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METABOLIC DISORDER; HYPERTENSION,HYPERLIPIDEMIA, ATHEROSCLEROSIS

PRAGYA PANDEY

Ph.D 1ST Yr

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METABOLISM Metabolism is the complex set of chemical reactions that our

body uses to maintain life, including energy production. Special enzymes break down food or certain chemicals so

our body can use them right away for fuel or store them. When these chemical processes don't work properly due to a

hormone or enzyme deficiency, a metabolic disorder occurs. Some metabolic disorders can be diagnosed by routine

screening tests done at birth. Others are identified only after a child or adult shows

symptoms of a disorder.

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HIGH BLOOD PRESSURE/ HYPERTENSION

Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body.

Blood pressure readings are usually given as two numbersThe top number is called the systolic blood pressure. The bottom

number is called the diastolic blood pressure. Hypertension (HTN) or high blood pressure, sometimes called arterial

hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.

CATEGORY BLOOD PRESSURE(mm/Hg)

NORMAL <120/80

PRE-HYPERTENSION 120/80-140/90

HIGH B.P. ≥140/90

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High blood pressure increases chance of having a stroke, heart attack, heart failure, kidney disease, or early death.

‘Most of the time, no cause of high blood pressure is found. This is called essential hypertension.’

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RISK FACTORS:

Factors: Amount of water and salt in the body The condition of kidneys, nervous system, or blood vessels hormone levels Age: Blood vessels become stiffer as you age and thus blood

pressure goes up. Obesity Stress Too much alcohol (more than one drink per day for women and

more than two drinks per day for men). Too much salt in your diet Family history of high blood pressure Diabetes Smoking

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‘High blood pressure that is caused by another medical condition or medication is called secondary hypertension.’

Secondary hypertension may be due to: Chronic kidney disease Disorders of the adrenal gland (such as Cushing syndrome) Hyperparathyroidism Pregnancy or preeclampsia Medications such as birth control pills, diet pills, some cold

medicines, and migraine medicines Narrowed artery that supplies blood to the kidney (renal artery

stenosis)

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SYMPTOMS

Most of the time, there are no symptoms. People can develop heart disease and kidney problems

without knowing they have high blood pressure. If you have a severe headache, nausea or vomiting, bad

headache, confusion, changes in your vision, or nosebleeds you may have a severe and dangerous form of high blood pressure called malignant hypertension.

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EXAMS AND TESTS

All adults should have their blood pressure checked every 1 to 2 years if their blood pressure was less than 120/80 mmHg at their most recent reading.

If you have high blood pressure, diabetes, heart disease, kidney problems, or certain other conditions, have your blood pressure checked more often -- at least once every year.

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TREATMENT Pre-hypertension: lifestyle changes to bring your blood pressure

down to a normal range. Medicines are rarely used.

Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water.

Exercise regularly. Quit Smoke. Limit alcohol. Limit the amount of sodium (salt) -- aim for less than 1,500 mg per

day. Reduce stress Stay at a healthy body weight

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OUTLOOK (PROGNOSIS)

When blood pressure is not well controlled, you are at risk for:Bleeding from the aorta (the large blood vessel that

supplies blood to the abdomen, pelvis, and legs)Chronic kidney diseaseHeart attack and heart failurePoor blood supply to the legsProblems with your visionStroke

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HYPERLIPIDEMIA Hyperlipidemia is a heterogeneous group of disorders

characterized by an excess of lipids in the bloodstream, especially excess LDL-C and/or excess triglycerides.

These lipids include Cholesterol Cholesterol esters Phospholipids Triglycerides.

Two better-known terms: high cholesterol high triglycerides

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LIPOPROTEINS

Based on density: Chylomicrons very low-density lipoproteins (VLDL) intermediate-density lipoproteins (IDL) low-density lipoproteins (LDL) high-density lipoproteins (HDL)

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Lipids are transported in the blood as large 'lipoproteins' Most triglyceride is transported in chylomicrons or VLDL,

and most cholesterol is carried in LDL and HDL Our bodies make and use a certain amount of cholesterol

every day, but sometimes that system gets out of whack, either through genetics or diet. The “good cholesterol” – known as high-density

lipoprotein, or HDL – helps coat the arteries like a protective oil, helping to prevent blockages.

