This document summarizes guidelines for screening and managing dyslipidemia from Malaysia and Canada. It discusses screening adults over age 40 in Malaysia, where 28% have dyslipidemia. Guidelines recommend lifestyle changes like Mediterranean diets, omega-3 supplements, and physical activity to improve lipid profiles and lower cardiovascular risk by up to 60%. Specific nutrition recommendations include nuts, legumes, fish, whole grains, and limiting saturated fats and trans fats. Physical activity guidelines suggest 150 minutes of medium exercise weekly plus strength training twice weekly.
the study was a pilot study done at National Institute of Ayurveda under the Phd Research Programme with an aim to find out new avenues in the managegement of Dyslipidemia - Medoroga and Coronary Heart Disease - Hridroga, thus initiating a new concept of Preventive Cardiology through Ayurveda & Panchakarma
the study was a pilot study done at National Institute of Ayurveda under the Phd Research Programme with an aim to find out new avenues in the managegement of Dyslipidemia - Medoroga and Coronary Heart Disease - Hridroga, thus initiating a new concept of Preventive Cardiology through Ayurveda & Panchakarma
Cardiovascular disease - more common in diabetic patients than in the general population
Dyslipidemia – common in patients with both types of diabetes.
Aggressive lipid treatment goals have been recommended for patients with type 2 diabetes
Diabetic Dyslipidemia is highly prevalent in the Indian diabetic population
Dyslipidemia in diabetes differs significantly with hypertriglyceridemia and small dense LDL-C
Deaths that are caused due to coronary heart disease CHD is a major cause of deaths in most of the population. Even though the mortality rate has been reducing, dyslipidemia is the major known risk factor in pathogenesis of CHD. In this paper we review the role of dyslipidemia and lipid changes that occur in men and women at different stages. We discuss about dyslipidemia causes symptoms and treatments and all the other issues that arise due to dyslipidemia. We talk about different drugs that are used in treating dyslipidemia and their side effects. Yong Yuan | Wen Chen | Lei Luo | Chen Xu "Dyslipidemia: Causes, Symptoms and Treatment" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38594.pdf Paper Url: https://www.ijtsrd.com/pharmacy/pharmaceutics/38594/dyslipidemia-causes-symptoms-and-treatment/yong-yuan
Diabetes is often accompanied by high triglyceride and high cholesterol levels. Saroglitazar (Lipaglyn) is a novel molecule that not only reduces elevated TG levels; it also reduces blood glucose levels. This presentation by Dr Vivek Baliga discusses this novel molecule.
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Cardiovascular disease - more common in diabetic patients than in the general population
Dyslipidemia – common in patients with both types of diabetes.
Aggressive lipid treatment goals have been recommended for patients with type 2 diabetes
Diabetic Dyslipidemia is highly prevalent in the Indian diabetic population
Dyslipidemia in diabetes differs significantly with hypertriglyceridemia and small dense LDL-C
Deaths that are caused due to coronary heart disease CHD is a major cause of deaths in most of the population. Even though the mortality rate has been reducing, dyslipidemia is the major known risk factor in pathogenesis of CHD. In this paper we review the role of dyslipidemia and lipid changes that occur in men and women at different stages. We discuss about dyslipidemia causes symptoms and treatments and all the other issues that arise due to dyslipidemia. We talk about different drugs that are used in treating dyslipidemia and their side effects. Yong Yuan | Wen Chen | Lei Luo | Chen Xu "Dyslipidemia: Causes, Symptoms and Treatment" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38594.pdf Paper Url: https://www.ijtsrd.com/pharmacy/pharmaceutics/38594/dyslipidemia-causes-symptoms-and-treatment/yong-yuan
Diabetes is often accompanied by high triglyceride and high cholesterol levels. Saroglitazar (Lipaglyn) is a novel molecule that not only reduces elevated TG levels; it also reduces blood glucose levels. This presentation by Dr Vivek Baliga discusses this novel molecule.
