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/

1. Lipids- Friend or Foe
Dr. Preeti Chhabria, M.D. (USA)
Consultant in Internal Medicine
Hinduja Hospital

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. Lipids-Friend or Foe
Major 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. 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

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 LDL
LDL goal based on Risk cateogory LDLgoal
High risk >20 % <100
Moderate
Risk 10-20% <130
Low risk
(0-1 risk factors) <160

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 Drug
High risk(CHD/ <100 >100 >130
Equivalent)>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. 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. 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. Lipids –Friend or Foe
Other lipid risk factors-
• Lp(a) lipoprotein, small LDL particles
Apolipoprotein B, Total cholesterol/HDL ratio
• ATP III guidelines do NOT recommend
measuring, following or treating these factors

10. Lipids-Friend or Foe
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

11. Lipids-Friend or Foe
Pharmacotherapy-
• 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. Lipids-Friend or Foe
• Side effects of Statins
• Well tolerated
• Muscle aches, weakness
• Alterations in liver enzymes
• Drug interactions

13. Lipids-Friend or Foe
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

14. Lipids-Friend or Foe
Low 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. Lipids-Friend or Foe
Geriatrics Age group 65-80
• Use statin for established CVD
• For primary prevention, check R/B ratio
• Greater risk of s/e, especially myopathy

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. Lipids-Friend or Foe
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

18. Lipids-Friend or Foe
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

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. LipidS- Friend or Foe
http://www.hindujahospital.com/dr-preeti-chhabria/
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