Coronary Heart Disease (CHD)
Coronary Heart Disease (CHD) <ul><li>>58 million American have at least one form of CHD. </li></ul><ul><li>50% of all card...
 
Mortality From Diseases of the Heart by Race/Ethnicity  (Deaths/100,000)
Coronary Heart Disease <ul><li>The major underlying cause is  atherosclerosis. </li></ul><ul><li>Atherosclerosis   is a sl...
Coronary Heart Disease <ul><li>Plaque  (the build-up of lipid/cholesterol) in the artery wall forms as a response to   inj...
 
 
 
 
 
Risk Factors for Coronary Heart Disease <ul><li>Age: </li></ul><ul><ul><li>Male > 45 years </li></ul></ul><ul><ul><li>Fema...
Risk Factors for Coronary Heart Disease <ul><li>Hypertension  </li></ul><ul><ul><li>Appears to weaken the artery wall at p...
Risk Factors for Coronary Heart Disease <ul><li>Diabetes  </li></ul><ul><ul><li>50% of deaths related to DM is due to CHD ...
Risk Factors for Coronary Heart Disease <ul><li>Inactivity </li></ul><ul><ul><li>Sedentary person has 2x risk for developi...
Risk Factors for Coronary Heart Disease <ul><li>Obesity </li></ul>
Risk Factors for Coronary Heart Disease <ul><li>Abnormal Blood Lipids </li></ul><ul><li>LDL Cholesterol (low density lipop...
Cholesterol Diet Liver Cholesterol Metabolism 15% 75%
Blood Lipids and Lipoproteins <ul><li>Some LDL-C can be oxidized and takes up by  endothelial cells and macrophages  in th...
Blood Lipids and Lipoproteins <ul><li>HDL-C  is thought to be involved in the transport of excess cholesterol from membran...
Blood Lipids and Lipoproteins <ul><li>HDL-C  IS INCREASED : </li></ul><ul><ul><li>Exercise, loss of weight, and moderate c...
Cholesterol and the CHD Patient <ul><li>Goal: </li></ul><ul><ul><li>The goal is a LDL-C level of 100 mg/dL </li></ul></ul>
 
Treatment in CHD Patients
Cholesterol and the CHD Patient <ul><li>Scandinavian Sinvastatian Survival Study: </li></ul><ul><li>N = 4,444 patients wit...
Cholesterol and the CHD Patient <ul><li>Results: </li></ul><ul><ul><li>Cholesterol Levels - total cholesterol decreased 25...
Diet Therapy of High Blood Cholesterol
Diet Therapy of High Blood Cholesterol <ul><li>Total Fat   </li></ul><ul><ul><li>20-35% calories from fat  </li></ul></ul>...
Diet Therapy of High Blood Cholesterol <ul><li>Polyunsaturated fatty acids   </li></ul><ul><li>Reduces LDL-C and risk of C...
α - Omega-3 Fatty Acids <ul><li>Help to thin blood and prevent blood platelets from clotting and sticking to artery walls....
<ul><li>Monounsaturated fatty acids </li></ul><ul><li>If equal amounts of MUFAs are substituted for saturated fatty acids,...
 
Diet Therapy of High Blood Cholesterol <ul><li>Trans-Fatty Acids </li></ul><ul><li>Increase LDL Cholesterol and decrease H...
Trans  fatty acid content of fast-food (Data compiled from Nutrition Action Health Letter, June 1999)         13 3 530 Sta...
Treatment for CHD <ul><li>Physical Activity </li></ul><ul><ul><li>prescribed by physician for patients with CHD </li></ul>...
Treatment for CHD <ul><li>Weight Control </li></ul><ul><li>5-10# weight loss </li></ul>
Diet Therapy of High Blood Cholesterol <ul><li>Soluble Fiber   </li></ul><ul><li>10-20 g/day </li></ul>
Drug Treatment <ul><li>Statins - </li></ul><ul><li>Bile Acid Sequestrants </li></ul><ul><li>Nicotinic Acid </li></ul>
Dietary Issues Requiring Further Research <ul><li>Elevated levels of   homocysteine   </li></ul><ul><li>Elevated homocyste...
Dietary Issues Requiring Further Research <ul><li>Several vitamins, including folic acid, vitamin B6 and B12, function are...
