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O ALMIGHTY
Tallee ninnu dalanchi pustakamu
chaetan boonitin neevu naa
ullambanduna nilchi jrumbhanamugaan
uktul su sabdambul
sobhillan balkumu naadu vaakkunan
sampreetin, Jaganmohinee
pullaabjaakshee Saraswatee Bhagavatee
poornaendu bimbaanana
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O! Almighty, the Goddess of Wisdom!
We start this learning process, keeping
YOU in our inner hearts, please shower
Your kind blessings on all of us and ensure
What ever we speak is eloquent
What ever we discuss is pertinent
What ever we learn is relevant.
May we be blessed with the best wisdom !
O! ALMIGHTY
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Dr.Sarma RVSN, M.D., M.Sc (Canada)Consultant in Medicine and Chest,
# 3, Jayanagar, Tiruvallur 602 001
98940 60593, 2766 0593
Visit us at : www.drsarma.in
Dyslipidemias-Practice Approach
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CD ROM Available
The contents of my todays presentations
are made available in a CD-ROM format
This CD, in addition, contains my talks on
Asthma, COPD, Hypertension, ECG, CAD
Dyslipidemias, Diabetes, Osteoporosis
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The Almighty
Pardons and Grants me heaven
Even if I don't know a single letter about
Crutz Feld Jacobs Disease
Tsutsugamushi Fever
Criggler Nazzar Syndrome
South American equine encephalitis and
Many and much more rarer topicsBUT .
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The Almighty
Will drag me to hell and will not pardon
My ignorance of even the minute details of HT, DM
My indifference to apply the current knowledge
My negligence in screening for Lipids, DM, HT, LVH
My despondency about preventing TOD and ACS
My inadequacy in maintaining my patients
Normotensive, Euglycemic, Eulipidemic
(This is applicable to all common diseases)
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National Cholesterol
Education Program -NCEP
Adult Treatment Panel III(ATP III) Guidelines -2002
Updated October 2004
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The Good, Bad, Ugly and Deadly
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Two Types of Lipids
LIPIDS IN BLOOD
TOTAL CHOLESTEROL TRIGLYCERIDES (TG)
GOOD CHOLESTEROL
HDL 1 and HDL 2
BAD CHOLESTEROL
LDL, VLDL (TG), Lp(a)
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Lipoprotein
TG, EC
Phospholipids
Free Cholesterol
(Hydrophilic)
Apoproteins A,
B, C, E, (a)
(Amphiphatic)
Lipids or Fats
(Hydrophobic)Size < RBC
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Good, Bad, Ugly & Deadly
CTG
B 100 + E +C
CTG
B 100
CT
GA I, A II
HDL LDL
VLDL
CTG
B 100+ (a)
Lp(a)
TG
GOOD BAD
UGLY DEADLY
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All are the terrorists !!
Apolipoprotein B
Non-HDL-CMeasurements
TG-rich lipoproteins
VLDL VLDLR IDL LDL SDL
Highly atherogenic
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Particle size & Density
Chylomicrons
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LIPIDS ESTIMATED
TOTAL CHOLESTEROL (TC) TRIGLYCERIDES (TG)
HDLc LDLc VLDLc Chylomicrons VLDL
Lipid Profile Report
PP Fasting
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Normal Lipid Profile
Total Cholesterol < 200
TG Ugly Lipid < 150
Bad Cholesterols LDL < 100
HDL Good cholesterol > 50
VLDL is Ugly TG 5 < 30
Lp(a) Deadly cholesterol < 20
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How to interpret Lipid Profile Report?