The “bad cholesterol,” low-density lipoprotein, or LDL – can lead to blockages if there’s too much in the body.

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Primary hyperlipidemia• genetically based, but the genetic

defects are known for only a minority of patients

Secondary hyperlipidemia

• may result from diseases such as diabetes, thyroid disease, renal disorders, liver disorders, and Cushing's syndrome, as well as obesity, alcohol consumption, estrogen administration, and other drug-associated changes in lipid metabolism

Hyperlipidemia

• is a major, modifiable risk factor for atherosclerosis and cardiovascular disease, including coronary heart disease.

TYPES

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Synonyms

Hypercholesterolemia

Hypertriglyceridemia

Hyperlipoproteinemia

Dyslipidemia

High serum cholesterol

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CAUSES

• COMMON CAUSE Familial combined hypercholesterolemia is the most common primary

lipid disorder, characterized by moderate elevation of plasma triglycerides & cholesterol and reduced plasma HDL-C

Familial hypertriglyceridemia Contributory or predisposing factors

Insulin-dependent diabetes mellitus Non-insulin dependent diabetes mellitus Hypothyroidism Cushing's syndrome Renal failure and nephrotic syndrome Cholestatic disorders Dysproteinemias

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Dietary causes:Fat intake per total calories greater than 40%Saturated fat intake per total calories greater than 10%Cholesterol intake greater than 300 mg per dayHabitual excessive alcohol use

• Lifestyle contributing factors include:Habitual excessive alcohol useObesityLack of exercise

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TREATMENT Treatment will vary based on which type of lipids that are

too high. Making healthy diet choices and increasing exercise are

important first steps in lowering your high cholesterol. Avoid fatty foods and lower your overall daily calorie

intake. Medication is also an effective tool For people with high triglycerides, alcohol can be

dangerous. Those with high cholesterol, a daily glass of wine or other

alcohol, along with healthy eating and exercise, may actually help.

1% reduction in the level of LDL-C, there is a 1-1.5% reduction in the risk of major cardiovascular events.

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Read food labels and choose foods with low cholesterol and saturated fat levels. 

Keeping daily cholesterol intake between 250 and 300 milligrams and make sure to limit saturated fat intake.

Limit your intake of red meat and eggs to reduce your saturate fat and cholesterol.

Choose skim milk, low fat or fat-free dairy products. Limit fried food, and use healthy oils in cooking, such as vegetable oil. Increase the amount of fiber you eat.

A diet high in fiber can help lower cholesterol levels by as much as 10 percent

Lose extra weight. A weight loss of 10 percent can go a long way to reversing, or lowering

your risk of hyperlipidemia Check your family history of high cholesterol

ATHEROSCLEROSIS

Atherosclerosis is a potentially serious condition where arteries become clogged up by fatty substances, such as cholesterol. These substances are called plaques or atheromas.

It is characterized by irregularly distributed lipid deposits in the intima of large and medium-sized arteries, causing narrowing of arterial lumens and proceeding eventually to fibrosis and calcification.

The plaques cause affected arteries to harden and narrow which is potentially dangerous for two reasons: restricted blood flow can damage organs and stop them

functioning properly if a plaque ruptures, it can cause a blood clot that blocks the

blood supply to the heart – triggering a heart attack, or the brain – triggering a stroke .

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WHAT CAUSES ATHEROSCLEROSIS? Arteries are blood vessels that carry blood from the heart throughout

the body. Two particularly important arteries are:

coronary arteries – which provide blood to the heart carotid arteries – which supply blood to the brain

The blood passes into tiny blood vessels, known as capillaries, where the oxygen in the blood is transferred into the cells of your body's tissues and organs. The blood then returns to the heart through the veins.

If a blood clot occurs in the coronary artery it can trigger a heart attack. Similarly a blood clot in the carotid artery can trigger a stroke.

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The endothelium layer works to keep the inside of arteries toned and smooth, which keeps blood flowing.

"Atherosclerosis starts when high blood pressure, smoking, or high cholesterol damage the endothelium, At that point, cholesterol plaque formation begins."

Cholesterol invasion. Bad cholesterol, or LDL, crosses damaged endothelium. The cholesterol enters the wall of the artery.