 
Dietary Issues Requiring Further Research <ul><li>Antioxidant Vitamin Supplements  - Vitamins E, C and A </li></ul><ul><li...
Dietary Issues Requiring Further Research <ul><li>Very low-fat diets (<15 % fat)  </li></ul>
Steps for Lowering LDL-C in the Diet <ul><li>Eggs: </li></ul><ul><ul><li><300 mg. cholesterol:  <  4 yolks/wk </li></ul></...
Guidelines for Selecting & Preparing Foods <ul><li>Milk and Milk Products: </li></ul><ul><ul><li>2-3 servings/day </li></u...
Steps for Lowering LDL-C in the Diet <ul><li>Fats, oils: </li></ul><ul><ul><li>< 6-8 tsp./day </li></ul></ul>
Steps for Lowering LDL-C in the Diet <ul><li>Monounsaturated Fats: </li></ul><ul><li>Canola, olive and peanut oil </li></u...
Steps for Lowering LDL-C in the Diet <ul><li>Polyunsaturated Fats </li></ul><ul><li>Margarine made with corn, soybean, saf...
Steps for Lowering LDL-C in the Diet <ul><li>Saturated Fat: </li></ul><ul><li>Butter, Coconut & Coconut Oil, Palm Oil </li...
Steps for Lowering LDL-C in the Diet <ul><li>Plant Sterols and Stanols : </li></ul><ul><li>Natural substances derived from...
Steps for Lowering LDL-C in the Diet <ul><li>Meat, Fish and Poultry </li></ul><ul><li>Select lean meat and poultry   </li>...
Steps for Lowering LDL-C in the Diet <ul><li>Tongue, kidneys Liver, sweetbreads, heart and brains are high in cholesterol....
Steps for Lowering LDL-C in the Diet <ul><li>Breads and Cereals :  </li></ul><ul><ul><li>6-11 servings/day </li></ul></ul>...
Steps for Lowering LDL-C in the Diet <ul><li>Vegetables: </li></ul><ul><ul><li>3-5 servings per day </li></ul></ul><ul><li...
Reading The Label <ul><li>Extra Lean   </li></ul><ul><ul><li><5 g total fat, 2 g saturated fat, and 95 mg cholesterol </li...
Reading The Label <ul><li>Fat Free </li></ul><ul><ul><li>less than 0.5 gm fat </li></ul></ul><ul><li>Low Fat </li></ul><ul...
Guidelines for Selecting & Preparing Foods <ul><li>Try reducing fat by 1/4 to 1/3 in baked products.  E.g. if recipe calls...
Risk Factors for Coronary Heart Disease <ul><li>Triglycerides </li></ul><ul><ul><li>Normal: < 200 mg/dl </li></ul></ul><ul...
Risk Factors for Coronary Heart Disease <ul><li>High Triglycerides (>200 mg/dl) and low HDL cholesterol is associated with...
Hypertriglyceridemia <ul><li>Factors Associated with Increased Triglycerides: </li></ul><ul><ul><li>Diets - low fat,  high...
Hypertriglyceridemia <ul><li>Treatment: </li></ul><ul><ul><li>Weight Loss </li></ul></ul><ul><ul><li>Low cholesterol, low ...
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  • One in 9 women and one in 6 men, age 45 to 64 have CHD. After age 65, one in 3 women and 1 in 8 men are afflicted.
  • Looks good on paper, but……. Differences between ethnicities
  • Per 100,000 2001
  • CHD results from a lack of blood flow to the block vessels surrounding the heart.
  • After injury, platelets adhere and release growth factors that increase the development of the lesion.
  • Related to the additional presence of other risk factors such as hyperlipidemia, hypertension and obesity
  • The magnitude of this risk is similar to high blood cholesterol and smoking.
  • LDL-C is the primary transporter of cholesterol in the blood.
  • Recent clinical trials have proven that lowering LDL-C levels sharply reduces the risk of MI, death from CHD and death from all cases
  • 4,444 patients with history of angina or MI Cholesterol levels between 213-310 mg/dL Placed on cholesterol-lowering diet and either a statin drug or placebo.
