Lipid Profile, Ischemic Heart

disease and Its Risk Factors

Muhammad Asif Shaheen
Lecturer Pathology
KEMU, Lahore
What are Lipids
• Lipids are a group of fats and fat-like substances that are important
constituents of cells and sources of energy. A lipid panel measures the
level of specific lipids in the blood.
• Two important lipids, cholesterol and triglycerides, are transported in
the blood by lipoproteins (also called lipoprotein particles). Each type
of lipoprotein contains a combination of cholesterol, triglyceride,
protein, and phospholipid molecules. 
What Are Lipoproteins?
• Cholesterol is insoluble in the blood; it must be attached to certain 
protein complexes called lipoproteins in order to be transported
through the bloodstream. 
• The HDL, LDL and VLDL lipoproteins are tiny “packages” in your blood,
with fat (lipid) on the inside and proteins on the outside, that carry
cholesterol throughout your body.
When Lipid Profile is advised
• The lipid panel is used as part of a cardiac risk assessment to help determine
your risk of heart disease and to help make decisions about what treatment may
be best if you have borderline risk, intermediate risk, or high risk. Initial
screening may involve only a single test for total cholesterol and not a full lipid
panel. However, if the screening cholesterol test result is high, it will likely be
followed by testing with a lipid panel.
• The results of the lipid panel are considered along with other known risk factors
of heart disease to develop a plan of treatment and follow-up. Depending on the
results and other risk factors, treatment options may involve lifestyle changes
such as diet and exercise or medications that lower lipid levels, typically statins.
• Additionally, a lipid panel may be used to monitor whether treatment has been
effective in lowering cholesterol levels.
Hyperlipidemia
• Hyperlipidemia is abnormally elevated levels of any or all lipids or 
lipoproteins in the blood.
• Hyperlipidemia is an umbrella term that refers to acquired or genetic
disorders that result in high levels of lipids (fats, cholesterol, or
triglycerides) circulating in the blood.
• This disease is usually chronic and requires ongoing medication to
control blood lipid levels.
Lipid Profile test includes
• Triglycerides (Tg)
• Total Cholestrol
• LDL
• VLDL
• HDL
Total Lipids
• Sample
• This is done on the serum of the patient.
• Fasting samples for minimum 12 hours is needed.
• Indication
• Total lipid is advised to assess lipid metabolism.
• This is helpful for the diagnosis of hyperlipidemia.
What Are Triglycerides?

• They are important to life and are the main form of fat – they are
sometimes called “lipids” -- in the body. When you think of fat
developing and being stored in your hips or belly, you're thinking of
triglycerides.
• They are the end product of digesting and breaking down fats in food.
Some are made in the body from other energy sources, such as
carbohydrates. When you’re between meals and need more energy,
your body’s hormones release them so you tap those unused calories.
What Are Normal and High Levels?

• The National Cholesterol Education Program sets guidelines for

triglyceride levels:
• Normal levels: Less than 150 milligrams per deciliter
• Borderline high:150 to 199
• High: 200 to 499
• Very high: 500 or more
Cholesterol levels

• Your test results will show your cholesterol levels in milligrams per
deciliter of blood (mg/dL). Your total cholesterol and HDL (good)
cholesterol are among numerous factors your doctor can use to
predict your lifetime or 10-year risk for a heart attack or stroke.
• Total cholesterol—measures all the cholesterol in all the lipoprotein
particles
Cholesterol levels
Cholesterol, a waxy substance that is present in blood plasma and in all 
animal tissues. Chemically, cholesterol is an organic compound
 belonging to the steroid family; its molecular formula is C27H46O.
In its pure state it is a white, crystalline substance that is odourless and
tasteless.
Cholesterol is essential to life; it is a primary component of the
membrane that surrounds each cell, and it is the starting material or an
intermediate compound from which the body synthesizes bile acids,
steroid hormones, and vitamin D.
• High levels of cholesterol in the bloodstream are an extremely
important cause of atherosclerosis. In this disorder, deposits of
cholesterol and other fatty substances circulating in the blood
accumulate in the interior walls of the blood vessels. These fatty
deposits build up, thicken, and become calcified, eventually
converting the vessel walls to scar tissue. The deposits narrow the
channels of the blood vessels and thus can constrict the blood flow,
causing heart attacks and strokes. 
High-density lipoprotein cholesterol (HDL-C
)
—
• High-density lipoprotein cholesterol (HDL-C)—measures the
cholesterol in HDL particles; often called "good cholesterol" because
HDL-C takes up excess cholesterol and carries it to the liver for
removal.
Very low-density lipoprotein cholesterol (VL
DL-C)
—
• Very low-density lipoprotein cholesterol (VLDL-C)—calculated from
triglycerides/5; this formula is based on the typical composition of
VLDL particles.
• Non-HDL-C—calculated from total cholesterol minus HDL-C
• Cholesterol/HDL ratio—calculated ratio of total cholesterol to HDL-C
Low-density lipoprotein cholesterol (LDL-C)
—
• Low-density lipoprotein cholesterol (LDL-C)—calculates or measures
the cholesterol in LDL particles; often called "bad cholesterol"
because it deposits excess cholesterol in walls of blood vessels, which
can contribute to atherosclerosis. Usually, the amount of LDL-C is
calculated using the results of total cholesterol, HDL-C, and
triglycerides.
• Fried-wald equation for LDL calculation
• LDL=Total Cholestrol-HDL-Tg/5
 Near/Above
Test Optimal or Desirable Optimal Borderline High High Very High

