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 5S. FREDRICKSON, M.D. Chief, Molecular Disease Branch National Heart Institute National Institutes of Health a 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 RISK FACTORS 1. HYPERLIPIDEMIA 2. CIGARETTE SMOKING 3. HYPERTENSION 4. DIABETES OPROTEIN HYPERLIPDPREMIA DECISIONS ABOUT HYPERLIPOPROTEINEMIA 1. What is the Type? 2. Primary vs. Secondary - 3. Is it Familial? 4. Treatment a DECISIONS ABOUT HYPERLI POPROTEINEMIA 1. What is the Type? a. Always do C, TG b. Always look at serum c. Sometimes do lipoproteins DETECTION OF ALL HYPERLIPOPROTEINEMIA BY LIPIDS ALONE* Cholesterol 60% Triglyceride 70% Cholesterol and Triglyceride 96% *Using Age Corrected Limits TYPE If *4. BETA-LP INCREASED oh 5. pre-beta normal or Ls increased Te eu TYPE II 1. C increased 2. TG Normal or Increased (<500) 3. Plasma clear e TYPE IIl 1. C, TG increased 2. C/TG~ 1 3. Plasma turbid, with faint cream layer TYPE III 4. Broad beta band pre-beta increased + * 5. BETA FLOATING AT D 1.006 DECISIONS ABOUT HYPERLIPOPROTEINEMIA 2. Primary vs. Secondary TYPE II PHENOCOPIES DECISIONS ABOUT HYPERLIPOPROTEINEMIA DIETARY EXCESS 3. Is it Familial? HYPOTHYROIDISM NEPHROSIS DYSGLOBULINEMIA HEPATIC DISEASE Familial Type II Relatives of 134 Propositi: TYPE III PHENOCOPIES N Il Tit IV Parents 44 46 0 4 UNCONTROLLED DIABETES Sibs 89 93 0 6 HYPOTHYROIDISM ? Children 140 140 0 5 273 «279 15 TYPE IV PHENOCOPIES DIABETES HYPOTHYROIDISM Familial Type IV DYSGLOBULINEMIAS Parents and Sibs of 42 Propositi: CALORIC EXCESS N IV V ALCOHOL EXCESS ~70 65 0 DECISIONS ABOUT HYPERLIPOPROTEINEMIA TYPE III i. What is the Type? —_—_—_—— b. Always look at serum TREATMENT c. Sometimes do lipoproteins 2. Primary vs. Secondary 1. DIET - Ideal Wet 3. Is it Familial? Hi P/S 4, Treatment . Low Chol a. Diet Limit CHO 1) calories b. Drage 2. DRUG - Chlofibrate Nicotinic Acid TYPE II Ettect of High Carbohydrate a TREATMENT nro 1. DIET - Hi P/S Low Chol 2. DRUG - Cholestyramine Nicotinic Acid d - Thyroxine Chlofibrate ‘41g 626 (455-1100) a 251 sss 19 U5 (31-188) 4 136 plasma triglyceride mg % #0) 350) meon of 12 subjects ee 8 ohne of eoch type BS nd a 00 = Ey = (Ne are av ae a . i 7 TR tc ae ea a eee MEF ON " = ioaiiaieiiamniialis Posies ia nitoe ecu EEE Be. g2S § TYPE IV TREATMENT 1. DIET - Ideal Wet Limit CHO Limit Alcohol 2. DRUG - Chlofibrate Nicotinic Acid WB.Iyo CVE L ON ee LAA aceny PY Pena Neee WW wew*e ey gp Oee ret a NP renee = he PLACEDO- 2. gms. O.D-0 [OS fF AOR. ORC, AL OO mg CMOLESTENR TT as S870 Mie 2 3S 6S OH MH 99 OH TT cays: DECISIONS ABOUT HYPERLIPOPROTEINEMIA 1. What is the Type? 2. Primary vs. Secondary 3. Is it Familial? 4. Treatment