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Secondary causes of dyslipidemia

INTRODUCTION

In many patients hyperlipidemia is caused by some underlying "non-lipid" etiology rather than a primary disorder of lipid metabolism. The secondary causes of dyslipidemia will be reviewed briefly here; many of these are discussed in more detail elsewhere:

  • Type 2 diabetes mellitus
  • Excessive alcohol consumption
  • Cholestatic liver diseases
  • Nephrotic syndrome
  • Chronic renal failure
  • Hypothyroidism
  • Cigarette smoking
  • Obesity
  • Drugs

In a cohort of 824 new patients referred to a lipid clinic at an academic medical center in the United States, 28 percent had one or more potential causes of secondary dyslipidemia [1]. The most common conditions that were felt to be contributing to dyslipidemia were excessive alcohol intake (10 percent) and uncontrolled diabetes mellitus (8 percent).

TYPE 2 DIABETES MELLITUS

Hyperlipidemia in association with insulin resistance is common in patients with type 2 diabetes mellitus (DM) [2,3]. Insulin resistance and the ensuing hyperinsulinemia are associated with hypertriglyceridemia and low serum high-density lipoprotein (HDL) cholesterol concentrations.

The lipoprotein abnormalities are related to the severity of the insulin resistance. A study that measured insulin sensitivity using a euglycemic clamp in patients with and without type 2 DM found that greater insulin resistance was associated with larger very low density lipoprotein (VLDL) particle size, smaller low density lipoprotein (LDL) particle size, and smaller HDL particle size [4]. Additionally, the number of VLDL, intermediate density lipoprotein (IDL), and LDL particles increase with increasing insulin resistance, while HDL particle concentration decreases.

          

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Literature review current through: Jul 2014. | This topic last updated: Aug 13, 2014.
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