A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 150
100150
50
200
20
30
Normal Lipid Profile
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Interpret this Lipid Profile Report
A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)
LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 150
140
190
50
240
20
30
Hyper cholesterolimia LDL, HDL, TG, Lp(a) - N
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A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 300
70150
50
200
20
60
Hyper triglyceridemia TG,HDL, LDL, Lp(a) - N
Interpret this Lipid Profile Report
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A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 150
85135
25
160
20
30
Low HDL :HDL,LDL, TG, Lp(a) - N
Interpret this Lipid Profile Report
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A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 150
75155
45
200
50
30
High Lipoprotein(a) :Lp(a),HDL, LDL, TG - N
Interpret this Lipid Profile Report
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A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 300
95175
25
200
20
60
High Lipoprotein(a) :HDL,TG, LDL, Lp(a) - N
Interpret this Lipid Profile Report
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Interpret this Lipid Profile Report
A. Total Cholesterol
HDL Cholesterol (Soldiers) - Good
Non HDL Cholesterol(Culprits)
LDL CholesterolBad fellows
Lipoprotein(a)Deadly fellows
VLDL Cholesterol (1/5 of TG)- Ugly
B. Triglycerides 250
120
210
50
260
40
50
Combined Dyslipidemia : TCLDLTG Lp(a)
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Dyslipidemic Triad
A. Isolated High LDL 32.90%
B. Isolated low HDL 21.35%
C. Isolated high TG 10.45%
IHJ, 2000, 52: 173-177
Am J Med, 1998, vol 105(1A), 48S-56S
LDL
HDL
TG
The Triad
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Indian Dyslipidemic Triad
IHJ, 2000, 52: 173-177
Am J Med, 1998, vol 105(1A), 48S-56S
Lp(a)
HDL
TG
The Indian Triad
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Indian Dyslipidemia
Low HDL 39.2%
High TG 32.5%
Lp(a) excess 28.6%
High LDL 10.8%
Normal Lipids 23.5%
Am J C 2001;88(suppl) 9N-13N; 22N
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Look at the risks
Low HDL + High LDL +
LP(a) excess > 30 mg% +
LP(a) excess > 30 mg% + LDL high ++
LP(a) excess > 30 mg% + low HDL +++
LP(a) excess > 30 mg% + Incr. tHCy ++++
LP(a) excess + Incr. tHCy + low HDL +++++
Circulating lipidsare one aspects Tissue lipidcontent is more important
J. Atherosclerosis : Hopkins PN, 199717, 2792
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Intestinal Cholesterol Absorption
Bays H et al. Expert Opin Pharmacother 2003;4:779-790.
Intestinal
epithelial cell
Biliary
cholesterol
Dietary
cholesterol
Luminal
cholesterol
Micellar
cholesterol
Bile
acid
Cholesteryl esters
Freecholesterol
excretion
uptake
ACAT
ABCG5ABCG8
(esterification)
MTP
CM
Throughlymphatic
system to
the liver
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Lymph Enterocyte IntestinalLumen
Cholesterol Absorption
Cholesterol
NPC1L1
CholesterylEster ABCG5/G8
ACAT
Ezetimibe
Avasimibe
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Lymph Enterocyte IntestinalLumen
Triglyceride Absorption
2 Fatty Acid
+Monoglyceride
DGAT
Triglyceride
www drsarma in
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CE
A-I
CE
A-I
CE
A-II A-II
HDL 1 HDL 2 HDL 3
APO A IAtheroprotective
Alcohol increasesAthero-neutral
The soldiers
The soldier-like
HDL Sub types
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LIVER
Reverse Cholesterol Transport
MF in Vascular
Endothelium
Free Chol.
L CAT
Enzyme
UECEC
HDL
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HDL Metabolism and
Reverse Cholesterol Transport
Liver
ABC1 = ATP-binding cassette protein 1; A-I = apolipoprotein A-I;
CE = cholesteryl ester; FC = free cholesterol;
LCAT = lecithin:cholesterol acyltransferase;
SR-BI = scavenger receptor class BI
Mature HDL
CE
A-I
CE
CEFCFC
LCATFC
Bile
SR-BI
A-I
ABC1
MacrophageNascent
HDL
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B
SRA
Mature HDL
Role of CETP in HDL Metabolism
A-I
Liver
CE
CEFC
FC
LCATFC
Bile
SR-BI
A-I
ABC1
Macrophage
CE
CETP = cholesteryl ester transfer protein
LDL = low-density lipoprotein
LDLR = low-density lipoprotein receptor
VLDL = very-low-density lipoprotein
LDLR
VLDL/LDL
CETP
Nascent HDL
CE
Torcitrapib
X
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Hyperlipidemias
Secondary 95%
Primary 5%
Familial & genetic
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Clinical Action
Presence of secondary causesof Hyperlipidemia Order for full lipid profile (LP)HT also
Presence of hyperlipidemiaincreased TG or EC
Investigate for all secondary causes For all above 20 years once in every 5 years
For those above 45 yrsonce in 2 years
For those with already known lipid abnormality
follow-up every 3-6 months Extended Lipid profile includes Homocysteine,
LP(a), SD-LDL, ALP, Apo A and Apo B, hS-CRP
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Clinical Photoes
Tuberous xanthoma.