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Plant-based Eating: Enhancing Health Benefits, Minimizing Nutritional RisksRobin Allen
Learning Objectives
At the end of the session, the participants will be able to:
1. Know there is no single definition of a plant-based diet.
2. Discuss health aspects of vegetarian and vegan diets and quality of evidence supporting health claims.
3. Assess nutritional adequacy/status of vegetarians and/or vegans throughout the life cycle and provide strategies for meeting dietary recommendations for vitamin B12, DHA calcium, and zinc.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Introduction, Integration of CM risk factors, Targeting obesity, Management of hypertension, Management of dyslipidemia, Antiplatelet therapy, Management of microalbuminuria, CB1 blockade
In Pakistan, the overall prevalence of dyslipidemia in adolescents aged 10–18 years is 21.7~25.2%; prevalence is reported to be two times higher (53.1~56.1%) in obese adolescents. However, few studies have been conducted on the relationship between height and blood lipid concentrations in children and adolescents The recent emphasis on treatment of the dyslipidemia of the metabolic syndrome (hypertriglyceridemia, reduced high-density lipoprotein, and increased small, dense low-density lipoprotein particle number) has compelled practitioners to consider lipid-lowering therapy in a greater number of their patients, as one in two individuals over age 50 has the metabolic syndrome. Individuals with the metabolic syndrome typically have normal low-density lipoprotein cholesterol levels, and current lipid-lowering guidelines may underestimate their cardiovascular risk. Two subgroups of patients with the metabolic syndrome are at particularly high risk for premature CAD. One, individuals with type 2 diabetes, accounts for 20-30% of early cardiovascular disease. The second, familial combined hyperlipidemia, accounts for an additional 10-20% of premature CAD. Familial combined hyperlipidemia is characterized by the metabolic syndrome in addition to a disproportionate elevation of apolipoprotein B levels. The measurement of fasting glucose and apolipoprotein B, in addition to the fasting lipid profile, can help to estimate CAD risk in patients with the metabolic syndrome. In this research we compared allopathic medication and medicinal herb in treating hyperlipidemia.
My STSH Scholary Article about TREATMENT of PRE-DIABETES with SSDDDr. Sutanu Patra
I had done research on "Scope of Individualistic treatment with Serially Succussed and Diluted Drugs in treating Pre-diabetic condition: an Open-label Exploratory trial – in search of Prevention of Diabetes" and this was got awarded in Short Term Studentship in Homeopathy (STSH) 2014 by Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, Govt. of India.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Dyslipidemia: Screening and Lifestyle Intervention.
Patient PBL W13B3 | Syameer Firdaus | MED 3051 MBBS | Monash University
Main References:
Zambahari R et.al. 2011. Clinical Practice Guideline: Management of Dyslipidemia. Min of Health Malaysia.
Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of
Cardiovascular Disease in the Adult. Canadian J Cardio; 32.
APBL presentation for
3. Screening for Dyslipidemia
Who
Why
How
Reference: Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
HDP is independently
associated with increased
risk of CVD death: 2.14 (1.3-
3.6) for women with
preeclampsia and 9.5 (4.5-
20.3) for severe
preeclampsia.
4. Screening for Dyslipidemia
Who
Why
How
Reference: Malaysian National Health and Morbidity Survey 2006 via Zambahari R et.al. 2011. Clinical Practice Guideline: Management of Dyslipidemia. Min of Health
Malaysia. Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
Prevalence of dyslipidemia amongst Malaysians
above the age of 40 years old:
28%
5. Screening for Dyslipidemia
Who
Why
How
Reference: Malaysian National Health and Morbidity Survey 2006 via Zambahari R et.al. 2011. Clinical Practice Guideline: Management of Dyslipidemia. Min of Health
Malaysia. Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
Individuals with a history of
tri-glyceride levels > 4.5
mmol/L that lipid and
lipoprotein levels be
measured fasting.
LDL-C levels do not reliably
indicate LDL particle number
when triglycerides are > 1.5
mmol/L. Hence use NHDLC
or ApoB as treatment target
because it is not altered after
eating.
6.
7. Mx of Dyslipidemia
Malaysian’s Target
Reference: Zambahari R et.al. 2011. Clinical Practice Guideline: Management of Dyslipidemia. Ministry of Health Malaysia.
8. Mx of Dyslipidemia
Malaysia
Reference: Zambahari R et.al. 2011. Clinical Practice Guideline: Management of Dyslipidemia. Ministry of Health Malaysia.
