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High Density Lipoprotein Cholesterol PowerPoint Presentation

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Description : Check out this medical presentation on Atherosclerosis, which is titled "High Density Lipoprotein Cholesterol", to know about the risk reduction of coronary heart disease.

Tags : Atherosclerosis, High Density Lipoprotein Cholesterol, risk, coronary heart disease

Published on : Jun 02, 2021 | Views : 2344 | Downloads : 3

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Slide 1-

High Density Lipoprotein Cholesterol Risk Reduction of Coronary Heart Disease.
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The underappreciated lipoprotein… Guidelines for dyslipidemia give little emphasis to treating low levels of HDL-C. Treating LDL-C is the primary target. The full benefits of increasing HDL-C have not been a major focus in clinical trials. Many providers are unaware of the benefits of raising HDL-C, and so put less effort into treating patients with low HDL-C levels.
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What is HDL-C? High density lipoproteins are not contributors of atherosclerosis! High density lipoproteins: inhibit the oxidation of low density lipoproteins decrease adhesion molecules decreases platelet activation help remove the excess cholesterol deposited by LDLs from the arterial wall through reverse cholesterol transport.
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Reverse Cholesterol Transport A-I Liver CE CE CE FC FC LCAT FC Bile SR-BI A-I 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 ABCA1 Macrophage Mature HDL Nascent HDL www.lipidsonline.org
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Why should you care about HDL-C? Independent of atherosclerosis or high levels of LDL-C, low HDL-C levels are a direct risk factor for CHD This is true even when total cholesterol is normal <200 mg/dL Low HDL-C levels are especially dangerous in diabetics 65% higher CHD death rate in diabetic men Greater risk for atherosclerosis in diabetics
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Why should you care about HDL-C? Low levels of HDL-C are associated with an increased risk for MI, restenosis after angioplasty, stroke, and sudden death Men with low HDL-C are twice as likely to experience an MI as men with higher levels. Women with low HDL-C are four to six times as likely to experience an MI as women with higher levels.
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CHD Risk According to HDL-C Levels (Framingham Study) 4.0 3.0 2.0 1.0 25 45 65 HDL-C (mg/dL) CHD risk ratio Kannel WB. Am J Cardiol 1983;52:9B–12B. Copyright ©1983, with permission from Excerpta Medica Inc. 2.0 1.0 0 4.0 www.lipidsonline.org
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Risk Reduction of CHD The risk for CHD decreases by 2-3% for every 1 mg/dL increase in HDL-C Framingham Study Helsinki Heart Study increasing HDL-C reduced risk of CHD better than lowering LDL-C Scandinavian Simvastatin Survival Study patients with low HDL-C and high TG had greater risk reduction than those with high LDL-C on statin therapy
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Risk Reduction Atherosclerotic plaque volume may be reduced by increasing HDL-C levels Administration of apoA-I Milano = 4.2% reduction over 5 wks Increases in HDL-C decrease rate for coronary events MI and death decreased by 22% Vetrans Affairs cooperative studies program High-density Intervention Trial.
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What are the guidelines? NCEP ATP III <40 mg/dL is a low level of HDL-C, and a level of >60 mg/dL is high enough that points will be deducted from your risk factor assessment (this is a good thing) American Heart Association <50mg/dL is low for women American Diabetes Association HDL-C goal of >40mg/dL for men and >50mg/dL for women
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Remember… evidence from numerous studies has shown that even slight increases in HDL-C correlate to decreases in risk for CHD
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How can HDL-C be increased? Lifestyle Changes Smoking Cessation Moderate Alcohol intake Dietary Modification Increased Physical Activity Current Pharmacology Developing Pharmacology
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Lifestyle Changes Smoking Cessation the relationship between smoking and low HDL-C is stronger in women compared to men All patients should be advised to quit smoking Moderate Alcohol intake moderate alcohol consumption = increases in HDL-C increases HDL associated PON1 enzyme, which inhibits the oxidation of LDL and breaks down oxidized LDL
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Lifestyle Changes Dietary Modification??? NCEP ATP III recommendations Dieting alone may lower LDL-C and triglycerides, but also lowers HDL-C levels Increase Physical Activity Moderate intensity exercise significantly increases HDL-C levels. Results are best if diet and exercise are combined!
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NOTICE The effects of lifestyle changes may be dependant on a person’s starting level of HDL-C. Does this mean that clinicians should not encourage patients to make lifestyle changes? No!, but they should specifically encourage these changes in patients with very low HDL-C.
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Current Pharmacology Statins capable of increasing HDL-C levels by 5-12% Fibrates associated with a 10-15% increase in HDL-C levels Niacin shown to increase HDL-C by 15-30% poorly tolerated flushing effect Combination Therapy
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Developing Pharmacology Apoprotein A-I or delipidated HDL-C apoA-I Milano 4.2% decrease in atheroma volume over a mere five weeks cholesteryl ester-transfer protein (CETP) inhibitors JTT-705 increased HDL-C by 34% reduced LDL-C by 7% Torcetrapib increased HDL-C by 16-91% reduced non HDL-C by 21-42%
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HDL-C in a nutshell For every 1 mg/dL increase in HDL-C, the risk for CHD decreases by 2-3% Increases in HDL-C can reverse atherosclerosis and reduce coronary events There are many current, effective methods for increasing HDL-C and there are more to come
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