Flat-topped, yellow, firm tumor
Xanthelasma. Multiple, longitudinal, creamy-
orange, slightly elevated papules on eyelids .
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Clinical Photoes
Tendinous xanthomas. Large sub-cutaneous tumors adherent to the
Achilles tendons.Papular eruptive xanthomas. Multiple,
discrete, red-to-yellow confluent papules
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Evaluation
1. History of eruptive xanthomas, Abd. pain
2. H/o wt. gain, DM, estrogens, Alcohol, Ex.
3. Fasting Lipid profile (TC, LDL, HDL, TG)
4. OGTT, TSH, Liver & Renal Function tests
5. CHD assessment by ECG, TMT, Angio
6. Risk factor assessment, Family H/o P.CHD
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The Weapons in our hand
Dietand Exercise (Life Style)
Drug therapy
1. HMGCo A Reductase Inhibitors
2. Fibric Acid derivatives
3. Nicotinic Acid
4. Ezetimibe
5. Bile Acid binding Resins (BAR)
6. Probucol
HMG is Hydroxy Methyl Glutaryl
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New Treatments
Drug therapy
1. Colesevelam (BAR)
2. Phytosterols
3. AvasimibeACAT inhibitor
4. TorcetrapibCETP inhibitor
5. Drugs decreasing Apo B synthesis6. Selective LDL apopheresis
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Therapeutic Lifestyle Changes - TLC
Nutrient Recommended Intake
Saturated fat < 7% of calories
PUFA fat Up to 10% of calories
MUFA fat Up to 20% of calories Total fat 2535% of calories
Carbohydrate 5060% of calories
Fiber 2030 grams per day Protein Approx. 15% of calories
Cholesterol Less than 200 mg/day
DIETARY THERAPY
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Our dietary fats
SFA (saturated)meet and diary products,
coconut oil, Kernel, Ghee, Butter, Palm oil,
Trans fatty acids in vanaspati, chocolates
confectionaries, baked, deep fat fried food
MUFA (N1)Olive oil, Gingili oil
PUFA (N6)Soya, Sun Flower oil, GN oil
PUFA (N3)Fish oilsTwice a wk 76% CAD
Legumes, fruits, olive oil all cause mortality
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Treatment of LDLc
High LDLc
Therapeutic Lifestyle Change
Add on drug - EZ , Niacin, BAR
Therapy of Choice: Statin
Drug Therapy
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StatinsMechanism of Action
1. Reduce hepatic cholesterol synthesis (HMG CoA),
2. lowering intracellular cholesterol,
3. Upregulation of LDL receptor and
4. the uptake of non-HDL from circulation.
LDL receptormediated
hepatic uptake of LDL
and VLDL remnants
Serum VLDL remnants
Serum LDL-C
Cholesterol
synthesisLDL receptor
(BE receptor)
synthesisIntracellular
Cholesterol
Apo B
Apo E
Apo B
Systemic CirculationHepatocyte
LDL
Serum IDL
VLDLR
VLDL
HMGCoA
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Time course of Statin effects
* Time course establishedDays Years
LDL-Clowered*
Inflammationreduced
Vulnerable
plaquesstabilized
Endothelial
functionrestored
Ischemic
episodesreduced
Cardiac events
reduced*
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HMG C A R d
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HMG CoA Reductase
Inhibitors (Statins)
Statin Dose Range
Lovastatin 2080 mg
Pravastatin 2040 mg
Fluvastatin 2080 mg
Simvastatin 2080 mg
Atorvastatin 1080 mg
Rosuvastatin 520 mg
Cerivastatin 0.40.8 mg
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Atorvastatin211 mg/dl*
Simvastatin
219 mg/dl*
-60%
-50%
-40%
-30%
-20%
-10%
0%
LDL-C Lowering - Statin Dose
Adapted from Jones P et al.Am J Cardiol1998;81:582-587.
