Page 146 - fbkCardioDiabetes_2017

122 Triglyceride And Cardiovascular Risk Whats New???

The pattern of Indian dyslipidemia is different from 3. Chylomicronemia Syndrome
western dyslipidemia.
4. Type III hyperlipidemia or Dysbetalipoproteinemia
In a study comparing lipid profiles of Indians,A-
sians,and American Whites,it was found that Indians Secondary causes of Hypertriglyceridemia
had higher triglycerides, lower HDL-C and higher li- 1. Metabolic Syndrome
poprotein(a) while LDL-C and total cholesterol were
8
similar in the two populations. In IACMR-INDIAB 2. Endocrine Disorder– type 2 diabetes mellitus,Poly-
study 11.8% had high LDL-C levels while 20.2% had cystic Ovary Syndrome,
isolated hypertriglyceridemia These observations 3. Others-acromegly, and pregnancy
reinforce the fact that Indians need different guide-
lines,consensus and targets for the management of 4. Drugs
dyslipidemia as compared to the Western population a) Oral estrogen treatment
Where guidelines are mainly focused in reduction of
LDL-C alone. b) Tamoxifen therapy (less pronounced with ral-
oxifene)
TRIGLYCERIDES AND ATHEROSCLEROSIS: c) Antihypertensive drugs with a potential to in-
Earlier the association between hypertriglyceridemia crease triglyceride levels are thiazide and Fu-
and atherosclerosis was debated, but now it is rosemide diuretics and β- adrenergic blocking
recognized that hypertriglyceridemia is associated agents and.
with coronary CV risk. Triglycerides are found only in d) Retinoids (e.g isotretinoin and bexarotene) are
minor quantities in atherosclerotic plaques with cho- associated with increased triglyceride levels
lesterol forming a major part.In 1972,Stockholm pro- ,and Mechanisms may involve both increased
spective study suggested that hypertriglyceridemia hepatic VLDLand apoC-III production and de-
was an independent risk factor for heart disease. 10 creased LpL, Hypertriglyceridemia can be seen
Again in 1977, a Finnish study correlated increased with certain Antipsychotic medications are as-
cardiac mortality with triglycerides levels more than sociated with weight gain,insulin resistance
150mg/dL. Hypertriglyceridemia is also associated and worsening of the metabolic Syndrome
12
with increased mortality in patients with Known CHD,
and both increased mortality and reduced event-free Atherogenic potential of triglycerides:
survival after coronary artery bypass graft surgery
(CABG). 13 1. Accumulation of Chylomicron remnants
2. Accumulation of VLDL remnants
Endogenous pathway of Lipid Metabolism
3. Generation of small,dense LDL
Nascent VLDL particles containing apolipoproteins B
100 and E are synthesized in the liver.Cholesteryl es- 4. Associationn with low HDL-C
ters and other lipoproteins derived from breakdown 5. Increased coagulability
of HDL are added to form VLDL particle The en-
zyme Lipoprotein lipase (LPL)lyses VLDL into smaller a) Increased plasminogen activator inhibitor(PAI-1)
VLDL remnants.these remants are enriched in apo B) Increased, factor VIIc6 .Activation of Prothrom-
B-100 and E.These VLDL remnents are cleared in the bin to thrombin
liver by LDL receptors, or subjected to the action of
hepatic lipase to form LDL particles containing apoB- FASTING VS NON FASTING LIPID PROFILE:
100(Fig.1)
Traditionally a blood sample for Lipid profile is taken
in the Fasting state.Severaal Recent studies have not
HYPERTRIGLYCERIDEMIA- Causes: shown any advantage of Performing a Fasting Lipid
Hypertriglyceridemia can result from increased pro- profile testing. Rather ,there is an advantage of Non-
duction, reduced catabolism,or a combination there- fasting Lipid profile measurements in that the blood
of. sampling process is simplified for patients,general
Genetic causes of Hypertriglyceridemia practitioners,and hospitals,and therefore probably
increases compliance to Lipid Lowering Therapy
1. Familial Combined Hyperlipidemia (FCHL) and Monitoring. Also it is Important to note that

2. Familial Hypertriglyceridemia (FHTG) most people eat Regularly throughout the day and

GCDC 2017