LIPOPROTEIN PATTERNS AND ATHEROSCLEROSIS DONALD S. FREDRICKSON, M.D. Chief, Molecular Disease Branch National Heart Institute National Institutes of Health Lecture given at Georgetown University Hospital Sponsored by THE DIVISION OF CARDIOLOGY DEPARTMENT OF MEDICINE GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE and THE COUNCIL ON CLINICAL CARDIOLOGY AMERICAN HEART ASSOCIATION DONALD S. FREDRICKSON, M.D. Chief, Molecular Disease Branch National Heart Institute National Institutes of Health EDITORS: James A. Ronan, Jr., M.D.* Assistant Professor of Medicine Georgetown University School of Medicine Teaching Scholar of the American Heart Assn. W. Proctor Harvey, M.D. Professor of Medicine Georgetown University School of Medicine Director, Division of Cardiology Georgetown University Medical Center Technical Assistance--Ruth Weinmann Georgetown University Hospital This is the first of a series of cardiovascular conferences sponsored by the Georgetown University Hospital and Council of Clinical Cardiology, American Heart Association. *Teaching project developed during Dr. Ronan's appointment as Teaching Scholar of the American Heart Association. PREMATURE ATHEROMAS 1. HYPERLIPIDEMIA 2. CIGARETTE SMOKING 3. HYPERTENSION 4. DIABETES RISK FACTORS OPROTEIN HYPERLIPAMEMIA 1. What is the Type? 2. Primary vs. Secondary 3. Is it Familial? 4. Treatment DECISIONS ABOUT HYPERLIEQPROTEINEMIA 1. What is the 'Qpe? a. Always do C, TG b. Always look at sexun c. Sometimes do lipoproteins DETECTION OF ALL HYPERLIPOPROTEINEMIA BY LIPIDS ALONE* Cholesterol 60% Triglyceride 70% Cholesterol and Triglyceride 96% *Using Age Corrected Limits *4. 5, 5 ?? o TYPE II BETA-LP INCREASED pre-beta normal or increased TYPE II 1. 2. 3. C increased TG Normal or Increased (esoo) Plasma clear TYPE III 1. C, TG increased 2. C/TG- 1 3. Plasma turbid, with faint cream layer TYPE III 4. Broad beta band pre-beta increased 2 * 5. BETA FLOATING AT D 1.006 . 1 DECISIONS ABOUT HYPERLIRXROTEINEMIA 2. Primary vs. Secondary TYPE II PHENOCOPIES DIETARY EXCESS HYPOTHYROIDISM NEPHROSIS DYSGLOBULINEMIA HEPATIC DISEASE TYPE III PHENOCOPIES UNCONTROLLED DIABETES HYPOTHYROIDISM ? TYPE IV PHENOCOPIES DIABETES HYPOTHYROIDISM DYSGLOBULINEMIAS CALORIC EXCESS ALCOHOL EXCESS DECISIONS ABOUT HYPERLIPOPROTEINEMIA 3. Is it Familial? Familial Type II Relatives of 134 Prupositi: N II III rv Parents 44 Sibs 89 Children 140 46 0 4 93 0 6 140 0 5 279 I3 Familial Type IV Parents and Sibs of 42 Propositi: DECISIONS ABOUT HYPERLIPOPRQTEINEM TYPE III 1. What is the Type? a. Alwaye do C, TG b. Always look at serum c. Sometimes do lipoproteins 2. Primary vs. Secondary 3. Is it Familial? 4. Treatment a. Diet 1) calories 2) content b. Drugs TYPE II TREATMENT 1. DIET - Hi P/S Low Chol 2. DRUG - Cholestyramine Nicotinic Acid d - Thyroxine Chlofibrate TREATMENT 1. DIET - 2. DRUG - Ideal Wgt Hi P/S Low Chol Limit CHO Chlofibrate Nicotinic Acid TYPE IV TREATMENT 1. DIET - Ideal Wgt Limit CHO Limit Alcohol 2. DRUG - Chlofibrate Nicotinic Acid DECISIONS ABOUT HYPERLIPOPkOTEINEMIA 1. What is the Type? 2. Primary vs. Secondary 3. Is it Familial? 4. Treatment