Daily Dose
10 mg
20 mg
40 mg
80 mg16% with
3 Titrations
13%
38%
46%
51%
54%
28%
35%
41%
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HMG CoA Reductase Inhibitors (Statins)
Common side effects
Headache, Myalgia, Fatigue, GI intol. Flu-like symptoms
Increase in liver enzymesserious problems are very rare
Occurs in 0.5 to 2.5% of cases in dose-dependent manner
Myopathy occurs in 0.2 to 0.4% of patients Rare cases of Rhabdomyolysis
We can reduce this risk by
Cautiously using statins in impaired renal function
Using the lowest effective dose
Cautiously combining statins with fibrates
Muscle toxicity requires the discontinuation of statin
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Short falls of Statins
Effectiveness and community impact are to be improved
Rebound increase in lipids and of events after
withdrawal of statin Rx.
High rate of discontinuation by patients
Differences in the efficacy of different statins
They reduce only endogenous lipidsIndividual variation
Modest effect on TG and HDL, No effect on Lp(a)
No effect on chylomicrons; escape phenomenon
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Lymph Enterocyte IntestinalLumen
Ezetimibe
Cholesterol
NPC1L1
CholesterylEster ABCG5/G8
ACAT
Ezetimibe
X
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Dual Inhibition
Duodenum
Jejunum
Ileum
CM
apoB48
Liver
CMRemnantapoB48
VLDLapoB100
EzetimibeX
LDLapoB100
XStatin
Colon
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Ezetimibe Efficacy (10 + 10 = 80)
Ballantyne CM et al. Circulation 2003;107:2409-2415.
Atorvastatin
40 mg
(n=66)
20 mg
(n=60)
10 mg
(n=60)
53%
37%42%
45%
54%
P < 0.01
80 mg
(n=62)
-60%
-50%
-40%
-30%
-20%
-10%
0%
Ezt + Ator
10+10 mg(n=65)
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Bile Acid Resins: Mechanism of Action
Net Effect - LDL-C
Gall Bladder
LDL Receptors
VLDL and LDL removal
Cholesterol 7- hydroxylaseConversion of cholesterol to BA
BA Secretion
Liver
BA Excretion
Terminal Ileum
Bile Acid
Enterohepatic Recirculation
Reabsorption of
bile acids
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Bile Acid Resins (BAR)
Major actions Reduce LDLc by 1530%
Raise HDLc by 35%
May increase TG
Side effects GI distress / constipation / nausea
Decreased absorption of other drugs
Contra indications
Dysbetalipoproteinemia,
Biliary Obstruction
Raised TG (especially >400 mg/dL)
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Bile Acid Resins
Drug Dose Range
Cholestyramine 416 g
Colestipol 520 g
Colesevelam 2.63.8 g
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T f HDL
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Treatment of HDLc
Low HDLc
Therapeutic Lifestyle Change
Add on drug - Finofibrate
Therapy of Choice : Niacin
Drug Therapy
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C f L HDL
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Causes of Low HDLSmoking
Obesity (visceral fat), Physical inactivity
Very high Carbohydrate diet
Type II Diabetes
Hyper-triglyceridemia
Drugs like beta-blockers, androgenic steroids
and androgenic progestins
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Nicotinic AcidMechanism of Action
Liver CirculationHDL
Serum VLDL
results in reduced
lipolysis to LDL
Serum LDL
VLDL
Decreases hepatic production of VLDL and of apo B
VLDLsecretion
Apo B
Hepatocyte Systemic Circulation
Mobilization of FFA
TG
synthesis
VLDL
LDL
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Eff f Ni i Li i
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Effect of Niacin on Lipoproteins
Adapted from Knopp RH. N Engl J Med 1999;341:498-511..
