk goes along with an increased risk in obesity, metabolic syndrome and diabetes mellitus1. Also, if your triglyceride levels, while fasting, reach to be 500 mg/dL, that is then considered severe hypertriglyceridemia and you are at risk for acute pancreatitis2. Roughly one in five adults have elevated triglyceride levels and 42% of adults over the age of sixty are affected by hypertriglyceridemia. Most adults do not experience any symptoms, so they are living with hypertriglyceridemia undetected. One way to visually detect severe hypertriglyceridemia is from eruptive xanthomas. This condition, while diagnosed on clinical evaluation is a giveaway for both severe hypertriglyceridemia and diabetes mellitus5. Xanthomas represent an inflammatory response to the deposition of chylomicron-associated lipids in tissues and are yellow-red papules that usually appear on the buttocks, back and extensor surfaces of the upper limb3. These lesions contain lipid laden foamy macrophages and are reported to be found in about 10% of patients with severe hypertriglyceridemia5.
Triglycerides are transported through plasma as very-low density lipoproteins; VLDL transport triglycerides primarily made in the liver and chylomicrons transport exogenous dietary fat3. The flux of free fatty acids (FFA) to the liver is part of what determines the extent of triglyceride synthesis3. The lipoprotein lipase complex hydrolyzes the triglycerides in both VLDL and chylomicrons. There are removal mechanisms that take place by hepatic TG lipase and apoA-V in the remnant clearance process when there are too many triglycerides saturating the plasma, but once these become saturated, the triglycerides will begin to accumulate and increase levels drastically. In addition to hypertriglyceridemia being caused by these environmental contributors and outside factors, it has also been classified as primary when a genetic familial basis is suspected3.
The therapeutic goals and treatment strategies for hypertriglyceridemia depend on the triglyceride level4. If the patient is borderline high, between around 150-199 mg/dL), the goal is to focus on non-pharmacologic strategies, so treat the environmental factors by limiting alcohol intake, eating too many refined carbohydrates and being inactive. For high levels (200-499 mg/dL), continue the previous strategies, but also incorporate fibrate, niacin or omega-3 fatty acids4. If the LDL-C is close to being in normal range, titrate statin dose to achieve both the LDL-C and non-HDL-D targets, but if the LDL-C is already at the goal and non-HDL-C is elevated, titrate statin dose can be added or incorporating the three things previously mentioned4. LDL refers to low-density lipoprotein, which is the “bad” cholesterol in our bodies and HDL refers to high-density lipoprotein, which is the good cholesterol. Lastly, for very high levels (above 500 mg/dL), the therapeutic strategies to consider are fibrate, niacin and omega-3 fatty acids, while also incorporating non-pharmacologic therapies at the same time4. The biggest concern with reaching a very high level of hypertriglyceridemia is the pancreatitis risk.
Reference List:
Yuan, George, et al. “Hypertriglyceridemia: Its Etiology, Effects and Treatment.” CMAJ : Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne, Canadian Medical Association, 10 Apr. 2007, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839776/.
“Hypertriglyceridemia: Causes, Risk Factors & Treatment.” Cleveland Clinic, 29 July 2022, https://my.clevelandclinic.org/health/diseases/23942-hypertriglyceridemia#:~:text=Hypertriglyceridemia%20means%20you%20have%20too,sugar%2C%20refined%20carbs%20and%20alcohol.
Chait A, Subramanian S. Hypertriglyceridemia: Pathophysiology, Role of Genetics, Consequences, and Treatment. [Updated 2019 Apr 23]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
Brahm, Amanda, and Robert A Hegele. “Hypertriglyceridemia.” Nutrients, MDPI, 22 Mar. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705331/#!po=22.4138.
Lee, Sun Yong, and Chirag A Sheth. “Eruptive Xanthoma Associated with Severe Hypertriglyceridemia and Poorly Controlled Type 1 Diabetes Mellitus.” Journal of Community Hospital Internal Medicine Perspectives, Taylor & Francis, 5 Sept. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735292/#:~:text=Eruptive%20xanthomas%20often%20indicate%20severe,based%20on%20the%20clinical%20evaluation.