High density lipoprotein prevention: Difference between revisions
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===Risk Assessment=== | ===Risk Assessment=== | ||
Patients without established [[coronary heart disease]] should be thoroughly assessed with an improved risk prediction tool e.g., [[Framingham risk score|Framingham risk prediction chart]] to determine when to start pharmacotherapy for those at high risk for CHD. | Patients without established [[coronary heart disease]] should be thoroughly assessed with an improved risk prediction tool e.g., [[Framingham risk score|Framingham risk prediction chart]] to determine when to start pharmacotherapy for those at high risk for CHD. Another way to assess the CHD risk is by the use of lipid CHD risk markers (e.g., lipoprotein(a), apolipoprotein B, dense LDL-C) and non-lipid CHD risk markers such as [[homocysteine]],<ref name="Boushey-1995">{{Cite journal | last1 = Boushey | first1 = CJ. | last2 = Beresford | first2 = SA. | last3 = Omenn | first3 = GS. | last4 = Motulsky | first4 = AG. | title = A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. | journal = JAMA | volume = 274 | issue = 13 | pages = 1049-57 | month = Oct | year = 1995 | doi = | PMID = 7563456 }}</ref> [[fibrinogen]], or [[C-reactive protein]] | ||
==Primary Prevention== | ==Primary Prevention== | ||
Revision as of 21:23, 27 September 2013
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High Density Lipoprotein Microchapters |
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High density lipoprotein prevention On the Web |
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Risk calculators and risk factors for High density lipoprotein prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Statins and fibrate appear to be effective in patients with low HDL levels compared to those in normal HDL levels in terms of risk reduction.Fibrates are more effective when low HDL levels coincide with low levels of LDL levels. Before a combination of statins and fibrates are considered, dietary modifications and lifestyle changes can be effective tools to raise HDL levels. However, a combination therapy of statins with fibrates can result in myopathy as a potential adverse effect.
Risk Assessment
Patients without established coronary heart disease should be thoroughly assessed with an improved risk prediction tool e.g., Framingham risk prediction chart to determine when to start pharmacotherapy for those at high risk for CHD. Another way to assess the CHD risk is by the use of lipid CHD risk markers (e.g., lipoprotein(a), apolipoprotein B, dense LDL-C) and non-lipid CHD risk markers such as homocysteine,[1] fibrinogen, or C-reactive protein
Primary Prevention
Lifestyle Modification
| LIFESTYLE MEASURE | EFFECT ON HDL |
| Physical exercise[2] | 5-30% increase |
| Weight reduction | 5-20% increase[3] |
| Smoking cessation | 5% increase[4] |
| Multivitamins | 31% increase in HDL |
| DASH diet | 21% increase in HDL[5] |
| Low carbohydrate diet | 4.5mg/dl increase in HDL[6] |
| Soy protein with isoflavones | 3% increase in HDL[7] |
| Fish oil (omega-3 fatty acid) | Significant increase in HDL2 fraction[8] |
| Fish oil with exercise | 8% increase in HDL[9] |
| Low fat diet | 5-14% increase in HDL when combined with exercise[10] |
| Moderate alcohol consumption | 5-10% increase in HDL[11] |
Who To Treat
Pharmacologic Therapy
| DRUGS | MECHANISM OF ACTION | EFFECT ON HDL | SIDE EFFECTS |
| Nicotinic acid (Niacin) | Decreases VLDL synthesis in the liver through diaglycerol acyl transferase-2 (DGAT-2),[12] decreases HDL-apo A-I catabolism[13] | 15-35% increase | Cutaneous flushing, hyperglycemia, hyperuricemia, hepatotoxicity |
| Fibrates | Direct stimulation of apo-A1 and apo-AII synthesis via peroxisome proliferator-activated receptors,[14] | 10-20% increase | Increased risk of myopathy when combined with statins, gallstones, dyspepsia |
