Dyslipidemia and it's management is such a topic that one single PPT is not enough to express all sorts of problems or scopes. This PPT will give you an overview on "Dyslipidemia and it's management"
Dyslipidemia and Management of Dyslipidemia | Muhammad-Nizam-Uddin
1.
2. A soft waxy substance found among lipids
(fats) in the bloodstream and all cells
Needed for digesting fats, making
hormones, building cell walls
Carried in particles called lipoproteins that
act as transport vehicles delivering
cholesterol to various body tissues to be
used, stored or excreted
Excess circulating cholesterol can lead to
plaque formation- Atherosclerosis
3.
4.
5. HMG Co-A reductase is the rate limiting
enzyme in the cholesterol synthesis.
Rate Limiting Enzyme
8. SINGLE OR MULTIPLE GENE MUTATION –
RESULTING IN DISTURBANCE OF LDL, HDL AND
TRIGYLCERIDE, PRODUCTION OR CLEARANCE.
Should be suspected in patients with
premature heart disease
family hx of atherosclerotic dx.
Or serum cholesterol level >240mg/dl.
Physical signs of hyperlipidemia.
21. LDL- (“bad” cholesterol) The major
cholesterol carrier in the blood. Excess
most likely to lead to plaque formation.
Goal: LOW
HDL- (“good” cholesterol) Transports
cholesterol away from arteries and back to
the liver to be eliminated. Removes excess
cholesterol from plaques, slowing growth.
Goal: HIGH
22.
23. LDL Cholesterol (mg/dl) HDL Cholesterol (mg/dl)
<100 Optimal < 40 Low
100-129 Near/Above Optimal > 60 High (Desirable)
130-159 Borderline High
160-189 High
>190 Very High
Categories of Risk that Modify LDL Goals
CHD and CHD risk equivalents <100
Multiple (2+) risk factors <130
Zero to one risk factor <160
24. Cigarette smoking
Hypertension (BP >140/90 or on BP med)
Low HDL cholesterol (<40mg/dl)
Family Hx premature CHD
- CHD in male 1st degree relative <55 years old
- CHD in female 1st degree relative <65 years old
Age (men >45 yrs. women >55 yrs)
HDL >60 counts as a “negative” risk factor. It’s presence removes one risk
factor from the total count
25. DM regarded as a CHD equivalent
For patients with multiple (2+) risk factors
-Perform 10 year risk assessment
For patients with 0-1 risk factor
-Most have 10 year risk assessment <10%;
risk assessment scoring unnecessary
27. Visit 1
Begin TLC
•Emphasize
reduction in
saturated fat
& chol.
•Encourage
moderate
Physical
activity
•Consider
referral to
dietician
Visit 2 (6 wks)
Eval. LDL response
Intensify Tx if not to
goal
•Reinforce dietary
recommendations
•Consider adding
plant stanols/sterols
•Increase fiber
intake
•Consider dietician
Visit 3 (6 wks)
Eval LDL response
Consider adding Rx
if not to goal
•Evaluate for
Metabolic syndrome
•Intensify wt mgmt &
physical activity
•Consider dietician
Visit N
Monitor
adherence to
TLC Q4-6
mos
28. Classification of Serum Triglycerides
Normal <150 mg/dl
Borderline High 150-199 mg/dl
High 200-499mg/dl
Very High >500 mg/dl
29. Management of Very High Triglycerides (>500 mg/dl)
Goal of therapy: Prevent acute pancreatitis
Very low fat diets (< 15% of caloric intake)
Triglyceride-lowering drug usually required (fibrate or
nicotinic acid)
Reduce triglycerides before lowering LDL
39. Reduce intake of saturated and trans-
unsaturated fat to less than 7-10% of total
energy
Reduce intake of cholesterol to < 250
mg/day
Replace sources of saturated fat and
cholesterol with alternative foods such as
lean meat, low-fat dairy products,
polyunsaturated spreads and low
glycaemic index carbohydrates
40. Reduce energy-dense foods such as fats
and soft drinks
Increase consumption of cardioprotective
and nutrient-dense foods such as
vegetables, unrefined carbohydrates, fish,
pulses, nuts, legumes, fruit etc.