LDL Cholesterol Less than 100 mg/dL 100-129 mg/dL 130-159 mg/dL 160-189 mg/dL Greater than
190 mg/dL

Total Cholesterol Less than 200 mg/dL (   200-239 mg/dL 240 mg/dL  

Fasting Triglycerides Less than 150 mg/dL   150-199 mg/dL 200-499 Greater than
500 mg/dL

Non-HDL Cholesterol Less than 130 mg/dL 130-159 160-189 mg/dL 190-219 mg/dL) Greater than
220 mg/dL
 Low Level, Increased Average Level, Average High Level, Less than
HDL Cholestero Risk Risk Average Risk
l

Women Less than 50 mg/dL 50-59 mg/dl 60 mg/dL

Men Less than 40 mg/dL 40-50 mg/dL 60 mg/dL

• Coronary artery disease (CAD), also known as coronary heart
disease (CHD), ischemic heart disease (IHD),[13] or simply heart disease, involves the
reduction of blood flow to the heart muscle due to build-up of plaque in the 
arteries of the heart
• It is the most common of the cardiovascular diseases.[Types include
• Stable angina
• Unstable angina
• Myocardial infarction, and 
• sudden cardiac death.
• A common symptom is chest pain or discomfort which may travel into the shoulder,
arm, back, neck, or jaw.
• Usually symptoms occur with exercise or emotional stress, last less than a few
minutes, and improve with rest.
• Shortness of breath may also occur and sometimes no symptoms are present.
• In many cases, the first sign is a heart attack
Risk Factors
• Risk factors fall into three broad categories:
• Major risk factors – Research has shown that these factors
significantly increase the risk of heart and blood vessel
(cardiovascular) disease.
• Modifiable risk factors – Some major risk factors can be modified,
treated or controlled through medications or lifestyle change.
• Contributing risk factors – These factors are associated with
increased risk of cardiovascular disease, but their significance and
prevalence haven’t yet been determined.
Major risk factors that can’t be changed