  • With statin drug
  • Total Fat 20-35% calories from fat Average of total calories consumed over a one week period. Saturated fatty acid Intake is the strongest dietary determinant of LDL-C Recommendation: 8-10% calories Help to thin blood and prevent blood platelets from clotting and sticking to artery walls. Food Sources: fatty fish, such as salmon, sardines, trout, swordfish, herring, albacore tuna, mackerel and, soy, canola and flaxseed oil. Consumption of 2 servings (~8ounces)per week of fish high in α -linolenic acid Monounsaturated fatty acids If equal amounts of MUFAs are substituted for saturated fatty acids, LDL-C decreases MUFAs do not lower HDL-C Recommended intakes: up to 20% of total calories
  • Found in prepared foods containing “partially hydrogenated vegetable oils” Some margarines, crackers, other baked goods, commercially fried foods
  • prescribed by physician for patients with CHD When aerobic activity is appropriate, activity that places moderate stress on the cardio-respiratory system can be included. brisk walking, jogging, swimming, bicycling, and tennis
  • 5-10# weight loss can double the LDL-C reduction achieved by reducing saturated fat and cholesterol in the diet.
  • Oats, legumes, pectin, psyllium and certain gums have been shown to reduce serum cholesterol when added to a reduced fat/cholesterol diet .
  • Statins - Reduces LDL-C by inhibiting a enzyme in the pathway for cholesterol synthesis. Bile Acid Sequestrants Binds with cholesterol-containing bile acids in the intestine, and promoting the conversion of cholesterol to bile acids in the liver. Nicotinic Acid - Niacin lowers LDL-C by 10-25%
  • Recent studies of 700 individuals with atherosclerosis and 800 control subjects free of overt disease showed that those with the highest levels of homocysteine had a 2x increase in vascular disease risk, similar to that of smoking. Elevated homocysteine levels may be present in 15% of Americans.
  • Several vitamins, including folic acid, vitamin B6 and B12, function are cofactors in the metabolism of methionine and homocysteine. A number of studies have shown an inverse relationship of blood homocysteine levels and plasma/serum levels of folate, B6 and B12.
  • To date there are no studies which clearly demonstrate a cause and effect relationship
  • Use 2 egg whites or an egg substitute product instead of one whole egg.
  • Use skim or 1% milk and low fat or non fat yogurt Use cheeses labeled ‘reduced fat’, ‘low fat’, ‘part-skim’ or ‘fat free’’ &lt;3g/oz.
  • Use tub margarine Monounsaturated oils - canola, olive Polyunsaturated oils – corn, soy, safflower, sunflower
  • Plant sterols and stanols structurally resemble cholesterol. Reduce cholesterol absorption in the intestine. 2-3 grams of plant sterols or stanols have been shown to reduce LDL-C ~ 10 - 20%.
  • USDA select or choice Loin, Round and Flank cuts Remove the skin from poultry Avoid high-fat process meats Tongue, kidneys Liver, sweetbreads, heart and brains are high in cholesterol.
  • WW, rye, pumpernickel, white bread, buns, dinner roles, bagels, English muffins, pita bread.
  • Coronary Artery Disease.ppt

    1. 1. Coronary Heart Disease (CHD)
    2. 2. Coronary Heart Disease (CHD) <ul><li>>58 million American have at least one form of CHD. </li></ul><ul><li>50% of all cardiac deaths result from CHD </li></ul>
    3. 4. Mortality From Diseases of the Heart by Race/Ethnicity (Deaths/100,000)
    4. 5. Coronary Heart Disease <ul><li>The major underlying cause is atherosclerosis. </li></ul><ul><li>Atherosclerosis is a slow, progressive disease which begins in childhood and takes decades to advance </li></ul>
    5. 6. Coronary Heart Disease <ul><li>Plaque (the build-up of lipid/cholesterol) in the artery wall forms as a response to injury to the endothelium in the artery wall. </li></ul>
