By Dr Srinivas Vasan

1. HYPERLIPIDEMIA - ROLE IN
ATHEROSCLEROSIS
DR. SRINIVASAN
VASCULAR RESIDENT
INSTITUTE OF VASCULAR SURGERY MMC,
CHENNAI

5. ATHEROSCLEROSIS – PATHOGENESIS
• INSUDATION HYPOTHESIS - INTIMAL CELL PROLIFERATION DUE TO INHIBITION OF LIPIDS
FROM BLOOD
• ENCRUSTATION HYPOTHESIS – ARTERIAL WALL ENCRUSTATION BY BLOOD.
COMPONENTS FORMING THROMBI
• MONOCLONAL HYPOTHESIS – MONOCLONAL PROLIFERATION OF SMC - G6PD
RESPONSE TO INJURY - EC DYSFUNCTION
RESPONSE TO RETENTION – LIPOPROTEIN ACCUMULATION IN SUBINTIMAL LAYER

9. LABORATORY METHODS
• SCREEN ?
• ATP III – NCEP : >20YRS , EVERY 5 YRS - FASTING LIPOPROTEIN PROFILE {TC,TG, LDL,
HDL-C, LDL-C}
• TC IN SNOT A GOOD PREDICTOR
• LDL-C = HDL-C
• TG – DM , METABOLIC SYNDROME, FHC
• LDL- P – SMALL, DENSE PARTICLE
• APO B 100
• NON HDL-C
• LIPO PROTEIN- C

11. GUIDELINESS FOR LIPID DISORDER
MANAGEMENT
• ADULT TREATMENT PANEL- I 1988
• EDUCATION AND LIFESTYLE MODIFICATION INTERVENTION
• LDL>190 OR LDL-C > 160 & 2 OR MORE RISK FACTORS
• ATP II 1993
• SECONDARY PREVENTION TRIAL
• LDL-C TARGET < 100MG/DL
• VULNERABLE PLAQUE – CAD- <70% CAS
• SECONDARY PREVENTION OF CHD

12. ATP III 2002
4 TRIALS
EVIDENCE BASED
AGREESIVE APPROACH TO ASSESS RISK & MANAGEMENT OF LIPID LEVELS
CHD RISK EQUIVALENTS
RISK STRATIFICATION
FRAMINGHAM RISK ASSESSMENT ALGORITHM
2005- AHA : PAD – LDL < 100 MG/DL CLASS I RECOMMENDATION, LDL<70 IF HIGH
RISK THERE
2013- AHA: 4 STATIN BENEFIT GROUPS :
SECONDARY PREVENTION OF ASCVD
PRIMARY PREVENTION –LIFE SPAN
LDL >190
DM , AGE 40- 75 ,LDL <190

21. NEWER AGENTS
• EXETIMIBE
• CHOLESTEROL ESTER TRANSFER PROTEIN AGENTS :
• TORCETRAPIB, ANA CETRAPIB – BOTH HOMO-,
HETEROTYPIC INH
• DALCETRAPIB- HETEROTYPIC INH
• PCSL9 PRO PROTEIN CONVERTASE SUBTILISE/KEXIN INH :
ALIROCUMAB , EVOLOCUMAB
• LOMITAPIDE , MIPOMERSIN - FH

22. Drugs HDl –C LDL-C TG
Statin 5- 25 18-60 7-30
Fibrate 3-15 10-20 25-50
Resin 10-20
Niacin 15-30 5-25
Ezetimib
e
15-20
Statin – 80 %
Doubling dose – 6%
Sequestrants -16%
Ezetimbe – 20%
STATIN
Cholesterol
blocking
agents
NiacinOmega 3 FA
Fenofibrate

23. TRIAL

25. Data from the Coronary Heart Disease Policy Model predict
that a population-wide decrease in sodium intake of 1200
mg
per day would decrease the annual number of CHD events
by 60 000 to 120 000 and overall mortality by 44 000 to
92 000
per year.