• Increasing Age
• The majority of people who die of coronary heart disease are 65 or older. While heart
attacks can strike people of both sexes in old age, women are at greater risk of dying
(within a few weeks).
• Male gender
• Men have a greater risk of heart attack than women do, and men have attacks earlier in
life.
• Even after women reach the age of menopause, when women’s death rate from heart
disease increases, women’s risk for heart attack is less than that for men.
• Heredity (including race)
• Children of parents with heart disease are more likely to develop heart disease
themselves.
Major risk factors you can modify, treat or control
• Tobacco smoke
• The risk that smokers will develop coronary heart disease is much higher than that
for nonsmokers.
• Cigarette smoking is a powerful independent risk factor for sudden cardiac death in
patients with coronary heart disease. Cigarette smoking also interacts with other risk
factors to greatly increase the risk for coronary heart disease. Exposure to other
people’s smoke increases the risk of heart disease even for nonsmokers.
• High blood cholesterol
• As your blood cholesterol rises, so does your risk of coronary heart disease. When
other risk factors (such as high blood pressure and tobacco smoke) are also present,
this risk increases even more. A person’s cholesterol level is also affected by age, sex,
heredity and diet
• High blood pressure
• High blood pressure increases the heart’s workload, causing the heart
muscle to thicken and become stiffer. This stiffening of the heart muscle is
not normal and causes the heart to function abnormally. It also increases
your risk of stroke, heart attack, kidney failure and congestive heart failure.
• When high blood pressure is present alongside obesity, smoking, high blood
cholesterol levels or diabetes, the risk of heart attack or stroke increases
even more.
• Physical inactivity
• An inactive lifestyle is a risk factor for coronary heart disease. Regular,
moderate to vigorous physical activity helps reduce the risk of
cardiovascular disease. Physical activity can help control blood cholesterol,
diabetes and obesity. It can also help to lower blood pressure in some
people.
• Obesity and being overweight
• People who have excess body fat – especially if a lot of it is at the waist – are
more likely to develop heart disease and stroke, even if those same people have
no other risk factors.
• Diabetes
• Diabetes seriously increases your risk of developing cardiovascular disease.
• Even when glucose levels are under control, diabetes increases the risk of heart
disease and stroke. The risks are even greater if blood sugar is not well-
controlled.
• At least 68 percent of people with diabetes over 65 years of age die of some
form of heart disease. Among that same group, 16 percent die of stroke.
Other factors that contribute to heart disease
risk
• Stress
• Individual response to stress may be a contributing factor for heart attacks.
• Some scientists have noted a relationship between coronary heart disease risk
and stress in a person’s life, along with their health behaviors and
socioeconomic status. These factors may affect established risk factors.
• Alcohol Consumption
• Drinking too much alcohol can raise blood pressure, and increase your risk for
cardiomyopathy, stroke, cancer and other diseases. It can also contribute to
high triglycerides, and produce irregular heartbeats. Additionally, excessive
alcohol consumption contributes to obesity, alcoholism, suicide and
accidents.
• Diet
• A healthy diet is one of the best weapons you have to fight cardiovascular
disease. What you eat (and how much) can affect other controllable risk
factors, such as cholesterol, blood pressure, diabetes and being
overweight.
• Choose nutrient-rich foods, which have vitamins, minerals, fiber and
other nutrients, but are lower in calories than nutrient-poor foods.
Choose a diet that emphasizes vegetables, fruits and whole grains. A
heart-healthy diet also includes low-fat dairy products, poultry, fish,
legumes, nuts and nontropical vegetable oils. Be sure to limit your intake
of sweets, sugar-sweetened beverages and red meats.
Diagnosis
• Baseline electrocardiography (ECG)
• Exercise ECG – Stress test-ETT (Exercise tolerance test)
• Exercise radioisotope test (nuclear stress test, myocardial scintigraphy
)
• Coronary angiography
• Intravascular ultrasound
• Magnetic resonance imaging (MRI)
• Biochemical Markers
Biochemical Markers of Myocardial
Infarction
• cardiac biomarkers ― include myoglobin, troponin and creatine
kinase. Historically, lactate dehydrogenase, or LDH, was also used but
is non-specific.
• Cardiac enzymes are released into the circulation when myocardial
necrosis occurs, as seen in myocardial infarction.
• Myoglobin
• Myoglobin is released into circulation with any damage to muscle
tissue, including myocardial necrosis. Because skeletal muscle
contains myoglobin, this measurement is quite nonspecific for MIs.
The benefit in myoglobin is that a detectable increase is seen only 30
minutes after injury occurs,
• Troponin
• The enzymes Troponin I (cTnI) and Troponin T (cTnt) are normal
proteins that are important in the contractile apparatus of the cardiac
myocyte.
• The proteins are released into the circulation between 2 and 4 hours
after myocardial infarction and remain detectable for 10-14 days
following. This long half-life allows for the late diagnosis of MI
• Troponin elevation is much more sensitive than myoglobin and even
creatine kinase.
• Creatine kinase (CK)
• Creatine kinase ― also known as creatine phosphokinase, or CPK ― is a
muscle enzyme that exists as isoenzymes. The Ck-MB type is specific to
myocardial cells,
• The CK level increases approximately 3 to 4 hours after MI and remains
elevated for 3 to 4 days.
• This makes it useful for detecting re-infarction in the window of 4 to 10
days after the initial insult; troponin remains elevated for 10 days,
making it less useful for this purpose.
Biochemical Marker of Heart Failure
• What is BNP (Beta-natriuritic Peptide)?
• BNP is a diuretic peptide that is stored in the myocytes of mammalian
hearts. It has important actions inducing down-regulation of the
sympathetic nervous system, natriuresis and diuresis, inhibition of the
renin-angiotensin system and decreasing the peripheral vascular
resistance
• BNP and proBNP are present in the circulation in normal physiological
states with values dependent on age, sex and the assay used for
measurement.
• BNP and NT-proBNP can be used in the diagnosis of heart failure in
ambulatory patients with dyspnoea as well as establishing the
severity or prognosis of patients with chronic heart failure or
congestive heart failure (CHF).
Metabolic syndrome
• Metabolic syndrome is a cluster of conditions that occur together,
increasing your risk of heart disease, stroke and type 2 diabetes.
These conditions include increased blood pressure, high blood sugar,
excess body fat around the waist, and abnormal cholesterol or
triglyceride levels.
Metabolic Risk Factors
• You must have at least three metabolic risk factors to be diagnosed
with metabolic syndrome.
• A large waistline. This also is called abdominal obesity or "having an
apple shape." Excess fat in the stomach area is a greater risk factor for
heart disease than excess fat in other parts of the body, such as on the
hips.
• A high triglyceride level
• A low HDL cholesterol level
• High blood pressure 
• High fasting sugar
•Question?
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