| HMG-CoA reductase inhibitor | Increases synthesis of apo-A1 and HDL in the liver,[15] increases ABCA1 mRNA in hepG2 cells,[16] inhibits CETP mass and activities[17] | 5-15% increase | Myopathy, rhabdomyolysis |
| Ezetimibe | Inhibits cholesterol absorption at intestine level | 3% increase in HDL along with statins[18] | Headache, diarrhea, hypersensitivity |
| Thiazolidinediones | Increase in adiponectin which increases insulin resistance | 14% increase in HDL[19] | Fluid retention |
| Hormone replacement therapy | Increases Apo-A1 and decreases activity of hepatic lipase | 5 to 20% increase | Increases risk of stroke and thromboembolic diseases |
| Bile acid sequestrants | Increases apo A-1 production[20] | 3-5% increase | GI discomfort, constipation, reduces absorption of other medications |
| Low HDL | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rule out secondary causes Hypothyroidism Diabetes mellitus Uremia Liver disease Medications - diuretics, progestin, androgens, beta blockers Acute illness - MI, burns, surgery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lifestyle modification Diet[21] Physical exercise Smoking cessation Weight loss[22] Intake of unhydrogenated monounsaturated fat[23][24] e.g., olive oil, canola oil | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Assess risk | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| High risk CHD risk>20% per 10 years | Low risk CHD≤20% per 10 years | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Statins or Niacin | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive family history of premature CHD | Negative family history of premature CHD | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Considar statins or niacin | Continue non-pharmacological approach | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Boushey, CJ.; Beresford, SA.; Omenn, GS.; Motulsky, AG. (1995). "A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes". JAMA. 274 (13): 1049–57. PMID 7563456. Unknown parameter
|month=ignored (help) - ↑ Thompson PD (1990). "What do muscles have to do with lipoproteins?". Circulation. 81 (4): 1428–30. PMID 2317921.
- ↑ Dattilo AM, Kris-Etherton PM (1992). "Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis". Am J Clin Nutr. 56 (2): 320–8. PMID 1386186.
- ↑ Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH (2011). "Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial". Am Heart J. 161 (1): 145–51. doi:10.1016/j.ahj.2010.09.023. PMC 3110741. PMID 21167347.
- ↑ Azadbakht, L.; Mirmiran, P.; Esmaillzadeh, A.; Azizi, T.; Azizi, F. (2005). "Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome". Diabetes Care. 28 (12): 2823–31. PMID 16306540. Unknown parameter
|month=ignored (help) - ↑ Nordmann, AJ.; Nordmann, A.; Briel, M.; Keller, U.; Yancy, WS.; Brehm, BJ.; Bucher, HC. (2006). "Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials". Arch Intern Med. 166 (3): 285–93. doi:10.1001/archinte.166.3.285. PMID 16476868. Unknown parameter
|month=ignored (help) - ↑ Zhan, S.; Ho, SC. (2005). "Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile". Am J Clin Nutr. 81 (2): 397–408. PMID 15699227. Unknown parameter
|month=ignored (help) - ↑ Sacks FM, Hebert P, Appel LJ, Borhani NO, Applegate WB, Cohen JD; et al. (1994). "The effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group". J Hypertens Suppl. 12 (7): S23–31. PMID 7769501.
- ↑ Herrmann W, Biermann J, Kostner GM (1995). "Comparison of effects of N-3 to N-6 fatty acids on serum level of lipoprotein(a) in patients with coronary artery disease". Am J Cardiol. 76 (7): 459–62. PMID 7653444.
- ↑ Varady KA, Jones PJ (2005). "Combination diet and exercise interventions for the treatment of dyslipidemia: an effective preliminary strategy to lower cholesterol levels?". J Nutr. 135 (8): 1829–35. PMID 16046704.