    6. 12. Risk Factors for Coronary Heart Disease <ul><li>Age: </li></ul><ul><ul><li>Male > 45 years </li></ul></ul><ul><ul><li>Female > 55 years or premature menopause without estrogen replacement therapy </li></ul></ul><ul><li>Family History of premature disease </li></ul><ul><ul><li>Male first-degree relative <55 years </li></ul></ul><ul><ul><li>Female first-degree relative < 65 years) </li></ul></ul>
    7. 13. Risk Factors for Coronary Heart Disease <ul><li>Hypertension </li></ul><ul><ul><li>Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol. </li></ul></ul><ul><li>Cigarette Smoking </li></ul><ul><ul><li>#1 cause of preventable death in US </li></ul></ul><ul><ul><li>1 in 5 CHD deaths attributable to smoking </li></ul></ul>
    8. 14. Risk Factors for Coronary Heart Disease <ul><li>Diabetes </li></ul><ul><ul><li>50% of deaths related to DM is due to CHD </li></ul></ul>
    9. 15. Risk Factors for Coronary Heart Disease <ul><li>Inactivity </li></ul><ul><ul><li>Sedentary person has 2x risk for developing CHD as a person who is active. </li></ul></ul>
    10. 16. Risk Factors for Coronary Heart Disease <ul><li>Obesity </li></ul>
    11. 17. Risk Factors for Coronary Heart Disease <ul><li>Abnormal Blood Lipids </li></ul><ul><li>LDL Cholesterol (low density lipoprotein) </li></ul><ul><li>HDL Cholesterol (high density lipoprotein) </li></ul>
    12. 18. Cholesterol Diet Liver Cholesterol Metabolism 15% 75%
    13. 19. Blood Lipids and Lipoproteins <ul><li>Some LDL-C can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis. </li></ul>
    14. 20. Blood Lipids and Lipoproteins <ul><li>HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body. </li></ul>
    15. 21. Blood Lipids and Lipoproteins <ul><li>HDL-C IS INCREASED : </li></ul><ul><ul><li>Exercise, loss of weight, and moderate consumption of ETOH. </li></ul></ul><ul><li>HDL-C is lowered: </li></ul><ul><ul><li>Obesity, inactivity, cigarette smoking, some oral contraceptives and steroids, hypertriglyceridemia and some genetic factors . </li></ul></ul>
    16. 22. Cholesterol and the CHD Patient <ul><li>Goal: </li></ul><ul><ul><li>The goal is a LDL-C level of 100 mg/dL </li></ul></ul>
    17. 24. Treatment in CHD Patients
    18. 25. Cholesterol and the CHD Patient <ul><li>Scandinavian Sinvastatian Survival Study: </li></ul><ul><li>N = 4,444 patients with history of angina or MI </li></ul><ul><li>Cholesterol levels = 213-310 mg/dL </li></ul><ul><li>Treatment A: </li></ul><ul><ul><li>Placed on cholesterol-lowering diet and </li></ul></ul><ul><ul><li>B: a statin drug or a placebo. </li></ul></ul>
    19. 26. Cholesterol and the CHD Patient <ul><li>Results: </li></ul><ul><ul><li>Cholesterol Levels - total cholesterol decreased 25%, LDL decreased 35% </li></ul></ul><ul><ul><li>34% decrease in major coronary events </li></ul></ul><ul><ul><li>42% decrease in CHD mortality </li></ul></ul><ul><ul><li>30% decrease in total mortality </li></ul></ul><ul><ul><li>37% decrease in surgery for CHD </li></ul></ul>
    20. 27. Diet Therapy of High Blood Cholesterol
    21. 28. Diet Therapy of High Blood Cholesterol <ul><li>Total Fat </li></ul><ul><ul><li>20-35% calories from fat </li></ul></ul><ul><ul><li>Average of total calories consumed over a one week period. </li></ul></ul><ul><li>Saturated fatty acid </li></ul><ul><ul><li>Intake is the strongest dietary determinant of LDL-C </li></ul></ul><ul><ul><li>Recommendation: 8-10% calories </li></ul></ul>
    22. 29. Diet Therapy of High Blood Cholesterol <ul><li>Polyunsaturated fatty acids </li></ul><ul><li>Reduces LDL-C and risk of CHD when substituted for saturated fat in the diet </li></ul><ul><li>Can cause small reduction in HDL-C when present in high amounts </li></ul><ul><li>Recommendation: ~10% of energy intake </li></ul>
