Veterinary Medicine - September 2007 - (Page 595)

Hyperlipidemia O P E E R - R E V I E W E D hyperlipidemia in dogs and cats are presented in Table 5. Tests for secondary hyperlipidemia Once hyperlipidemia is confirmed and recognizing that lipemia is usually secondary, additional testing aimed at identifying the primary cause is recommended. Additional testing (including a complete blood count, serum chemistry profile, and urinalysis) may include a low-dose dexamethasone suppression test, thyroid function testing (serum T4 and thyroid-stimulating hormone concentrations), and serum pancreatic lipase immunoreactivity. creased or absent lipoprotein lipase activity.1 Molecular polymerase chain reaction analysis is available for lipoprotein lipase deficiency in cats with hyperchylomicronemia.16 ESSENTIAL ELEMENT The treatment Treatment of secondary hyperlipidemia involves treating the underlying disease. Primary hyperlipidemia may require feeding a low-fat diet or administering lipidlowering agents such as omega-3 fatty acids, niacin, gemfibrozil, lovastatin, or cholestyramine. TREATMENT Treatment options for hyperlipidemia include treatment of inciting diseases, diet modification, and pharmacologic intervention. The importance of testing for inciting causes of hyperlipidemia cannot be overemphasized. Hyperlipidemia secondary to an underlying disorder will probably resolve or improve after the metabolic disturbance is corrected. Tests for primary hyperlipidemia If secondary hyperlipidemia is ruled out, primary hyperlipidemia is likely, and additional testing may include lipoprotein electrophoresis and lipoprotein lipase activity. However, lipoprotein electrophoresis has limited value in the clinical evaluation of lipid disorders in dogs and cats because validation of lipoprotein classes by electrophoresis is incomplete.2 Furthermore, it is unlikely that electrophoretic patterns are disease-specific.2 The absence or decreased activity of lipoprotein lipase can be evaluated by determining the plasma activity of this enzyme. Indirect activity can be determined by collecting serum samples both before and 15 minutes after an intravenous injection of heparin (90 IU/kg) in dogs. 1 In cats, samples should be collected before and 10 minutes after an intravenous injection of heparin (45 IU/kg).1 Heparin causes lipoprotein lipase release from vascular endothelium, stimulating the hydrolysis of chylomicrons and VLDLs.7 Cholesterol and triglyceride concentrations are measured in pre- and postheparin samples. A post-heparin decrease in triglyceride and cholesterol concentrations confirms lipoprotein lipase activity. Similar pre- and postheparin triglyceride and cholesterol concentrations are compatible with de- Hypertriglyceridemia In cases of familial or idiopathic hyperlipidemia with elevated triglyceride concentrations, combined dietary and pharmacologic intervention may be necessary. We recommend treating patients with moderate to severe hyperlipidemia. Dogs that require cataract surgery (diabetic patients) should ideally have a fasted triglyceride concentration 500 mg/dl aggressively before cataract surgery. The goal of therapy is not to reduce triglyceride and cholesterol concentrations to the normal range. Instead, triglyceride and cholesterol concentrations should be reduced so that clinical signs are ameliorated while avoiding drug-induced side effects. Dietary modification. In some patients, switching the patient to a low-fat diet may be the only therapy needed. It is generally recommended that diets should contain less than 20% fat on a metabolizable energy basis for dogs and less than 25% for cats (Table 6).3,17 However, obtaining a good diet history to estimate the level of consumed fat is important before deciding the degree of fat restriction. The patient should be fed a diet with a fat level lower than the previous diet. Treats should be reTABLE 5 Classification of Hyperlipidemia in Dogs and Cats* Classification Dogs Mild Moderate Severe Cats Mild Moderate Severe 950 650 1,000 750 Triglyceride concentration (mg/dl) Cholesterol concentration (mg/dl) *Source: Whitney MS. Evaluation of hyperlipidemias in dogs and cats. Semin Vet Med Surg (Small Anim) 1992;7:292-300. VETERINARY MEDICINE September 2007 595

Table of Contents Feed for the Digital Edition of Veterinary Medicine - September 2007

Contents Letters Leading Off The Veterinary Medicine Interview: Dr. William J. Kay Idea Exchange Practical Matters Salivary Mucoceles in Cates: A Retropspective Study of Seven Cases Hyperlipidemia in Dogs and Cats Purina Insert The Latest Management Recommendations for Cats and Dogs with Nonketotic Diabetes Mellitus CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2007

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