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Hinduja hospital conducts regular webinars and tweetinars for online users where they can seek advice from expert doctors of hinduja hospital for free. Above is summary of webinar conducted by hinduja hospital on lipids where issues like lipids, lipids treatment ,lipids treatment guidelines were discussed successfully by Dr. Preeti Chhabria, M.D(USA), Consultant in Internal Medicine at hinduja hospital. To know more about such upcoming webinars and tweetinars from hinduja hospital , visit http://www.hindujahospital.com/communityportal/
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Lipids- Friend or Foe
Dr. Preeti Chhabria, M.D. (USA)Consultant in Internal MedicineHinduja Hospital
Lipids-Friend or Foe
•Heart disease is the leading cause of death among Indians (Million deaths study by Center for Global Health Research)
•The disease occurs at a much younger age in Indians vs North America and Europe
•There is an urgent need for primary and secondary prevention of this growing
epidemic.
Lipids-Friend or FoeMajor risk factors for heart disease are- • High LDL cholesterol
• Cigarette smoking
• High BP (more than 140/90 or taking medicines for high BP)
• Low HDL cholesterol
• Family h/o premature heart disease
• Age (men >45, women >55)
Lipids- Friend or Foe
Lipid profile consists of-
• Total cholesterol
• LDL (bad or harmful) cholesterol
• HDL (good or protective cholesterol)
• Triglycerides
• Total cholesterol/ HDL ratio
Lipids-Friend or Foe• Start screening for high cholesterol at age 20 yrs
and with a fasting lipid panel
• Primary goal of lipid treatment is LDL
LDL goal based on Risk cateogory LDLgoal
High risk >20 % <100
ModerateRisk 10-20% <130
Low risk(0-1 risk factors) <160
Lipids- Friend or Foe•Risk stratification (10 year risk of CAD)(Risk calculated by using Framingham risk calculator)
Risk cateogory LDL goal Start TLC Start Drug
High risk(CHD/ <100 >100 >130Equivalent)>20%
Moderately high <130 >130 >130(>2 risk factors)10-20%
Moderate risk <130 >130 >160(>2 risk factors)<10%
Low risk(0-1 risk factors) <160 >160 >190
Lipids-Friend or Foe
High Triglycerides
• Increase CV risk
• Causes of high triglycerides
• Drugs thiazide diuretics, estrogens, steroids, beta blockers
• Diabetes
• Obesity
• Kidney disease
• Diet and alcohol induced
Lipids-Friend or Foe HDL cholesterol • 1% decrease HDL increases CVD risk by 2-3%
• Low HDL is associated with small dense LDL particles and with high triglycerides
Causes of low HDL• Obesity, smoking, inactivity, • high carbohydrate diet• Beta blockers, high triglycerides, type 2 DM • Genetics
Lipids –Friend or Foe
Other lipid risk factors-
•Lp(a) lipoprotein, small LDL particlesApolipoprotein B, Total cholesterol/HDL
ratio
•ATP III guidelines do NOT recommend measuring, following or treating these factors
Lipids-Friend or Foe
Management-
Total lifestyle changes: recommended for all
• Saturated fat intake to be <7% of all total calories• Dietary cholesterol reduced to <200 mg/day• Increase monounsaturated fat intake to 10-15% of total calories• Increase exercise
Other measures-• Add oatmeal (reduces LDL)• Add intake of fiber 10-25 g/day, fruits, legumes
Lipids-Friend or FoePharmacotherapy-
• Statins are the first line of treatment• Statins reduce LDL by 18-55% increase HDL by 5-15% reduce triglycerides by 7-30%• Statins reduce CHD risk in primary and secondary prevention reduce mortality by 20-30% in pts with CAD reduce inflammatory markers such as hsCRP• Statins are contraindicated in pregnancy or if
pregnancy is being planned.
Lipids-Friend or Foe
•Side effects of Statins
•Well tolerated
•Muscle aches, weakness
•Alterations in liver enzymes
•Drug interactions
Lipids-Friend or Foe
Drug combinations-
•Statin + bile acid sequestrant •Statin+ fibrate •Statin + Ezetimibe •Statin + Niacin
•EPA (eicosapentaenoic acid) (dec TG by 50%)
Found in fish oil supplements Studies have not yet shown benefit on mortality or CV
events
Lipids-Friend or Foe
Low HDL cholesterol treatment-
• If low cardiac risk- exercise, weight loss and smoking cessationincrease HDL by 30%
• If high risk (CHD or risk equivalent)-Primary goal is LDL tx with statinif LDL normal/at goal, add fibrate or niacin
Geriatrics Age group 65-80
• Use statin for established CVD
• For primary prevention, check R/B ratio
• Greater risk of s/e, especially myopathy
Lipids-Friend or Foe
Lipids-Friend or Foe
• Stroke prevention-Pt with CVDtx of hyperlipidemia helps prevent CVA
• For secondary stroke prevention-keep LDL <70control non HDL cholesterol
Lipids-Friend or Foe
Metabolic syndrome:
• 7 fold increased risk of DM• 2 fold increase in future risk of cv disease• 1.5 fold increase in future all cause mortality
Definition- 3 of the following criteria:
• Truncal obesity• High BP• High triglycerides• Low HDL• High Fasting sugar
Lipids-Friend or Foe
Metabolic syndrome treatment-• ASA recommended if 10 yr CHD risk is >6%• Keep Bp <130/80• Cholesterol goal LDL < 100 for high risk <130 for
intermediate risk• Address low HDL as well
Diabetes prevention- • Exercise, weight loss, low gylcemic diet and
metformin if needed
Lipids-Friend or Foe
•Adopt lifestyle changes
•Take the initiative to test your lipids
•Do not resist treatment
•Ensure follow up
• Let’s befriend our foe
LipidS- Friend or Foe
http://www.hindujahospital.com/dr-preeti-chhabria/
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