    23. 30. α - Omega-3 Fatty Acids <ul><li>Help to thin blood and prevent blood platelets from clotting and sticking to artery walls. </li></ul><ul><li>Food Sources: fatty fish, such as salmon, sardines, trout, swordfish, herring, albacore tuna, mackerel and, </li></ul><ul><li>soy, canola and flaxseed oil. </li></ul><ul><li>Consumption of 2 servings (~8ounces)per week of fish high in α -linolenic acid </li></ul>
    24. 31. <ul><li>Monounsaturated fatty acids </li></ul><ul><li>If equal amounts of MUFAs are substituted for saturated fatty acids, LDL-C decreases </li></ul><ul><li>MUFAs do not lower HDL-C </li></ul><ul><li>Recommended intakes: up to 20% of total calories </li></ul>
    25. 33. Diet Therapy of High Blood Cholesterol <ul><li>Trans-Fatty Acids </li></ul><ul><li>Increase LDL Cholesterol and decrease HDL Cholesterol </li></ul><ul><li>Recommendations: Intakes of trans-fatty acids should be as low as possible </li></ul>
    26. 34. Trans fatty acid content of fast-food (Data compiled from Nutrition Action Health Letter, June 1999)         13 3 530 Starbucks cinnamon scone (5 oz) 6 7 540 Burger King fries (6 oz King size) 7 2 610 Burger King chicken sandwich (8 oz) 6 3 510 McDonalds chicken McNuggets (9 oz) 14 3 660 Hamburger (7 oz) Saturated Fatty Acids (g) Trans Fatty Acids (g) Calories Food
    27. 35. Treatment for CHD <ul><li>Physical Activity </li></ul><ul><ul><li>prescribed by physician for patients with CHD </li></ul></ul><ul><ul><li>When aerobic activity is appropriate, activity that places moderate stress on the cardio-respiratory system can be included. </li></ul></ul>
    28. 36. Treatment for CHD <ul><li>Weight Control </li></ul><ul><li>5-10# weight loss </li></ul>
    29. 37. Diet Therapy of High Blood Cholesterol <ul><li>Soluble Fiber </li></ul><ul><li>10-20 g/day </li></ul>
    30. 38. Drug Treatment <ul><li>Statins - </li></ul><ul><li>Bile Acid Sequestrants </li></ul><ul><li>Nicotinic Acid </li></ul>
    31. 39. Dietary Issues Requiring Further Research <ul><li>Elevated levels of homocysteine </li></ul><ul><li>Elevated homocysteine levels may be present in 15% of Americans. </li></ul>
    32. 40. Dietary Issues Requiring Further Research <ul><li>Several vitamins, including folic acid, vitamin B6 and B12, function are cofactors in the metabolism of methionine and homocysteine . </li></ul>
    33. 42. Dietary Issues Requiring Further Research <ul><li>Antioxidant Vitamin Supplements - Vitamins E, C and A </li></ul><ul><li>Results of epidemiological observations suggest a relationship between increased intake of these vitamins and decreased CHD risk. </li></ul>
    34. 43. Dietary Issues Requiring Further Research <ul><li>Very low-fat diets (<15 % fat) </li></ul>
    35. 44. Steps for Lowering LDL-C in the Diet <ul><li>Eggs: </li></ul><ul><ul><li><300 mg. cholesterol: < 4 yolks/wk </li></ul></ul><ul><ul><li>< 200 mg. Cholesterol: < 2 yolks/wk </li></ul></ul>
    36. 45. Guidelines for Selecting & Preparing Foods <ul><li>Milk and Milk Products: </li></ul><ul><ul><li>2-3 servings/day </li></ul></ul>
    37. 46. Steps for Lowering LDL-C in the Diet <ul><li>Fats, oils: </li></ul><ul><ul><li>< 6-8 tsp./day </li></ul></ul>
    38. 47. Steps for Lowering LDL-C in the Diet <ul><li>Monounsaturated Fats: </li></ul><ul><li>Canola, olive and peanut oil </li></ul><ul><li>Avocado </li></ul><ul><li>Olives: black and green </li></ul><ul><li>Nuts: almonds, cashews, peanuts, pecans </li></ul><ul><li>Sesame seeds </li></ul>
    39. 48. Steps for Lowering LDL-C in the Diet <ul><li>Polyunsaturated Fats </li></ul><ul><li>Margarine made with corn, soybean, safflower, sesame oils </li></ul><ul><li>Tub, squeeze or stick </li></ul><ul><li>Nuts: walnuts and English </li></ul><ul><li>Salad dressings </li></ul><ul><li>Seeds: pumpkin, sunflower </li></ul>
