Hinduja Hospital Webinar on Lipids : Friends and Foe


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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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Hinduja Hospital Webinar on Lipids : Friends and Foe

  1. 1. Lipids- Friend or FoeDr. Preeti Chhabria, M.D. (USA)Consultant in Internal MedicineHinduja Hospital
  2. 2. 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.
  3. 3. 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)
  4. 4. Lipids- Friend or FoeLipid profile consists of-• Total cholesterol• LDL (bad or harmful) cholesterol• HDL (good or protective cholesterol)• Triglycerides• Total cholesterol/ HDL ratio
  5. 5. 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 LDLLDL goal based on Risk cateogory LDLgoalHigh risk >20 % <100ModerateRisk 10-20% <130Low risk(0-1 risk factors) <160
  6. 6. 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 DrugHigh 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
  7. 7. 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
  8. 8. 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
  9. 9. Lipids –Friend or FoeOther 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
  10. 10. Lipids-Friend or FoeManagement-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 exerciseOther measures-• Add oatmeal (reduces LDL)• Add intake of fiber 10-25 g/day, fruits, legumes
  11. 11. 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.
  12. 12. Lipids-Friend or Foe• Side effects of Statins• Well tolerated• Muscle aches, weakness• Alterations in liver enzymes• Drug interactions
  13. 13. Lipids-Friend or FoeDrug 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
  14. 14. Lipids-Friend or FoeLow HDL cholesterol treatment-• If low cardiac risk- exercise, weight loss and smoking cessation increase HDL by 30%• If high risk (CHD or risk equivalent)- Primary goal is LDL tx with statin if LDL normal/at goal, add fibrate or niacin
  15. 15. Lipids-Friend or FoeGeriatrics Age group 65-80• Use statin for established CVD• For primary prevention, check R/B ratio• Greater risk of s/e, especially myopathy
  16. 16. Lipids-Friend or Foe• Stroke prevention- Pt with CVD tx of hyperlipidemia helps prevent CVA• For secondary stroke prevention- keep LDL <70 control non HDL cholesterol
  17. 17. Lipids-Friend or FoeMetabolic syndrome:• 7 fold increased risk of DM• 2 fold increase in future risk of cv disease• 1.5 fold increase in future all cause mortalityDefinition- 3 of the following criteria:• Truncal obesity• High BP• High triglycerides• Low HDL• High Fasting sugar
  18. 18. Lipids-Friend or FoeMetabolic 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 wellDiabetes prevention-• Exercise, weight loss, low gylcemic diet and metformin if needed
  19. 19. 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
  20. 20. LipidS- Friend or Foehttp://www.hindujahospital.com/dr-preeti-chhabria/ ! •