High density lipoprotein prevention
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High Density Lipoprotein Microchapters |
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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.
Primary Prevention
Lifestyle Modification
Certain changes in lifestyle can have a positive impact on raising HDL levels:[1]
- Aerobic exercise[2]
- Weight loss
- Smoking cessation
- Using supplements such as omega 3 fish oil
- Limiting intake of dietary fat to 30–35% of total calories
- Removing trans fatty acids from the diet
- Adding monounsaturated and polyunsaturated fats to the diet, and reducing or eliminating saturated fats.
- Drinking 1–2 servings of alcoholic beverages per day
- Adding soluble fiber to diet
Risk Assessment
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),[3] decreases HDL-apo A-I catabolism[4] | 15-35% increase | Cutaneous flushing, hyperglycemia, hyperuricemia, hepatotoxicity |
| Fibrates | Direct stimulation of apo-A1 and apo-AII synthesis via peroxisome proliferator-activated receptors,[5] | 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,[6] increases ABCA1 mRNA in hepG2 cells,[7] inhibits CETP mass and activities[8] | 5-15% increase | Myopathy, rhabdomyolysis |
| Ezetimibe | Inhibits cholesterol absorption at intestine level | 3% increase in HDL along with statins[9] | Headache, diarrhea, hypersensitivity |
| Thiazolidinediones | Increase in adiponectin which increases insulin resistance | 14% increase in HDL[10] | 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[11] | 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[12] Physical exercise Smoking cessation Weight loss[13] Intake of unhydrogenated monounsaturated fat[14][15] 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
- ↑ Richard N. Fogoros, M.D. "Raising Your HDL Levels".
- ↑ Spate-Douglas, T., Keyser, R. E. Exercise intensity: its effect on the high-density lipoprotein profile. Arch Phys Med Rehabil 80, 691-695. PMID 10378497
- ↑ 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)