    40. 49. Steps for Lowering LDL-C in the Diet <ul><li>Saturated Fat: </li></ul><ul><li>Butter, Coconut & Coconut Oil, Palm Oil </li></ul><ul><li>Cream, half and half </li></ul><ul><li>Cream cheese </li></ul><ul><li>Shortening or lard </li></ul><ul><li>Sour cream </li></ul><ul><li>Fat from animal products including milk and meats </li></ul>
    41. 50. Steps for Lowering LDL-C in the Diet <ul><li>Plant Sterols and Stanols : </li></ul><ul><li>Natural substances derived from wood, vegetables, vegetable oils and other plants - sitosterol and sitostanol </li></ul>
    42. 51. Steps for Lowering LDL-C in the Diet <ul><li>Meat, Fish and Poultry </li></ul><ul><li>Select lean meat and poultry </li></ul><ul><ul><li>< 6 oz/day for Step I diet and < 5 oz/day for Step II </li></ul></ul><ul><li>Eat fish on a weekly basis </li></ul>
    43. 52. Steps for Lowering LDL-C in the Diet <ul><li>Tongue, kidneys Liver, sweetbreads, heart and brains are high in cholesterol. </li></ul>
    44. 53. Steps for Lowering LDL-C in the Diet <ul><li>Breads and Cereals : </li></ul><ul><ul><li>6-11 servings/day </li></ul></ul><ul><li>Low fat crackers </li></ul><ul><li>Tortillas </li></ul><ul><li>Hot and cold cereals excepts granola or meusli </li></ul>
    45. 54. Steps for Lowering LDL-C in the Diet <ul><li>Vegetables: </li></ul><ul><ul><li>3-5 servings per day </li></ul></ul><ul><li>Fruits </li></ul><ul><ul><li>2-4 servings per day </li></ul></ul><ul><li>Use sweets and modified fat desserts in moderation </li></ul>
    46. 55. Reading The Label <ul><li>Extra Lean </li></ul><ul><ul><li><5 g total fat, 2 g saturated fat, and 95 mg cholesterol </li></ul></ul><ul><li>Lean </li></ul><ul><ul><li>< 10 g total fat, 4 g saturated fat and 95 mg cholesterol </li></ul></ul>
    47. 56. Reading The Label <ul><li>Fat Free </li></ul><ul><ul><li>less than 0.5 gm fat </li></ul></ul><ul><li>Low Fat </li></ul><ul><ul><li>3 grams or less fat </li></ul></ul><ul><li>Reduced fat </li></ul><ul><ul><li>at least 25% less fat </li></ul></ul><ul><li>Light </li></ul><ul><ul><li>one-third fewer calories or 50% less fat </li></ul></ul>
    48. 57. Guidelines for Selecting & Preparing Foods <ul><li>Try reducing fat by 1/4 to 1/3 in baked products. E.g. if recipe calls for 1 cup oil, try 2/3 C. </li></ul><ul><li>In casseroles and main dishes, cut back or eliminate the fat. </li></ul><ul><li>Sauté or stir fry with very little fat or use water, wine, or broth. </li></ul><ul><li>Chill soups, gravies and stews and skim off hardened fat before serving. </li></ul>
    49. 58. Risk Factors for Coronary Heart Disease <ul><li>Triglycerides </li></ul><ul><ul><li>Normal: < 200 mg/dl </li></ul></ul><ul><ul><li>Borderline: 200 - 400 mg/dl </li></ul></ul><ul><ul><li>High: 400 - 1000 mg/dl </li></ul></ul><ul><ul><li>Very High:> 1000 mg/dl </li></ul></ul>
    50. 59. Risk Factors for Coronary Heart Disease <ul><li>High Triglycerides (>200 mg/dl) and low HDL cholesterol is associated with increased risk. </li></ul><ul><li>Stronger in women than men and older adults </li></ul>
    51. 60. Hypertriglyceridemia <ul><li>Factors Associated with Increased Triglycerides: </li></ul><ul><ul><li>Diets - low fat, high refined sugar </li></ul></ul><ul><ul><li>Estrogens </li></ul></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Untreated Diabetes, hypothyroidism, chronic renal failure and liver disease </li></ul></ul>
    52. 61. Hypertriglyceridemia <ul><li>Treatment: </li></ul><ul><ul><li>Weight Loss </li></ul></ul><ul><ul><li>Low cholesterol, low saturated fat diet </li></ul></ul><ul><ul><li>Increased physical activity </li></ul></ul><ul><ul><li>Smoking cessation </li></ul></ul><ul><ul><li>Management of Diabetes </li></ul></ul><ul><ul><li>Restricted alcohol use </li></ul></ul>
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