Summary
Disorders of lipoprotein metabolism-dyslipoproteinemias-can be classified based on the primary biochemical disturbance, such as high or low plasma levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, or triglyceride (TG), or some combination of these. Lipoproteins are physiological transporters of hydrophobic lipids and fat-soluble vitamins through plasma from their site of origin (intestine or liver) to their site of uptake and disposition. Abnormal levels of certain plasma lipids and lipoproteins increase the risk of cardiovascular disease (CVD) end points, such as myocardial infarction and stroke, and other complications such as pancreatitis. Numerous genetic and environmental factors contribute to inter-individual variation in plasma concentrations of lipids and lipoproteins. Disorders with a monogenic basis typically present earlier in life, while those that present later in life also have genetic, mainly polygenic, determinants, but their expression further depends on interactions with nongenetic environmental or lifestyle factors. Early diagnosis is central to specific dietary, lifestyle, and pharmacological interventions to delay death, disability, and medical complications. For example, to prevent premature CVD in heterozygous familial hypercholesterolemia, it is important to screen subjects at risk, make the appropriate diagnosis (which may include DNA analysis), and initiate treatment, which includes diet, exercise, and lipid-lowering medications. Here we describe the current understanding of genetic determinants, clinical manifestations, and treatment of disorders of lipoprotein metabolism, focusing on defined monogenic disorders that are diagnosed throughout the lifespan.
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References
Anderson TJ, Gregoire J, Pearson GJ, et al. Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2016;32(11):1263–82.
Berberich AJ, Hegele RA. The role of genetic testing in dyslipidaemia. Pathology. 2019;51(2):184–92.
Brahm AJ, Hegele RA. Chylomicronaemia—current diagnosis and future therapies. Nat Rev Endocrinol. 2015;11(6):352–62.
Brunham LR, Ruel I, Aljenedil S, et al. Canadian Cardiovascular Society position statement on familial hypercholesterolemia: update 2018. Can J Cardiol. 2018;34(12):1553–63.
Burnett JR, Hooper AJ, Hegele RA. Abetalipoproteinemia. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A, editors. GeneReviews® [Internet]. Seattle, WA: University of Washington, Seattle; 2018 Oct 25.
Catapano AL, Graham I, De Backer G, et al. ESC/EAS guidelines for the management of dyslipidaemias: the task force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) developed with the special contribution of the European Association for Cardiovascular Prevention & rehabilitation (EACPR). Atherosclerosis. 2016;253:281–344.
Cuchel M, Bruckert E, Ginsberg HN, et al. Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society. Eur Heart J. 2014;35(32):2146–57.
Defesche JC, Gidding SS, Harada-Shiba M, Hegele RA, Santos RD, Wierzbicki AS. Familial hypercholesterolaemia. Nat Rev Dis Primers. 2017;3:17093.
Grundy SM, Stone NJ, Bailey AL, et al.. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082–e1143.
Hegele RA, Ban MR, Cao H, McIntyre AD, Robinson JF, Wang J. Targeted next-generation sequencing in monogenic dyslipidemias. Curr Opin Lipidol. 2015;26(2):103–13.
Hooper AJ, Bell DA, Hegele RA, Burnett JR. Clinical utility gene card for: Sitosterolaemia. Eur J Hum Genet. 2017a;25:4.
Hooper AJ, McCormick SPA, Hegele RA, Burnett JR. Clinical utility gene card for: Tangier disease. Eur J Hum Genet. 2017b;25:7.
Lee J, Hegele RA. Abetalipoproteinemia and homozygous hypobetalipoproteinemia: a framework for diagnosis and management. J Inherit Metab Dis. 2014;37(3):333–9.
Levy E, Poinsot P, Spahis S. Chylomicron retention disease: genetics, biochemistry, and clinical spectrum. Curr Opin Lipidol. 2019;30(2):134–9.
Ng DM, Burnett JR, Bell DA, Hegele RA, Hooper AJ. Update on the diagnosis, treatment and management of rare genetic lipid disorders. Pathology. 2019;51(2):193–201.
Peretti N, Sassolas A, Roy CC, et al. Guidelines for the diagnosis and management of chylomicron retention disease based on a review of the literature and the experience of two centers. Orphanet J Rare Dis. 2010;5:24.
Raal FJ, Hovingh GK, Catapano AL. Familial hypercholesterolemia treatments: guidelines and new therapies. Atherosclerosis. 2018;277:483–92.
Rader DJ, deGoma EM. Approach to the patient with extremely low HDL-cholesterol. J Clin Endocrinol Metab. 2012;97(10):3399–407.
Stroes E, Moulin P, Parhofer KG, Rebours V, Löhr JM, Averna M. Diagnostic algorithm for familial chylomicronemia syndrome. Atheroscler Suppl. 2017;23:1–7.
Wiegman A, Gidding SS, Watts GF, et al. Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. Eur Heart J. 2015;36(36):2425–37.
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Hooper, A.J., Hegele, R.A., Burnett, J.R. (2022). Disorders of Lipoprotein Metabolism. In: Blau, N., Dionisi Vici, C., Ferreira, C.R., Vianey-Saban, C., van Karnebeek, C.D.M. (eds) Physician's Guide to the Diagnosis, Treatment, and Follow-Up of Inherited Metabolic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-67727-5_53
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