Dyslipoproteinemia typing

The study of lipoprotein fractions in clinical practice is used for typing dyslipoproteinemia. Dyslipoproteinemia is a deviation of the lipoprotein spectrum of the blood, manifested in a change in the content (increase, decrease, absence or disturbance of the ratio) of one or more classes of lipoproteins. In 1967, a classification of GLP types was proposed, which was approved by WHO experts and became widespread. By the end of the 1970s, the term DLP was introduced to replace the designation GLP (a narrow term reflecting an increase in some class or classes of lipoproteins in the blood). This is explained by the fact that among patients with atherosclerosis and coronary heart disease, patients were often found who did not have an increase in the concentration of lipoproteins (i.e. GLP was actually absent), but the ratios between the content of atherogenic and antiatherogenic LP were disturbed.

Classification of the main types of homeopathic drugs.

Type I - hyperchylomicronemia. This type of HLP is characterized by high chylomicron levels, normal or slightly elevated VLDL levels, and a sharp increase in triglyceride levels to 1000 mg/dL or even higher. Type I is rare and manifests itself in childhood (hepatosplenomegaly, abdominal colic, pancreatitis). Xanthomas and lipoid arcus cornea may develop. Atherosclerosis does not develop. The cause of this type of HLP is a genetic defect based on the body's inability to produce lipoprotein lipase, which breaks down triglyceride-rich lipoprotein particles.

Type II - hyper-β-lipoproteinemia.

• Option A. Characterized by elevated LDL and normal VLDL levels, elevated cholesterol levels, sometimes very significant, and normal triglyceride levels. HDL concentrations are often absolutely or relatively reduced. Option A manifests itself in coronary heart disease and MI at a relatively young age, and is characterized by early mortality in childhood. The essence of the genetic defect underlying option IIA is a deficiency of LDL receptors (primarily, a deficiency of liver receptors), which greatly complicates the elimination of LDL from blood plasma and contributes to a significant increase in the concentration of cholesterol and LDL in the blood.
• Option B. The content of LDL and VLDL, cholesterol (sometimes significantly) and TG (in most cases moderately) is increased. This option is manifested by coronary heart disease and MI at a relatively young age, as well as tubercular xanthomas in childhood or in adults.

Type III - hyper-β- and hyper-pre-β-lipoproteinemia (dysbetalipoproteinemia). Characterized by an increase in the blood of VLDL, which have a high content of cholesterol and high electrophoretic mobility, that is, the presence of pathological VLDL (floating), the level of cholesterol and TG is increased, the ratio of cholesterol to TG approaches 1. VLDL contains a lot of apo-B. Clinically, this type is characterized by the development of relatively early and severe atherosclerosis, affecting not only the vessels of the heart, but also the arteries of the lower extremities. To diagnose type III HLP, it is necessary to take into account the extreme lability of lipid concentration in such patients and the ease of correction of lipid metabolism disorders in them under the influence of diet and medications.

Type IV - hyper-pre-β-lipoproteinemia. In type IV, the blood shows an increase in the level of VLDL, normal or decreased LDL content, absence of chylomicrons, an increase in the level of TG with normal or moderately increased cholesterol. Clinical manifestations of type IV HLP are not strictly specific. Both coronary and peripheral vessels may be affected. In addition to coronary heart disease, peripheral vessels are affected, expressed in intermittent claudication. Xanthomas are observed less often than in type II. There may be a combination with diabetes mellitus and obesity. It is believed that in patients with type IV HLP, lipolysis processes in adipose tissue are enhanced, the level of non-esterified fatty acids in the blood increases, which, in turn, stimulates the synthesis of TG and VLDL in the liver.

Type V - hyper-pre-β-lipoproteinemia and hyperchylomicronemia. In this type, the blood shows an increase in the concentration of VLDL, the presence of chylomicrons, an increase in the content of cholesterol and triglycerides. Clinically, this type of HLP is manifested by attacks of pancreatitis, intestinal dyspepsia, and an enlarged liver. All these manifestations occur mainly in adults, although they can also occur in children. Cardiovascular lesions are rare. Type V HLP is based on a deficiency of lipoprotein lipase or its low activity.

Increased levels of one or more classes of lipoproteins in the blood may be caused by various reasons. LDL may occur as an independent disease (primary LDL) or may accompany diseases of internal organs (secondary LDL). The former include all familial (genetic) forms of LDL, the latter include LDL observed in a number of diseases and conditions.

Diseases and conditions accompanied by the development of secondary HLP

Diseases or conditions	Type of GLP
Alcoholism	I, IV, V
Pregnancy or estrogen administration	IV
Hypothyroidism	IIA, IIB, IV
Diabetes mellitus	IIB, IV, V
Dysgammaglobulinemia	IIB, IV, V
Nephrotic syndrome	IIB, IV, V
OPP	IIA, IIB
Pancreatitis	IV, V
GC therapy	IV, V

The lipid metabolism disorders found in the listed diseases and conditions may be caused by the underlying pathology, not always indicating the presence of atherosclerosis. However, this list includes a number of diseases in which, as is known from everyday clinical practice, atherosclerosis develops very often. It seems obvious that, for example, lipid metabolism disorders in diabetes mellitus or hypothyroidism are caused by the presence of type IV lipid metabolism disorders in these patients.

In primary cases of HLP, specific treatment is necessary; in secondary cases of HLP, treatment of the underlying disease often leads to normalization of lipid levels.

It should be remembered that a single determination of the content of lipoproteins in the blood (especially during an outpatient examination) can lead to incomplete or erroneous identification of the type of lipoprotein, therefore it is necessary to conduct repeated studies.

In addition to the listed "classic" types of HLP, currently, DLP are differentiated, characterized by very low or high HDL content, as well as their complete absence (Tangier disease). At the same time, it should be noted that the phenotypic classification of DLP is now considered outdated, since it does not allow adequately separating patients at risk of coronary heart disease.