Download Free Medical High Density Lipoprotein Cholesterol PowerPoint Presentation

High Density Lipoprotein Cholesterol PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

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 : 2003 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

High Density Lipoprotein Cholesterol Risk Reduction of Coronary Heart Disease.
Slide 2-

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.
Slide 3-

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.
Slide 4-

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
Slide 5-

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
Slide 6-

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.
Slide 7-

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
Slide 8-

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
Slide 9-

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.
Slide 10-

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
Slide 11-

Remember… evidence from numerous studies has shown that even slight increases in HDL-C correlate to decreases in risk for CHD
Slide 12-

How can HDL-C be increased? Lifestyle Changes Smoking Cessation Moderate Alcohol intake Dietary Modification Increased Physical Activity Current Pharmacology Developing Pharmacology
Slide 13-

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
Slide 14-

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!
Slide 15-

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.
Slide 16-

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
Slide 17-

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%
Slide 18-

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
Slide 19-

References Bhalodkar NC, Blum S, Rana T, Bhalodkar A, Kitchappa R, Enas EA. Effect of Leisure Time Exercise on High-Density Lipoprotein Cholesterol, Its Subclasses, and Size in Asian Indians. Am J Cardiol 2005;96:98-100. Brewer HB Jr. Focus on high-density lipoproteins in reducing cardiovascular risk. Am Heart J 2004;148:S14-8. Choudhury RP, Rong JX, Trogan E, Elmalem VI, Dansky HM, Breslow JL et al. High-Density Lipoproteins Retard the Progression of Atherosclerosis and Favorably Remodel Lesions Without Suppressing Indices of Inflammation or Oxidation. Arterioscler Thromb Vasc Biol 2004;24:1904-1909. Clark RW, Sutfin TA, Ruggeri RB, Willhauer AT, Sugarman GM, Cosgrove PG et al. Raising High-Density Lipoprotein in Humans Through Inhibition of Cholesteryl Ester Transfer Protein: An Initial Multidose Study of Torcetrapib. Arterioscler Thromb Vasc Biol 2004;24:490-497. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction. JAMA 2005;293:43-53. Devroey D, Vantomme K, Betz W, Vandevoorde J, Kartounian. A Review of the Treatment Guidelines on the Management of Low Levels of High-Density Lipoprotein Cholesterol. Cardiol 2004; 102:61-66. Ellison RC, Zhang Y, Qureshi MM, Knox S, Arnett DK, Province MA. Lifestyle determinants of high-density lipoprotein cholesterol: The National Heart, Lung, and Blood Institute Family Heart Study. Am Heart J 2004;147:529-535. Goldbourt U, Yaari S, Medalie JH. Isolated Low HEL Cholesterol As a Risk Factor for Coronary Heart Disease Mortality: A 21-Year Follow-up of 8000 Men. Arterioscler Thromb Vasc Biol 1997;17:107-113. Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD et al. High-Density Lipoprotein Cholesterol and Cardiovascular Disease: Four Prospective American Studies. Circulation 1989; 79:8-15. Human Physiology, Eighth Edition. S Fox. NewYork: McGraw-Hill Companies, Inc., 2004. Leon AS, Gaskill SE, Rice T, Bergeron J, Gagnon J, Rao DC et al. Variability in the Response of HDL Cholesterol to Exercise Training in the HERITAGE Family Study. Int J Sports Med 2002;23:1-9. National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. NIH Publication 2001:no.01-3670. National Institutes of Health, Bethesda, MD. Rao MN, Marmillot P, Gong M, Palmer DA, Seef LB, Strader DB et. al. Light, But Not Heavy Alcohol Drinking, Stimulates Paraoxonase by Upregulating Liver mRNA in Rats and Humans. Metabolism 2003;52:1287-1294. Temelkova-Kurkstschiev T, Hanefled M. The Lipid Triad in Type 2 Diabetes – Prevalence and Relevance of Hypertriglyceridaemia/Low High-Density Lipoprotein Syndrome in Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2004;112:75-79. Toth PP. High-Density Lipoprotein as a Therapeutic Target: Clinical Evidence and Treatment Strategies. Am J Cardiol 2005;96(suppl 1):50-58. Van der Steeg WA, Kuivenhoven JA, Klerkx AH, Boekholdt SM, Hovingh GK, Kastelein JJP. Role of CETP inhibitors in the treatment of dyslipidemia: [Therapy and clinical trials]. Curr Opin Lipidol 2004; 15(6):631-636. Varady KA, Jones PJH. Combination Diet and Exercise Interventions for the Treatment of Dyslipidemia: an Effective Preliminary Strategy to Lower Cholesterol Levels? J Nutr 2005;135:1829-1835. Wierzbicki AS, Mikhailidis DP. Beyond LDL-C - The Importance of Raising HDL-C Curr Med Res Opin 2002;18(1):36-44. Williams PT. The Relationships of Vigorous Exercise, Alcohol, and Adiposity to Low and High High-Density Lipoprotein-Cholesterol Levels. Metabolism 2004;53(6):700-709.