Plaque formation. White blood cells stream in to digest the LDL cholesterol. Over years, the accumulating mess of cholesterol and cells becomes a plaque in the wall of the artery.

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ATHEROSCLEROSIS AND PLAQUE ATTACKS

Plaques from atherosclerosis can behave in different ways.

They can stay within the artery wall. They can grow in a slow, controlled way into the path of

blood flow. Eventually, they cause significant blockages. Pain on exertion (in the chest or legs) is the usual symptom.

The worst-case scenario: plaques can suddenly rupture, allowing blood to clot inside an artery. In the brain, this causes a stroke; in the heart, a heart attack.

24The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.

FIGURE A REPRESENTS A HEALTHY ARTERY. FIGURE B SHOWS AN ARTERY WITH PLAQUE BUILD-UP

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Cardiovascular disease caused by plaques of atherosclerosis

Coronary artery disease: • Stable plaques in the heart's

arteries cause angina (chest pain on exertion).

• Sudden plaque rupture and clotting causes heart muscle to die.

• This is a heart attack, or myocardial infarction.

Cerebrovascular disease: • Ruptured plaques in the brain's

arteries causes strokes, with the potential for permanent brain damage.

• Temporary blockages in an artery can also cause transient ischemic attacks (TIAs),however, there is no brain injury.

Peripheral artery disease: • Narrowing in the arteries of the

legs caused by plaque.• Peripheral artery disease causes

poor circulation. • This causes pain on walking and

poor wound healing. Severe disease may lead to amputations

WHAT IS THE DIFFERENCE BETWEEN ARTERIOSCLEROSIS AND ATHEROSCLEROSIS?

Arteriosclerosis is the stiffening or hardening of the artery walls.

Atherosclerosis is the narrowing of the artery because of plaque build-up.

All patients with atherosclerosis have arteriosclerosis, but those with arteriosclerosis might not necessarily have atherosclerosis.

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SIGNS AND SYMPTOMS:

The first signs of atherosclerosis can begin to develop during adolescence, with streaks of white blood cells appearing on the artery wall.

Arteries affected: Carotid Arteries - these arteries provide blood to the brain, when the

blood supply is limited patients can suffer stroke and may experience: Weakness Difficulty breathing Headache Facial numbness Paralysis

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Coronary Arteries - these arteries provide blood to the heart, when the blood supply to the heart is limited it can cause angina and heart attack, symptoms include:

Vomiting Extreme anxiety Chest pain Coughing Feeling faint Renal Arteries- these supply blood to the kidneys; if the blood supply

becomes limited, there is a serious risk of developing chronic kidney disease, and the patient may experience:

Loss of appetite Swelling of the hands and feet Difficulty concentrating

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Peripheral arterial disease - the arteries to the limbs, usually the legs, are blocked.

The most common symptom is leg pain, either in one or both legs, usually in the calves, thighs or hips.

The pain may be described as one of heaviness, cramp, or dullness in the leg muscles.

Other symptoms may include: Hair loss on legs or feet Male impotence (erectile dysfunction) Numbness in the legs The color of the skin on the legs change The toenails get thicker Weakness in the legs

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CAUSES

smoking a high-fat diet a lack of exercise being overweight or obese having either type 1 or type 2 diabetes having high blood pressure (hypertension) having high cholesterol Diabetes Genetics Air pollution - exposure to diesel exhaust particles in air

pollution leads to a higher risk of bad cholesterol build-up in the arteries.(in 2007, researchers from the University of California in Los Angeles)

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Medication: To prevent the build up of plaque or to help prevent blood clots

(anteplatelets). Other medications such as statins may be prescribed to lower

cholesterol, and Angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure.

Surgery - Severe cases of atherosclerosis may be treated by surgical procedures, such as angioplasty or coronary artery bypass grafting (CABG). Angioplasty involves expanding the artery and opening the blockage, so

that the blood can flow through properly again. CABG is another form of surgery that can improve blood flow to the

heart by using arteries from other parts of the body to bypass a narrowed coronary artery.

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Treatment

PREVENTION Avoid saturated fats, they increase bad cholesterols level . Exercise will improve fitness level and lowers blood pressure. Stop Smoking Flu vaccine - Flu vaccination may reduce the risk of heart attack by 50% in

middle-aged individuals with narrowed arteries.

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THANK YOU