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Features of Lipid Metabolism in Diabetes Mellitus and Ischemic Heart Disease
Published in E.I. Sokolov, Obesity and Diabetes Mellitus, 2020
After the taking of food, chylomicrons are detected in the intestine. They form in the cells of the mucous membrane of the small intestine and pass into the lymphatic tracts. After getting into the blood channel, the chylomicrons experience numerous changes, in particular phospholipids are detached or are exchanged for other lipid fractions. The triglycerides of the chylomicrons are exogenic fats and contain the fats from food. The duration and level of increased chylomicronemia depend on the amount and composition of the introduced fats, and also on the amount of carbohydrates in the food. If the latter are taken together with fats, the chylomicron level after a lipid toad diminishes.
Lipoprotein lipase deficiency/type I hyperlipoproteinemia
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
Management of the acute abdominal pain requires vigilance about the diagnosis of pancreatitis and recognition that amylase values may be normal. The treatment of pancreatitis should follow the usual conservative regimen, with the additional precept that fat should be eliminated. In a neonate with chylomicronemia and congestive cardiac failure, triglyceride levels of 38,000 mg/dL were reduced to normal by plasmapheresis, and cardiac function became normal [82]. The treatment of apoC-II deficiency should generally be the same as that of lipoprotein lipase deficiency. An episode of pancreatitis may be successfully treated in apoC-II deficiency by the infusion of normal human plasma.
Dietary treatment of overweight and obesity
Published in G. Michael Steelman, Eric C. Westman, Obesity, 2016
Eric C. Westman, Mary C. Vernon, James A. Wortman
Other medical conditions that require consideration include congestive heart failure, gout, hyperchylomicronemia (triglycerides >1000 mg/dL), or history of calcium oxalate renal stones. Patients with heart failure may need to limit sodium and water consumption. Patients with a history of gout may be placed on prophylactic allopurinol prior to initiation or a prescription for colchicine or NSAID may be provided as well for the patient to initiate if needed. Patients with a history of calcium oxalate renal stones may reduce the risk of subsequent stones by taking potassium citrate supplements. GERD medications may be eliminated on a trial basis at any time—resume if the GERD recurs. After significant weight loss, continuous positive airway pressure therapy for sleep apnea may be discontinued if upon retesting, apnea and hypoxia are resolved. Some practitioners repeat a sleep study to document resolution of the sleep apnea. Although we have observed many patients with severe hypertriglyceridemia (>6500 mg/dL) improve with a low-carbohydrate diet, the current diet recommendation for these patients is a low-fat diet, due to the possibility of worsening hyperchylomicronemia. A high-fat diet in the presence of chylomicronemia may lead to pancreatitis (33). If the hypertriglyceridemia is chylomicron in origin, then a low-carbohydrate, high-fat diet is contraindicated. Test for this by asking your laboratory to measure for the presence of chylomicrons if the fasting serum triglycerides are >500 mg/dL. Careful clinical monitoring will show rapid decreases in serum triglycerides if the elevation is due to hyperinsulinemia. Triglyceride values will begin to decrease in a few days. Areas of the body that have a substantial loss of weight may require plastic surgery for removal of the stretched skin.
Safety and efficacy of therapies for chylomicronemia
Published in Expert Review of Clinical Pharmacology, 2022
Isabel Shamsudeen, Robert A. Hegele
Chylomicronemia syndrome refers to the presence of >1 associated clinical feature in patients with primary chylomicronemia [1]. Common clinical features include failure to thrive, nausea and vomiting, abdominal pain, eruptive xanthomas on the trunk and limbs, lipemia retinalis, and hepatosplenomegaly [4,19,20]. Less common clinical features include anemia, intestinal bleeding, diarrhea, seizures, and encephalopathy [7]. FCS develops in childhood, adolescence, or in early adulthood [2]. In contrast, MCS tends to develop later in life, usually in adulthood, often in the context of a secondary medical condition or medication [2]. Therefore, patients with MCS more often present with poorly controlled or undiagnosed diabetes mellitus, obesity, excessive alcohol intake, poor diet, chronic kidney disease, nephrotic syndrome, and hypothyroidism, all of which are associated with HTG [2]. Clinical features of MCS are similar to those of FCS, but without the pediatric features such as failure to thrive [2]. Moreover, patients with FCS tend to have normal or low weight, whereas patients with MCS have a high prevalence of overweight and obesity [2].
Management of asymptomatic severe hypertriglyceridemia
Published in Baylor University Medical Center Proceedings, 2022
Nathalie V. Scherer, Dipesh Bista
Chylomicronemia syndrome is defined as TG >1000 mg/dL with additional manifestations, such as eruptive xanthelasmas or lipemia retinalis.8 Our patient met these criteria. A variety of underlying pathophysiological changes can give rise to chylomicronemia syndrome, but the precise etiology in our patient is unclear. The most common cause of chylomicronemia syndrome is familial hypertriglyceridemia, an autosomal dominant trait, but the patient had no relevant family history, and genetic testing was not indicated.8 A variety of other factors can aid in developing this syndrome, such as uncontrolled diabetes mellitus, a diet high in fats, and pregnancy.3 Given that this patient had given birth several months prior, presented with hyperosmolar hyperglycemia syndrome, and had a body mass index ≥25 kg/m2, it is likely that her chylomicronemia syndrome developed from a combination of genetic predisposition and some modifiable risk factors.
Experimental therapies targeting apolipoprotein C-III for the treatment of hyperlipidemia – spotlight on volanesorsen
Published in Expert Opinion on Investigational Drugs, 2019
Dimitrios Milonas, Konstantinos Tziomalos
Two phase III trials (see Table 1) evaluated the safety and efficacy of volanesorsen in patients with elevated TG levels. In COMPASS, a double-blind multicenter study, 113 patients with fasting TG levels >500 mg/dl were randomized to receive volanesorsen 300 mg once weekly or placebo for 26 weeks [30]. A 72.7% mean reduction in TG levels was observed in patients treated with volanesorsen, corresponding to a mean absolute decrease by 869 mg/dl. Among patients with FCS, volanesorsen induced a 73% decrease in TG levels. Again, these findings suggest that volanesorsen appears to be similarly effective in patients with FCS and in those with multifactorial chylomicronemia. A reduction in the risk of acute pancreatitis was also observed in patients treated with volanesorsen. The agent was generally well-tolerated except for an increased incidence of injection-site reaction, which occurred in 23.5% of volanesorsen injections [30].