60-80% lower risk of
CHD with low-risk
lifestyle behaviors.
REGARDS Prospective
Study.
10-15% improvement
in Total Cholesterol
9. Mx of Dyslipidemia
Malaysia
Reference: Zambahari R et.al. 2011. Clinical Practice Guideline: Management of Dyslipidemia. Min of Health Malaysia.
Also improve
cardiovascular fitness,
lower BP, increase
insulin sensitivity,
increase HDL-C levels
and decrease TG
levels.
10.
11.
12. “Low-risk lifestyle behaviors are variably defined as follows: a
healthy body weight (body mass index of 18.5-25 to < 30
kg/m2 or waist circumference of < 88 cm for women or < 95 to
< 102 cm for men), healthy diet (higher fruits and vegetables
Mediterranean dietary pattern), regular physical activity (! 1
time per week to 40 min/d plus 1 h/wk of intense exercise),
smoking cessation (never smoked to smoking cessation for > 12
months), moderate alcohol consumption (12-14 g/mo to 46
g/d), and moderate sleep duration (6-8 hours per night).
Individuals can achieve benefits in a dose-dependent manner.”
13. Mx of Dyslipidemia
Canadian’s Target
Reference: Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
14. Mx of Dyslipidemia
Canada
Nutrition
• Objective
• Evidences
• What to eat?
Physical Activity
• Requirements
Reference: Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
To maintain and achieve healthy body weight, improve lipid profile and reduce
risk of CV events.
15.
16. Mx of Dyslipidemia
Canada
Nutrition
• Objective
• Recommendation
• What to eat?
Physical Activity
• Requirements
Reference: Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
Adopt Mediterranean Diet
High doses of Omega-3 PUFAs (2-4 g/d)
Avoid trans fats
Decrease saturated fats intake
Polyunsaturated fats with Omega-3/6 PUFA
Choose plant source of MUFA and carbohydrates
30% reduced risk of
CV event in PREDIMED
study. Otherwise
DASH diet.
Lower doses will have
no benefit.
<9% of of total daily
energy intake
preferably
17. Mx of Dyslipidemia
Canada
Nutrition
• Objective
• Recommendation
• What to eat?
Physical Activity
• Requirements
Reference: Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
Nuts
Legumes
Soy
Olive oil
Fish
Fruits and Vegetables
Highly-soluble Fibre
Whole Grains
Low GI
Vegetarian
Oats, Barley, Psyllium,
Pectin, Konjac
Mannan
Omega-3 rich fish e.g.
Mackerel, Herring,
Sardines, Salmon
18. Mx of Dyslipidemia
Canada
Nutrition
• Objective
• Recommendation
• What to eat?
Physical Activity
• Requirements
Reference: Anderson TJ et.al. 2016. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease
in the Adult. Canadian J Cardio; 32.
At least 150 mins accumulated
medium to vigorous aerobic/week of
at least 10 mins
Muscle & bone strengthening activities
at least 2/7
More activities= more benefits
4-7 kcal/min at least
Stationary bike, brisk
walking, water
aerobics.
Women diagnosed with HDP should be approached for screening with a lipid panel regardless of age. There is insufficient evidence to classify these individuals in the high-risk (ie, statin-indicated condition) category. How- ever, drug therapy could be discussed with the patient because of the high long-term risk. Statins are contraindicated during pregnancy so risk-benefit ratios must be particularly assessed for treatment in women of child-bearing age (see the Hyper- tensive Disorders of Pregnancy and Cardiovascular Risk section of the Supplementary Material for a full narrative).
Women diagnosed with HDP should be approached for screening with a lipid panel regardless of age. There is insufficient evidence to classify these individuals in the high-risk (ie, statin-indicated condition) category. How- ever, drug therapy could be discussed with the patient because of the high long-term risk. Statins are contraindicated during pregnancy so risk-benefit ratios must be particularly assessed for treatment in women of child-bearing age (see the Hyper- tensive Disorders of Pregnancy and Cardiovascular Risk section of the Supplementary Material for a full narrative).
