Table Of Contents

Overview of Lipids

Watch ▶Dyslipidemias: Pathology review

LDL (Low-Density Lipoprotein)

• Elevated levels are atherogenic (promote atherosclerosis).

HDL (High-Density Lipoprotein)

• Anti-atherogenic (protective against atherosclerosis).

Triglycerides

• At very high levels (> 1000 mg/dL), associated with pancreatitis.
• Generally, no clear association with atherosclerosis.

Clinical Manifestations

Generally asymptomatic unless very high levels are present.

• Possible manifestations include

  • Xanthomas

    • plaques or nodules composed of lipid-laden histiocytes in the skin [A], especially on the eyelids (xanthelasma [B]).

  • Tendinous Xanthoma

    • Lipid deposits in tendons [C], especially the Achilles tendon and finger extensors.

  • Corneal Arcus

    • Lipid deposits in the cornea.
    • Common in older adults (arcus senilis [D]), but appears earlier in life with hypercholesterolemia.

    

• Eruptive Xanthomas

• Xanthelasma

Types of Xanthomas

Triglyceride-Induced Pancreatitis

Risk

• Triglyceride levels (mg/dL)
  • <500 → minimal risk
  • 500-999 → mild risk
  • 1,000-1,999 → moderate risk
  • ≥2,000 → high risk
• Other risk factors
  • Pregnancy
  • Alcoholism
  • Obesity
  • Uncontrolled diabetes

Clinical Features

• Acute epigastric pain radiating to back