- ↑ Rimm, EB.; Williams, P.; Fosher, K.; Criqui, M.; Stampfer, MJ. (1999). "Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors". BMJ. 319 (7224): 1523–8. PMID 10591709. Unknown parameter
|month=ignored (help) - ↑ Wierzbicki, AS. (2011). "Niacin: the only vitamin that reduces cardiovascular events". Int J Clin Pract. 65 (4): 379–85. doi:10.1111/j.1742-1241.2011.02630.x. PMID 21401825. Unknown parameter
|month=ignored (help) - ↑ Kamanna, VS.; Kashyap, ML. (2008). "Mechanism of action of niacin". Am J Cardiol. 101 (8A): 20B–26B. doi:10.1016/j.amjcard.2008.02.029. PMID 18375237. Unknown parameter
|month=ignored (help) - ↑ Vu-Dac, N.; Schoonjans, K.; Kosykh, V.; Dallongeville, J.; Fruchart, JC.; Staels, B.; Auwerx, J. (1995). "Fibrates increase human apolipoprotein A-II expression through activation of the peroxisome proliferator-activated receptor". J Clin Invest. 96 (2): 741–50. doi:10.1172/JCI118118. PMID 7635967. Unknown parameter
|month=ignored (help) - ↑ Yamashita, S.; Tsubakio-Yamamoto, K.; Ohama, T.; Nakagawa-Toyama, Y.; Nishida, M. (2010). "Molecular mechanisms of HDL-cholesterol elevation by statins and its effects on HDL functions". J Atheroscler Thromb. 17 (5): 436–51. PMID 20513953. Unknown parameter
|month=ignored (help) - ↑ Maejima, T.; Sugano, T.; Yamazaki, H.; Yoshinaka, Y.; Doi, T.; Tanabe, S.; Nishimaki-Mogami, T. (2011). "Pitavastatin increases ABCA1 expression by dual mechanisms: SREBP2-driven transcriptional activation and PPARα-dependent protein stabilization but without activating LXR in rat hepatoma McARH7777 cells". J Pharmacol Sci. 116 (1): 107–15. PMID 21521932.
- ↑ van Venrooij, FV.; Stolk, RP.; Banga, JD.; Sijmonsma, TP.; van Tol, A.; Erkelens, DW.; Dallinga-Thie, GM. (2003). "Common cholesteryl ester transfer protein gene polymorphisms and the effect of atorvastatin therapy in type 2 diabetes". Diabetes Care. 26 (4): 1216–23. PMID 12663600. Unknown parameter
|month=ignored (help) - ↑ Ballantyne, CM.; Houri, J.; Notarbartolo, A.; Melani, L.; Lipka, LJ.; Suresh, R.; Sun, S.; LeBeaut, AP.; Sager, PT. (2003). "Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial". Circulation. 107 (19): 2409–15. doi:10.1161/01.CIR.0000068312.21969.C8. PMID 12719279. Unknown parameter
|month=ignored (help) - ↑ Szapary, PO.; Bloedon, LT.; Samaha, FF.; Duffy, D.; Wolfe, ML.; Soffer, D.; Reilly, MP.; Chittams, J.; Rader, DJ. (2006). "Effects of pioglitazone on lipoproteins, inflammatory markers, and adipokines in nondiabetic patients with metabolic syndrome". Arterioscler Thromb Vasc Biol. 26 (1): 182–8. doi:10.1161/01.ATV.0000195790.24531.4f. PMID 16284192. Unknown parameter
|month=ignored (help) - ↑ Shepherd, J. (1989). "Mechanism of action of bile acid sequestrants and other lipid-lowering drugs". Cardiology. 76 Suppl 1: 65–71, discussion 71-4. PMID 2713876.
- ↑ Wood, PD.; Stefanick, ML.; Dreon, DM.; Frey-Hewitt, B.; Garay, SC.; Williams, PT.; Superko, HR.; Fortmann, SP.; Albers, JJ. (1988). "Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise". N Engl J Med. 319 (18): 1173–9. doi:10.1056/NEJM198811033191801. PMID 3173455. Unknown parameter
|month=ignored (help) - ↑ Berns, MA.; de Vries, JH.; Katan, MB. (1989). "Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period". Am J Epidemiol. 130 (6): 1109–22. PMID 2589304. Unknown parameter
|month=ignored (help) - ↑ Oh, K.; Hu, FB.; Manson, JE.; Stampfer, MJ.; Willett, WC. (2005). "Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study". Am J Epidemiol. 161 (7): 672–9. doi:10.1093/aje/kwi085. PMID 15781956. Unknown parameter
|month=ignored (help) - ↑ Mensink, RP.; Katan, MB. (1990). "Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects". N Engl J Med. 323 (7): 439–45. doi:10.1056/NEJM199008163230703. PMID 2374566. Unknown parameter
|month=ignored (help)