Hinduja Hospital Webinar on Lipids : Friends and Foe

Lipids- Friend or Foe

Dr. Preeti Chhabria, M.D. (USA)Consultant in Internal MedicineHinduja Hospital

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.

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)

Lipids- Friend or Foe

Lipid profile consists of-

• Total cholesterol

• LDL (bad or harmful) cholesterol

• HDL (good or protective cholesterol)

• Triglycerides

• Total cholesterol/ HDL ratio

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 LDL

LDL goal based on Risk cateogory LDLgoal

High risk >20 % <100

ModerateRisk 10-20% <130

Low risk(0-1 risk factors) <160

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 Drug

High 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


High Triglycerides

• Increase CV risk

• Causes of high triglycerides

• Drugs thiazide diuretics, estrogens, steroids, beta blockers

• Diabetes

• Obesity

• Kidney disease

• Diet and alcohol induced

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

Lipids –Friend or Foe

Other 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


Management-

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 exercise

Other measures-• Add oatmeal (reduces LDL)• Add intake of fiber 10-25 g/day, fruits, legumes

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.


•Side effects of Statins

•Well tolerated

•Muscle aches, weakness

•Alterations in liver enzymes

•Drug interactions


Drug 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


Low HDL cholesterol treatment-

• If low cardiac risk- exercise, weight loss and smoking cessationincrease HDL by 30%

• If high risk (CHD or risk equivalent)-Primary goal is LDL tx with statinif LDL normal/at goal, add fibrate or niacin

Geriatrics Age group 65-80

• Use statin for established CVD

• For primary prevention, check R/B ratio

• Greater risk of s/e, especially myopathy



• Stroke prevention-Pt with CVDtx of hyperlipidemia helps prevent CVA

• For secondary stroke prevention-keep LDL <70control non HDL cholesterol


Metabolic syndrome:

• 7 fold increased risk of DM• 2 fold increase in future risk of cv disease• 1.5 fold increase in future all cause mortality

Definition- 3 of the following criteria:

• Truncal obesity• High BP• High triglycerides• Low HDL• High Fasting sugar


Metabolic 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 well

Diabetes prevention- • Exercise, weight loss, low gylcemic diet and

metformin if needed


•Adopt lifestyle changes

•Take the initiative to test your lipids

•Do not resist treatment

•Ensure follow up

• Let’s befriend our foe

LipidS- Friend or Foe

http://www.hindujahospital.com/dr-preeti-chhabria/

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Hinduja Hospital Webinar on Lipids : Friends and Foe

Health & Medicine

Transcript of Hinduja Hospital Webinar on Lipids : Friends and Foe