0 1 g / d 2 g / d 3 g / d
Baseline
-15%
12.5%
25%
-30%
HDL-C with Niaspan
TG with Niaspan
TG with crystalline niacin
LDL-C with Niaspan
LDL-C with crystalline niacin
35%HDL-C with crystalline niacin
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Ni ti i A id
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Nicotinic Acid Products available
Immediate-release, 24 g/d, Sustained Release 3 g /d Extended-release (Niaspan) 12 g/d
Best agent to raise HDL-C
Reduces coronary events
Adverse effects
Flushing, itching, headache (immediate-release, Niaspan)
Hepatotoxicity, GI (sustained-release)
Activation of peptic ulcer
Hyperglycemia and reduced insulin sensitivity
Contraindications
Active liver disease or unexplained LFT elevations
Peptic ulcer disease
Coronary heart disease and HDL C
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Coronary heart disease and HDL-C
Framingham Heart Study
Gordon, Castelli et al. Am J Med 1977; 62: 707714
0
50
100
150
200
Rate/
1000
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Relative risks of MI
3.21
3.78
1.00
2.41Low HDL cholesterol
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HDL-C vs LDL-C
as a predictor of CHD risk
*Men aged 5070 Gordon, Castelli et al. Am J Med 1977; 62: 707714
100 mg/dl 160 mg/dl 220 mg/dl0
0.5
1
1.5
2
2.5
3
Risk of CAD over 4
years of follow-up*
LDL-C
85 mg/dl
65 mg/dl
45 mg/dl
25 mg/dl
CHD RR
HDL-C
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T f TG
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Treatment of TG
High TG
Therapeutic Lifestyle Change
Add on drugStatin, Niacin
Therapy of Choice : Fibrate
Drug Therapy
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Triglycerides
TG Level Classification Treatment
< 150 mg% Normal TG No Rx.
150 to 200 mg% Borderline high Diet alone
201 to 500 mg% High Diet + drugs
> 500 mg% Very high Diet + Intensive Rx
NCEP 2004 Guidelines by expert panel on TG
F fib t
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Fenofibrate
Mode of Action Enhances the activity of lipoprotein lipase
Reduces hepatic fatty acid synthesis
Inhibits HMG co-enzyme A reductase activity
Reduces the CETP activity
Increases the LCAT activity Increases the production of Apo AI and Apo A II
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Fibric Acid Derivatives
Major actions
Lower TG 2050%,VLDL synthesis
Raise HDL-C 1020%
LDL (TG is N), LDL (TG is ) Increase the SDL particle size (less athero)
Side effects
Dyspepsia, gallstones, myopathy, Abn. LFT Contraindications
Severe renal or hepatic / biliary disease
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Fibric Acid Derivatives
Drug Dose
Clofibrate 1000 mg BID
Bezafibrate 200 mg BIDGemfibrozil 600 mg BID
Fenofibrate 200 mg OD
Fenofibrate micronized 160 mg OD
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Treatment of LDL + TG
Combined
Therapeutic Lifestyle Change
Add on drugNiacin, BAR
Therapy of Choice : Statin + Fibrate
Drug Therapy
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Da Col PG et al. Curr Ther Res Clin Exp 1973;53:473-482.
Statin + Fibrate
-60
-50
-40
-30
-20
-10
0
10
20
30
Simva +
Gemfibrozil
50%
39%
16%22%
41%
28%
Ator or Simva +
Fenofibrate
230 332
38
191166
LDLTG
HDL
LDL
TG
HDL
PercentChange
34
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Statin + FibratePrecautions
Use statin alone for non-HDL-C goals
Use fish oils or niacin rather than fibrates
Keep the doses of the statin and fibrate low
Dose the fibrate in the AM and the statin in the PM
Avoid (or cautiously use) combo in renal impairment
Teach the patient to recognize muscle symptoms
Discontinue therapy if muscle symptoms are present
and CK is >10 times the upper limit of normal
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Probucol
1. Probucol (Lorelco) 500mg b.i.d with food
2. Third line drugerratic effect on LDL & HDL
3. Lowers Cholesterol and the only drug which
regresses xanthomas
4. It is an antioxidant of LDL
5. Diarrohea, flatulence, nausea, increases QTc
6. Can be combined with BAR
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The Three Canons
LDL - STATIN
DYSLIPIDEMIA
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How do we treat ?
