Ped488 dyslipidemia s 11
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Transcript of Ped488 dyslipidemia s 11
Dyslipidemia and Exercise
Dyslipidemia Abnormal blood lipid / lipoprotein levels Severe dyslipidemia linked to genetic defects in cholesterol
metabolism Less severe cases
response to other diseases or combining a specific genetic pattern with various environmental exposures (diet, smoking)
Overview of Pathophysiology TG and CHL move b/t the intestine, liver and tissue A variety of environmental, genetic and pathologic factors alter
TG and CHL transport High lipoprotein concentrations may alter pathways
influence CAD risk
Combined these factors are related to elevated lipid levels known as DYSLIPIDEMIA
Overview of Lipoprotein Metabolic Pathways
Lipids Lipids non-soluble in plasma so combines with proteins to form
lipoproteins Chylomicrons: from absorption of dietary triglyceride Very-low-density-Lipoprotein (VLDL): synthesized in the liver, primary
transport mechanism for synthesized triglyceride Low-density-Lipoprotein (LDL): final stage of breakdown VLDL, carier
of cholesterol High-density-Lipoprotein (HDL): involved in reverse transport of
cholesterol
Triglycerides Composed of three fatty acids and a glycerol
molecule Several functions
Membrane structure Eich energy source
9 calories of energy for each fat gram
Found in all cell membranes
Cholesterol Waxy, fat-like substance produced by liver Absorbed by intestine during food digestion
Dietary cholesterol is present in most food derived from animals (not in plants)
Essential to body to build cell membranes, produce sex hormones, form bile acids (necessary for digestion of fats)
Travels thru bloodstream as part of a larger particle called Lipoproteins classified based on thickness or density of the surrounding
protein shell
LDL-”the bad guy” VLDL molecule with most of TriG removed;
all of the chol remains Consumed by the body cells as building blocks for
hormones and cell membranes Excess LDL in blood forms deposits (plaques) on
artery walls which narrows them Susceptible to oxidation by free radicals which
enhances the atherosclerotic process Blood clots as plaques grow leading to atherosclerosis, HD
and heart attacks
HDL-”the good guy” Transports excess cholesterol back to the liver
to be excreted (reverse chol transport) Exists in two main subclasses: HDL2 and
HDL 3
Forms of Dyslipidemia Hypercholesterolemia
elevated blood cholesterol levels Hypertriglyceridemia
elevated triglyceride levels Hyperlipidema
elevated chol and TG Hyperlipoproteinemia
elevated lipoproteins Hypoalphalipoprotein syndrome
low LDL
Causative Factors for Dyslipidemia
Heredity/Genetics Advanced age Gender Smoking Excessive alcohol consumption Fat diet Over fat Certain meds Steroids DM, Hypothyroid Menopause
Video http://www.youtube.com/watch?v=hRx_i9npTDU&feature=related http://www.youtube.com/watch?v=QfaoHAIUy0g http://www.youtube.com/watch?v=R1DAjRixZKg&feature=related http://www.youtube.com/watch?v=-WhADd1GKtA&feature=related
Forms Dyslipidemia: Lipids General term for fat molecules from diet or produced by
the body: either in the form of triglycerides or cholesterol
Required for absorption of fat soluble vitamins (A,D,E,K) Insoluble in blood and must combine with proteins
(lipoproteins) to circulate Excess is harmful and increases risk Some is essential for good health and normal functioning
Cholesterol Guidelines
Diagnostic and Lab Evaluations Identified thru a complete blood lipid profile
following a 12-hr fast Most lab reports will provide: total cholesterol,
HDL, LDL and TG National Cholesterol Education Program (NCEP)
goals for both individual management of CHOL Recommends: adults over 20 have their total chol
measured 1 time every 5 years
Treatments Intensity of treatment depends on patients
overall risk status for disease Diet and exercise-3 to 6 months Pharmacological management-considered an
adjunct to the above
Types of Medications Used Statins-most effective and most commonly used Nicotinic acid-comes with several side effects:
skin irritation/flushing Bile Acid Sequestrants (reduce uptake) Fibric Acids (increase HDL) Probucol-inhibits LDL oxidation Estrogen Replacement Therapy (ERT)
Impact of Statins Powerful effect to lower LDL and raise HDL
by blocking an enzyme needed to produce cholesterol in the liver
Typical improvements: 18-55% decrease in LDL, 5-15% increase in HDL and 7-30% decrease in TG
Statins: Cholesterol Lowering DrugsName Brands Crestor Lipitor* Altacor Zocor* Pravachol Zetia Advicor Mevacor*
Additional Benefits: Improved endothelial
function Decrease vascular
inflammation Decrease potential for
thrombosis Promote plaque
stabilization
Complications HTN-drive LDL particles into the arterial
wall with higher pressures Diabetes makes LDL particles more likely to
stick within the arterial wall Smoking-makes arterial endothelium more
permeable (vulnerable) Metabolic Syndrome
Effects of Exercise on Lipid Metabolism Lowering of TG’s is most consistent effect of acute
and chronic exercise (better skeletal muscle uptake) HDL’s often increased with sustained aerobic exercise
(exp of > 1200 cal/wk) Weight/fat loss is required for significant reductions in
LDL and TCH Total amount of PA is more important than intensity to
induce benefits No conclusive evidence for resistance training impact Improvement in lipid profiles is NOT universal w/ EX
Exercise and PA Guidelines Check with individuals physician (meds and
coexisting conditions) Emphasize aerobic endurance and caloric exp 3-5x/wk for 20-60 min Progress as tolerated to 5-7x/wk for 40-60
min Ex with higher volume and intensity shown to
increase HDL
Ex Rx Guidelines Mode: aerobic large muscle activities Intensity: moderate (40-75% of FC) Frequency: most days of week-volume Duration: as tolerated, the more the better-
can accumulate thru day Total energy expenditure = 1000-1600
kcal/wk
Dyslipidemia: Exercise Prescription Frequency: ≥5 d·wk-1 to maximize caloric
expenditure Intensity: 40% to 75% VO2R or HRR Time: 30 to 60 min·d-1. However, to promote or
maintain weight loss, 50 to 60 min/d-1 or more of daily exercise is recommended. Performance of intermittent exercise of at least 10 minutes in duration to accumulate these duration recommendations is an effective alternative to continuous exercise.
.
Dyslipidemia: Exercise Prescription (cont.) Type: the primary mode should be aerobic
physical activities that involve the large muscle groups. As part of a balanced exercise program, resistance training exercise should be incorporated. People with dyslipidemia without comorbidities may follow the resistance training guidelines for healthy adults.