Adjust alcohol consumption, reducing
intake if excessive or if associated with
hypertension, hypertriglyceridaemia or
central obesity
41. Achieve additional benefits with
supplementary intake of foods containing
lipid-lowering nutrients such as n-3 fatty
acids, dietary fibre and plant sterols.
42.
43.
44. Nutrient Recommended Intake
Saturated fat < 7% of total calories
Polyunsaturated fat Up to 10% of total calories
Monounsaturated fat Up to 20% of total calories
Total fat 25-30% of total calories
Carbohydrates 50-60% of total calories
Fiber 20-30 grams/day
Protein Approx. 15% of total calories
Cholesterol <200 mg/day
Total calories Balance energy intake and
expenditure to maintain
desirable body weight/prevent
weight gain
45. HMG-CoA Reductase Inhibitors (Statins)
Partially block an enzyme necessary for formation of
cholesterol
Speed removal of LDL from blood
18%-60% reduction in LDL
Most effective at lowering LDL; esp. HS dosing
Liver enzymes MUST be monitored. Check baseline,
3mos., then semi-annually (D/C if > 3x normal limits)
Side effects: Myalgias (D/C if total CK >10x normal),
rhabdomyolysis
Metabolized by CP450 (watch for drug interactions)
Contraindicated in pregnancy.
47. Bile Acid Sequestrants:
Cholestyramin , Cholestipol
Convert cholesterol to bile acids
Bind bile acids and prevent reabsorption in
the gut
May increase triglyceride levels
Most common side effects: GI-constipation
Alternative for statins
48. Cholesterol Absorption Inhibitor(Ezetimibea):
Monotherapy or in combination with statin
Not recommended with fibrates
Reduces LDL number : esp. Lp(a)
hepatic LDL receptor,Inhibit intestinal mucosa
transporter NPCILT.
Lipid-Regulating Agent: Omega 3 acid ethyl esters
Omega 3 Fish oil (salmon, herring, mackerel, swordfish,
albacore tuna, sardines, lake trout)
Only FDA approved supplement for tx of dyslipidemias
Decreases hepatic production of TG and VLDL
Increases LDL size to large buoyant particles
49. Nicotinic Acid/Niacin (B3)
Inhibition of lipolysis
Reduces production and release of LDL
Effective in reduction of triglycerides (<400mg/dl)
Increases HDL
Very effective in increasing LDL particle size
Monitor liver enzymes and glucose
Most common side effect: FLUSHING (take
ASA/ibuprofen 30 min. prior and take with light
snack). Decreased with time released formulas
Liver function disterbance
Exacerbation of gout and hyperglycemia.
50. Fibric Acid Derivatives/Fibrates
M/A: PPAR∞- stimulation metabolism of TG & LDL
Very effective in reducing triglycerides (>400)
Increase HDL
SIE: Myolgia,Myopathy,Abnormal LFT,Choleclithiasis
Containdications: Gallbladder disease, hepatic
disease, renal dysfunction
Increase LDL particle size but not quantity
Caution with statins
Gemfibrozil, Benza fibrates, feno fibrates.
51.
52. After 6 weeks ( 12 weeks for fibrates)
Parameter:
1. Lipid response
2. Side effects- CK, LFT
3. Others-a) Dietary compliance
b) Exercise
c) Cardiovascular signs and symptoms
d) Wt.
e) BP
53. Dyslipidemia(Silent killer)
Artherosclerosis MI,Stroke
At least 12 hrs fasting for the
measurement of lipid profile.
TLC-very important But usually ignored
Statin-(Commission is better than
omission)widely well tolerated
Other risk factors should be addressed
appropriately.