Increased LDL Statins +/- EZ
Increased TG Fibrates
Decreased HDL Niacin
Increased Lp(a) Niacin
Increased LDL + TG Statin + Fibrate
LDL + HDL Statin + Niacin TG + HDL Fibrate + Niacin
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Summary of Drug choice
Lipid abnormality type First choice Additional Remarks
LDL Statin Ezetimibe Myopathy
TG Fibrate Niacin CHO intake
HDL Niacin Fibrate Exercise
LDL + TG Statin + Fibrate Niacin Myo risk
LDL + HDL Statin + Niacin Fibrate Exercise
TG + HDL Fibrate + Niacin Statin Exercise
LDL + TG + HDL Statin + Fibrate E, N, BA, FO Myo risk
Atherogenecity of small dense LDL
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Atherogenecity of small, dense LDL
SDL is highly atherogenic. It
Generates free radicals
Increases trans endothelial filtration
Increases susceptibility to oxidation
Reduces affinity for the LDL receptor
Increased binding to intimal proteoglycan
Formation of pro-aggregators / vasoconstrictors
Impaired in vivo ED independent of HDL, LDL, TG
Circulation, 2000, 102: 716-721
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Lp(a) or Littlea
Similar to LDL molecule
Apo B + additional Apo a attached by S=S bond
Primary determinant is genetic
Normal value 20 mg%, > 30 high risk
It competes with plasminogen because of its
structural similarity and so interferes with
plasmin synthesis and thrombolytic pathway
Nicotinic acid, ? Bezafibrate, Estrogens it
Phenotype B or ALP
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This ALP or phenotype B is present andseen in most often
Insulin resistant individuals
Diabetics Obese persons
Sedentary life style
More prevalent in India
Apo A I Apo B will be < 1
Phenotype B or ALP
Cumulative Distribution of TG Levels
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0
10
20
30
40
50
60
70
80
90
100
20 40 60 80 100120 140160180200 220240 260280 300 500
Phenotype A
Phenotype B
% Cumulative
frequency
TG (mg/dL)
Phenotypes A and B
Austin M et al. Circulation. 1990;82:495-506.
Cumulative Distribution of HDL levels
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20 25 30 35 40 45 50 55 60 65 70 75 80
Phenotype A
Phenotype B
% Cumulativefrequency
HDL-C (mg/dL)
10090
80
70
60
50
40
30
20
Phenotypes A and B
Austin M et al. Circulation. 1990;82:495-506.
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Homocysteine
Normal value is up to 10 mols./L
Folic acid, Vitamin B6and B12are essential for
the normal transulfuration and remethylation
cycles Excess of homocystine generates oxidative
stress on the cell membranes. DNA and protein
denaturation through ROS formation Folic acid 5 mg/ day+ Vit. B6and B12are to be
given on regular basis
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Summary of Drug choice
Lipid abnormality type Advised Rx. Remarks
Homocysteine Folic acid B6+ B12helps
Small dense LDL Statin + Fibrate Aggressive Rx.
Little a or LP(a) Niacin Statin no effect
Phenotype B Under research DM, Obesity
in Phenotype A Under research Aerobic exercise
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Atherosclerosis and IR and DM
Hypertension
Obesity
Hyperinsulinemia
Diabetes
Hypertriglyceridemia
Small, dense LDL
Low HDL
Hypercoagulability
Insulin
ResistanceAtherosclerosis
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Elevated TG
Elevated VLDL
Reduced HDL-C Increase in SD-LDL
Decrease in Apo A I
Increase in Apo B
Ratio of Apo B / Apo 1 > 2
Dyslipidemia in IR and DM
All Diabetics must be given STATIN
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Diabetes Treatment and Lipids
Type Rx used Effect on lipids
1. Insulin Favourable
2. Metformin Mildly favourable
3. Sulfonylureas Not favourable
4. Glitazones Favourable
5. Acarbose No effect
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Hypertension Treatment and Lipids
Type Rx used Effect on lipids
1. Diuretics Unfavourable
2. Indapamide Mildly favourable
3. ACEi and ARB Very favourable
4. Betablockers Unfavourable
5. Ca channel blockers No effect
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Web Resources on Lipids
www.lipidsonline.org
www.hypertensiononline.org
www.ncbi.nlm.nih.gov
www.univbaylore.org
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Announcements
1.Purpose, Men behind
2.Our emphasis and topics
3.Frequency, timings4.Very informal - Interactive
5.Funds, sponsors, venues
6.Let us know you correctly
7.Feed back, make friends
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CD ROM Available
The contents of my todays presentations
are made available in a CD-ROM format
This CD, in addition, contains my talks on
Asthma, COPD, Hypertension, ECG, CAD
Dyslipidemias, Diabetes, Osteoporosis
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Visit us at: www.drsarma.in
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It is time for
Coffee Break