8. ⢠Elevated total TG
⢠Reduced HDL
⢠Small, dense LDL
⢠â HDL 3 and â HDL1 and HDL 2
⢠LDL is not usually high
⢠Postprandial Hyper lipemia
8
16. ⢠Accumulation of chylomicron remnants
⢠Accumulation of VLDL remnants
⢠Generation of small, dense LDL
⢠Association with low HDL
⢠Increased coagulability
â˘ ďĄ PAI-1, and ďĄ factor VIIc
⢠Activation of prothrombin to thrombin
16
17. ⢠Increased susceptibility to oxidation
⢠Increased vascular permeability
⢠Conformational change in Apo B
⢠â Affinity for LDL receptor (â clearance)
⢠Association with insulin resistance syndrome
⢠Association with high TG and low HDL
17
Austin MA et al. Curr Opin Lipidol 1996;7:167-171.
18. ď¨ 1) Plays an important role
ď¨ 2) Has no role
ď¨ 3) Unsure
ď¨ 4) Is only a tie breaker for people with
intermediate risk
19. 1.00
0.99
0.98
0.97
0.96
0.00
0 2 4 6 8
Years of Follow-up
CRP AND LDL IN THE WOMENâS HEALTH
SURVEY
Ridker PM et al, N Engl J Med. 2002;347:1157-1165.
Probability
of
Event-free
Survival
Median LDL 124 mg/dl
Median CRP 1.5mg/l
low CRP â low LDL
high CRP â high LDL
low CRP â high LDL
high CRP â low LDL
CRP and
LDL interact
in risk
generation
28. ď¨ Total CHO to be reduced < 50% of calories
ď¨ Saturated fat must reduced to< 7% of calories
ď¨ MUFA and PUFA up to 15% of calories
ď¨ Protein in take to be increased â 25% of cal.
ď¨ Dietary fiber > 20 g/day -Soy protein,
Fenugreek
ď¨ Vegetables, Nuts and fruits must every day
28
29. ďś If all lipid values are normal
1. Lifestyle interventions (TLC)
MNT, Physical Activity, Weight and Waist reduction
2. Statin in a minimum dose of 10 mg o.d
3. Follow up every one year by full lipid profile
4. All Indians must be tested for LP(a) and
If > 30 mg% - Niacin SR 350 to 500 mg started
29
30. ďś LDL cholesterol lowering â First priority
1. Lifestyle interventions (TLC)
2. Drugs - First choice â Statin with or without
3. Cholesterol absorption inhibitors (EZ)
4. Second choice â Niacin and Fibrate
5. Add on â BAR (Bile acid binding resins)
30
31. 31
ďś HDL cholesterol raising â Second priority
1. Lifestyle interventions
2. First choice - Niacin ( doses <2 g/day)
3. Preferably short acting Niacin
4. Fibrates are second choice
32. 32
ďś Triglyceride lowering â Third priority
1. First choice: Lifestyle interventions
2. Glycemic control is the best Rx for âTG
3. Fibrates
4. Niacin
5. High dose statins (if LDL is also high )
33. Drug Rx. â Effect on Lipoproteins
Pharmacological Agents LDL HDL TG
Statins (HMG CoA Reductase In) ď ď ďą ď ďą ď
Fibrates (PPAR- Îł Activators) ď ďą ď ď ď
BAR (Bile Acid Sequestering
Resins)
ď ďą ď
Niacin (Plain or SR) ď ď ď ď ď
ADA. Diabetes Care 2003;26 (suppl 1):S 83-S 86
33
34. Statins
⢠Rosuvastati
n
⢠Atorvastati
n
⢠Simvastatin
⢠Lovastatin
⢠Pravastatin
⢠Cervistatin
Fibric Acid
⢠Fenofibrate
⢠Gemfibrozil
⢠Benzafibrat
e
⢠Clofibrate
⢠Ciprofibrat
e
⢠Clofibride
Niacin
⢠Neasyn SR
⢠Neasyn
⢠Nialip
⢠Neaspan
www.drsarma.in 34