In contrast to changes in triglyceride levels after a large oral fat load, triglyceride and LDL-C levels change relatively little after normal meals in most of the population. General and community-based population studies reported that triglycer- ide levels increase only 0.2-0.3 mmol/L or 20% after eating normal meals,27,28 typically peaking 4 hours postprandi- ally.29,30 LDL-C levels are reduced after eating, by an average of 0.1-0.2 mmol/L or 10%,27,28 either because of hemodi- lution,27 exchange of cholesterol on LDL by triglycerides, or because of calculation using the Friedwald formula. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and apolipoprotein (apo)B100 do not vary appreciably after eating. Recent data from the National Health and Nutrition Survey (NHANES) showed that the ability to predict CVD events was identical for nonfasting and fasting LDL-C determination.31
Nonfasting lipid testing increases convenience for patients and laboratory operations. Nonfasting testing does not affect risk assessment strategies, because total and HDL-C, used to estimate 10-year CVD risk, are not altered significantly in the nonfasting state.
Because the major studies that determined changes in nonfasting lipids excluded individuals with previous triglyc- eride levels > 4.5 mmol/L, we do not have data on changes in lipid levels in this subgroup of patients (estimated to be 1.5%- 2% of the population27,28) after eating. Moreover, triglyceride replacement of cholesterol on LDL occurs with elevated tri- glyceride levels, meaning reported LDL-C levels do not reli- ably indicate LDL particle number when triglycerides are > 1.5 mmol/L.32 For this reason it remains the recommendation to use the non-HDL-C level (or apoB), which is not altered after eating or by triglycerides, as the treatment target of choice when triglyceride levels are > 1.5 mmol/L.33 Finally, individuals with a previous triglyceride level > 4.5 mmol/L should have their lipids tested in the fasting state.
The purpose of this guideline change is to provide physi- cians and patients with the option to have screening and follow- up nonfasting lipid testing, however, it is recognized that some physicians will prefer that patients have their lipid profiles tested fasting (Fig. 2). Although nonfasting triglycerides are predictive of increased CVD and mortality risk, and increased levels are indicators of insulin resistance and atherogenic remnant lipoproteins,34,35 nonfasting triglyceride targets are not currently included in any national lipid guidelines. A nonfasting approach has recently been advocated in Europe.36
Low-risk lifestyle behaviours are variably defined as follows: a healthy body weight (body mass index of 18.5-25 to < 30 kg/m2 or waist circumference of < 88 cm for women or < 95 to < 102 cm for men), healthy diet (higher fruits and vegetables Mediterranean dietary pattern), regular physical activity (! 1 time per week to 40 min/d plus 1 h/wk of intense exercise), smoking cessation (never smoked to smoking cessation for > 12 months), moderate alcohol consump- tion (! 12-14 g/mo to 46 g/d), and moderate sleep duration (6-8 hours per night). Individuals can achieve benefits in a dose-dependent manner.
Recognizing that nutrient-based approaches might miss important cholesterol-lowering interactions,78 there has been a move toward more food and dietary pattern-based approaches to CV risk reduction. The Prevención con Dieta Medi- terránea (PREDIMED) study was a Spanish, multicentre, randomized trial of the effect of a Mediterranean diet sup- plemented with either extra-virgin olive oil or mixed nuts compared with a low-fat control diet on major CV events (MI, stroke, or death from CV causes) in 7447 participants at high CV risk.79 The primary outcome was reduced by 30% in both Mediterranean diet groups after the trial was stopped early for benefit at a median follow-up of 4.8 years.79 Other dietary patterns that include shared elements of a Mediterra- nean dietary pattern have also shown some evidence of CV benefit in systematic reviews and meta-analyses (Supplemental Table S1). These include a Portfolio dietary pattern (Supplemental Table S2),80 Dietary Approaches to Stop Hypertension (DASH) dietary pattern,81 low-glycemic index/ glycemic load dietary pattern (Supplemental Table S3),82 and vegetarian dietary pattern,83 as well as dietary patterns high in nuts,79,84 legumes,84 olive oil,79 fruits and vegetables,85 total fibre,86 and whole grains.87 Dietary therapy using these means can be considered to augment drug therapy with statins.
In Supplemental Table S4 the expected CV and lipid- lowering benefits of the various evidence-based dietary pat- terns for dyslipidemia management are summarized. Canadian nutrition practice guidelines for cardiac rehabilitation and CVD prevention are cited elsewhere.88
