Ped488 dyslipidemia s 11


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  • Triglycerides <150 Normal 150-199 Borderline high 200-499 High > Very High Total Cholesterol <200 Desia
  • New class of agents: HMG-CoA reductase inhibitors (Lovastatin (mevacor) and Simvastatin (zocor) reduce levels of total and LDL-chol more powerfully and simultaneously boost HDL Bile Acids-administered as a powdered resin dissolved in liquid or as tablets. Resins inhibit the intestinal reabsorption of bile and its transport in the portal circulation to the liver. This loss of bile stimulates the up-regulation of hepatic (liver) LDL receptor activity that reduces plasma LDL levels. These drugs are most effective when give with the fattiest meal as it encounters bile in the gut. Major side effects are constipation, bloating and gas and they interfere with absorption of fat soluble vitamins. Fibric Acids-reduces elevated TG levels-well tolerated with few side effects Nicotinic acid-useful for those with low HDL or elevated TG-main effect is to inhibit lipolysis which reduces the quantity of plasma FFA and their available transport to the lever which reduces their synthesis into TG
  • *These drugs have a powerful effect on lowering LDL and raising HDL by blocking an enzyme needed to produce cholesterol in the liver
  • Ped488 dyslipidemia s 11

    1. 1. Dyslipidemia and Exercise
    2. 2. Dyslipidemia <ul><li>Abnormal blood lipid / lipoprotein levels </li></ul><ul><li>Severe dyslipidemia linked to genetic defects in cholesterol metabolism </li></ul><ul><li>Less severe cases </li></ul><ul><ul><li>response to other diseases or combining a specific genetic pattern with various environmental exposures (diet, smoking) </li></ul></ul>
    3. 3. Overview of Pathophysiology <ul><li>TG and CHL move b/t the intestine, liver and tissue </li></ul><ul><li>A variety of environmental, genetic and pathologic factors alter TG and CHL transport </li></ul><ul><ul><li>High lipoprotein concentrations may alter pathways </li></ul></ul><ul><ul><ul><li>influence CAD risk </li></ul></ul></ul><ul><li>Combined these factors are related to elevated lipid levels </li></ul><ul><ul><li>known as DYSLIPIDEMIA </li></ul></ul>
    4. 4. Overview of Lipoprotein Metabolic Pathways
    5. 5. Lipids <ul><li>Lipids non-soluble in plasma so combines with proteins to form lipoproteins </li></ul><ul><ul><li>Chylomicrons: from absorption of dietary triglyceride </li></ul></ul><ul><ul><li>Very-low-density-Lipoprotein (VLDL): synthesized in the liver, primary transport mechanism for synthesized triglyceride </li></ul></ul><ul><ul><li>Low-density-Lipoprotein (LDL): final stage of breakdown VLDL, carier of cholesterol </li></ul></ul><ul><ul><li>High-density-Lipoprotein (HDL): involved in reverse transport of cholesterol </li></ul></ul>
    6. 6. Triglycerides <ul><li>Composed of three fatty acids and a glycerol molecule </li></ul><ul><li>Several functions </li></ul><ul><ul><li>Membrane structure </li></ul></ul><ul><ul><li>Eich energy source </li></ul></ul><ul><ul><ul><li>9 calories of energy for each fat gram </li></ul></ul></ul><ul><li>Found in all cell membranes </li></ul>
    7. 7. Cholesterol <ul><li>Waxy, fat-like substance produced by liver </li></ul><ul><li>Absorbed by intestine during food digestion </li></ul><ul><ul><li>Dietary cholesterol is present in most food derived from animals (not in plants) </li></ul></ul><ul><li>Essential to body to build cell membranes, produce sex hormones, form bile acids (necessary for digestion of fats) </li></ul><ul><li>Travels thru bloodstream as part of a larger particle called Lipoproteins </li></ul><ul><ul><li>classified based on thickness or density of the surrounding protein shell </li></ul></ul>
    8. 8. LDL-”the bad guy” <ul><li>VLDL molecule with most of TriG removed; </li></ul><ul><ul><li>all of the chol remains </li></ul></ul><ul><li>Consumed by the body cells as building blocks for hormones and cell membranes </li></ul><ul><li>Excess LDL in blood forms deposits (plaques) on artery walls which narrows them </li></ul><ul><li>Susceptible to oxidation by free radicals which enhances the atherosclerotic process </li></ul><ul><ul><li>Blood clots as plaques grow leading to atherosclerosis, HD and heart attacks </li></ul></ul>
    9. 9. HDL-”the good guy” <ul><li>Transports excess cholesterol back to the liver to be excreted (reverse chol transport) </li></ul><ul><li>Exists in two main subclasses: HDL2 and HDL 3 </li></ul>
    10. 10. Forms of Dyslipidemia <ul><ul><li>Hypercholesterolemia </li></ul></ul><ul><ul><ul><li>elevated blood cholesterol levels </li></ul></ul></ul><ul><ul><li>Hypertriglyceridemia </li></ul></ul><ul><ul><ul><li>elevated triglyceride levels </li></ul></ul></ul><ul><ul><li>Hyperlipidema </li></ul></ul><ul><ul><ul><li>elevated chol and TG </li></ul></ul></ul><ul><ul><li>Hyperlipoproteinemia </li></ul></ul><ul><ul><ul><li>elevated lipoproteins </li></ul></ul></ul><ul><ul><li>Hypoalphalipoprotein syndrome </li></ul></ul><ul><ul><ul><li>low LDL </li></ul></ul></ul>
