Hyperlipidaemia

Causes	Appropriate Tests
	Lipid investigations should be done in patients with a personal or family history of atherosclerosis and patients with disease associated with hyperlipidaemia eg, diabetes mellitus, hypothyroidism, chronic renal disease, xanthomas. The tests should not be performed on specimens collected between 24 hours and 8 weeks after myocardial infarction, as levels will be lower than usual. The specimen is collected without venostasis, following a fast of at least 12 hours. The initial screen is fasting plasma Cholesterol and Triglycerides, ideally with Cholesterol (HDL and LDL). Apolipoprotein B can provide a measure of the number of attherogenic lipoprotein particles. Plasma lipoprotein (a) is an independent risk factor for atherosclerosis and may be indicated in patients with a personal or strong family history of atherosclerosis, with normal Cholesterol (HDL and LDL).
Hypercholesterolaemia	Characterised by increased LDL cholesterol (type IIa pattern on lipoprotein electrophoresis).
Inherited Familial hypercholesterolaemia Familial combined hyperlipidaemia
Secondary causes Hypothyroidism Nephrotic syndrome Cholestasis Hypergammaglobulinaemia Anorexia nervosa Porphyria	Hypercholesterolaemia is due to lipoprotein X, rather than to elevated LDL cholesterol; further investigation is not indicated.
Hypertriglyceridaemia	Characterised by increased chylomicrons or VLDL. Patients may also have Hypercholesterolaemia of chylomicron or VLDL origin, but LDL cholesterol is normal.
Inherited Familial hyperchylomicronaemia Familial hypertriglyceridaemia Familial combined hyperlipidaemia	Post-heparin lipoprotein lipase, apolipoprotein C-II - consult pathologist.
Secondary causes Alcohol Obesity Diabetes mellitus Renal failure - chronic Drug induced, especially Oral contraceptives Glucocorticoids Nephrotic syndrome Hypothyroidism Cushing's syndrome Pancreatitis Acromegaly Hypopituitarism Hypergammaglobulinaemia Glycogen storage diseases	See Alcoholism.
Hypercholesterolaemia and hypertriglyceridaemia	Characterised by increased LDL and VLDL, IDL, or VLDL and chylomicrons.
Inherited Familial combined hyperlipidaemia Familial dysbetalipoproteinaemia	ApoE genotyping (Molecular genetics; Apolipoprotein).
Secondary causes Diabetes mellitus Pancreatitis Nephrotic syndrome Hypothyroidism Glucocorticoid therapy

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