Dyslipidemia

Key Points

• Patients undergoing screening for dyslipidemia should have a complete fasting lipid profile.

• LDL and non-HDL (total cholesterol - HDL) are atherogenic and have defined targets for therapy based on global risk factor burden.

• LDL-C is currently the primary target of therapy in patients with dyslipidemia, although non-HDL-C or apoB100 may become the next primary target of therapy.

• HDL is antiatherogenic, and when less than 40 mg/dL in men and

50 mg/dL in women, therapeutic effort should be made to raise HDL.

• Therapeutic lifestyle changes are an important component of any regimen designed to treat dyslipidemia.

Figure 27-1 Molecular and histologic pathways for reverse cholesterol transport. To deliver peripheral cholesterol back to the liver or steroidogenic organs such as the adrenal glands, placenta, or ovaries, apoA-I and nascent discoidal HDL interact with cells such as macrophages and foam cells within blood vessel walls. The HDL undergoes a series of cell receptor-dependent and serum enzyme-dependent maturation and speciation reactions (HDL speciation). HDL can interact directly with a variety of hepatocyte surface receptors, including SR-BI. The cholesterol esters in HDL can also be transported back to the liver by an indirect pathway for reverse cholesterol transport that depends on CETP and the LDL and LDL-RRP receptors. ABCA1, ATP-binding membrane cassette transporter A1; apoA-I, apoprotein A-I; ApoE, apoprotein E; CE, cholesteryl ester; CETP, cholesterol ester transfer protein; GI, gastrointestinal; HDL, high-density lipoprotein; HL, hepatic lipase; IDL, intermediate-density lipoprotein; LCAT, lecithin:cholesterol acyltransferase; LDL, low-density lipoprotein; LDL-R, low-density lipoprotein receptor; LDL-RRP, low-density lipoprotein receptor-related protein; LysoPC, lysophosphatidylcholine; PC, phosphatidylcholine; PGN, proteoglycan; PL, phospholipid; PLTP, phospholipid transfer protein; SR-BI, scavenger receptor BI; UC, unesterified cholesterol; VLDL, very-low-density lipoprotein. (Reproduced with permission from Toth PP. High-density lipoprotein as a therapeutic target: clinical evidence and treatment strategies. Am J Cardiol 2005;96:50K-58K.)

Figure 27-1 Molecular and histologic pathways for reverse cholesterol transport. To deliver peripheral cholesterol back to the liver or steroidogenic organs such as the adrenal glands, placenta, or ovaries, apoA-I and nascent discoidal HDL interact with cells such as macrophages and foam cells within blood vessel walls. The HDL undergoes a series of cell receptor-dependent and serum enzyme-dependent maturation and speciation reactions (HDL speciation). HDL can interact directly with a variety of hepatocyte surface receptors, including SR-BI. The cholesterol esters in HDL can also be transported back to the liver by an indirect pathway for reverse cholesterol transport that depends on CETP and the LDL and LDL-RRP receptors. ABCA1, ATP-binding membrane cassette transporter A1; apoA-I, apoprotein A-I; ApoE, apoprotein E; CE, cholesteryl ester; CETP, cholesterol ester transfer protein; GI, gastrointestinal; HDL, high-density lipoprotein; HL, hepatic lipase; IDL, intermediate-density lipoprotein; LCAT, lecithin:cholesterol acyltransferase; LDL, low-density lipoprotein; LDL-R, low-density lipoprotein receptor; LDL-RRP, low-density lipoprotein receptor-related protein; LysoPC, lysophosphatidylcholine; PC, phosphatidylcholine; PGN, proteoglycan; PL, phospholipid; PLTP, phospholipid transfer protein; SR-BI, scavenger receptor BI; UC, unesterified cholesterol; VLDL, very-low-density lipoprotein. (Reproduced with permission from Toth PP. High-density lipoprotein as a therapeutic target: clinical evidence and treatment strategies. Am J Cardiol 2005;96:50K-58K.)

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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