    11. 11. Causative Factors for Dyslipidemia <ul><li>Heredity/Genetics </li></ul><ul><li>Advanced age </li></ul><ul><li>Gender </li></ul><ul><li>Smoking </li></ul><ul><li>Excessive alcohol consumption </li></ul><ul><li>Fat diet </li></ul><ul><li>Over fat </li></ul><ul><li>Certain meds </li></ul><ul><li>Steroids </li></ul><ul><li>DM, Hypothyroid </li></ul><ul><li>Menopause </li></ul>
    12. 12. Video <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    13. 13. Forms Dyslipidemia: Lipids <ul><li>General term for fat molecules from diet or produced by the body : either in the form of triglycerides or cholesterol </li></ul><ul><li>Required for absorption of fat soluble vitamins (A,D,E,K) </li></ul><ul><li>Insoluble in blood and must combine with proteins (lipoproteins) to circulate </li></ul><ul><li>Excess is harmful and increases risk </li></ul><ul><li>Some is essential for good health and normal functioning </li></ul>
    14. 14. Cholesterol Guidelines
    15. 15. Diagnostic and Lab Evaluations <ul><li>Identified thru a complete blood lipid profile following a 12-hr fast </li></ul><ul><li>Most lab reports will provide: total cholesterol, HDL, LDL and TG </li></ul><ul><li>National Cholesterol Education Program (NCEP) </li></ul><ul><ul><li>goals for both individual management of CHOL </li></ul></ul><ul><ul><li>Recommends: adults over 20 have their total chol measured 1 time every 5 years </li></ul></ul>
    16. 16. Treatments <ul><li>Intensity of treatment depends on patients overall risk status for disease </li></ul><ul><li>Diet and exercise-3 to 6 months </li></ul><ul><li>Pharmacological management-considered an adjunct to the above </li></ul>
    17. 17. Types of Medications Used <ul><li>Statins -most effective and most commonly used </li></ul><ul><li>Nicotinic acid-comes with several side effects: skin irritation/flushing </li></ul><ul><li>Bile Acid Sequestrants (reduce uptake) </li></ul><ul><li>Fibric Acids (increase HDL) </li></ul><ul><li>Probucol-inhibits LDL oxidation </li></ul><ul><li>Estrogen Replacement Therapy (ERT) </li></ul>
    18. 18. Impact of Statins <ul><li>Powerful effect to lower LDL and raise HDL by blocking an enzyme needed to produce cholesterol in the liver </li></ul><ul><li>Typical improvements: 18-55% decrease in LDL, 5-15% increase in HDL and 7-30% decrease in TG </li></ul>
    19. 19. Statins: Cholesterol Lowering Drugs <ul><li>Name Brands </li></ul><ul><li>Crestor </li></ul><ul><li>Lipitor* </li></ul><ul><li>Altacor </li></ul><ul><li>Zocor* </li></ul><ul><li>Pravachol </li></ul><ul><li>Zetia </li></ul><ul><li>Advicor </li></ul><ul><li>Mevacor* </li></ul><ul><li>Additional Benefits: </li></ul><ul><li>Improved endothelial function </li></ul><ul><li>Decrease vascular inflammation </li></ul><ul><li>Decrease potential for thrombosis </li></ul><ul><li>Promote plaque stabilization </li></ul>
    20. 20. Complications <ul><li>HTN -drive LDL particles into the arterial wall with higher pressures </li></ul><ul><li>Diabetes makes LDL particles more likely to stick within the arterial wall </li></ul><ul><li>Smoking -makes arterial endothelium more permeable (vulnerable) </li></ul><ul><li>Metabolic Syndrome </li></ul>
    21. 21. Effects of Exercise on Lipid Metabolism <ul><li>Lowering of TG’s is most consistent effect of acute and chronic exercise (better skeletal muscle uptake) </li></ul><ul><li>HDL’s often increased with sustained aerobic exercise (exp of > 1200 cal/wk) </li></ul><ul><li>Weight/fat loss is required for significant reductions in LDL and TCH </li></ul><ul><li>Total amount of PA is more important than intensity to induce benefits </li></ul><ul><li>No conclusive evidence for resistance training impact </li></ul><ul><li>Improvement in lipid profiles is NOT universal w/ EX </li></ul>
    22. 22. Exercise and PA Guidelines <ul><li>Check with individuals physician (meds and coexisting conditions) </li></ul><ul><li>Emphasize aerobic endurance and caloric exp </li></ul><ul><li>3-5x/wk for 20-60 min </li></ul><ul><li>Progress as tolerated to 5-7x/wk for 40-60 min </li></ul><ul><li>Ex with higher volume and intensity shown to increase HDL </li></ul>
    23. 23. Ex Rx Guidelines <ul><li>Mode: aerobic large muscle activities </li></ul><ul><li>Intensity: moderate (40-75% of FC) </li></ul><ul><li>Frequency: most days of week-volume </li></ul><ul><li>Duration: as tolerated, the more the better-can accumulate thru day </li></ul><ul><li>Total energy expenditure = 1000-1600 kcal/wk </li></ul>
    24. 24. Dyslipidemia: Exercise Prescription <ul><li>Frequency: ≥5 d·wk -1 to maximize caloric expenditure </li></ul><ul><li>Intensity: 40% to 75% VO 2 R or HRR </li></ul><ul><li>Time: 30 to 60 min·d -1 . However, to promote or maintain weight loss, 50 to 60 min/d -1 or more of daily exercise is recommended. Performance of intermittent exercise of at least 10 minutes in duration to accumulate these duration recommendations is an effective alternative to continuous exercise. </li></ul>.
    25. 25. Dyslipidemia: Exercise Prescription (cont.) <ul><li>Type: the primary mode should be aerobic physical activities that involve the large muscle groups. As part of a balanced exercise program, resistance training exercise should be incorporated. People with dyslipidemia without comorbidities may follow the resistance training guidelines for healthy adults. </li></ul>