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Cardiology

Question
9 out of 67
 

A patient with hypertriglyceridemia is treated with Omega -3- polyunsaturated fatty acids. Treatment with omega-3- polyunsaturated fatty acids, win have the following effect on lipid profile:



A Increased LDL and Increased total cholesterol

B Decreased LDL and Decreased total cholesterol

C Increased LDL and Decreased total cholesterol

D Decreased LDL and Increased total cholesterol

Ans. C

Increased LDL and Decreased total cholesterol

Preventing Measures

1. High fibre diet:

a. Fibre supplements may reduce levels of total cholesterol and LDL Cholesterol, and may cause a reduction in coronary heart disease.

b. However use of high fibre diet has not shown any benefit in overall mortality from CHD and has not yet been recommended for risk reduction in CHD by the American Heart Association (AHA)

2. Sterol Esters:

a. Sterol esters containing food have been documented to decrease Total Cholesterol levels and LDL cholesterol levels.

b. They may be recommended in selected individual with hypercholesterolemia for lowering of total and LDL cholesterol levels and for secondary prevention after an atherosclerotic event.

c. However the use of these agents require further monitoring as concerns have been raised regarding their tendency to decrease Beta carotene (vitamin A) and alpha-tocopherol (vit-E) levels.

d. A clear benefit in reduction of mortality has not been documented

3. Omega 3 polyunsaturated fatty acids (ω3-PUFA) (AIIMS May 2011)(Ref. Hari 18th ed., Pg 3160)

a. Omega 3 PUFA decrease total mortality and sudden death in patients with CAD.

b. Omega 3 PUF A's derived from marine sources namely Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)

c. The supplemental use of Omega 3 Fatty acids (EPA plus DHA) has been recommended by the American Heart Association.

4. Effect of omega 3 fatty acids on LDL levels

a. Omega-3 fatty acids lower plasma triglyceride levels, particularly in persons with hyper-triglyceridemia, by inhibiting the synthesis of very-low-density lipoprotein (VLDL) cholesterol and triglycerides in the liver.

b. Total cholesterol was not significantly affected.

5. Potassium Supplements: These agents have not been recommended by the American heart association for risk reduction in patients with coronary heart disease. (AIIMS MAY 2014)

Treatment of hyperlipidemia

1. Triglycerides:

a. A fibrate (gemfibrozil or fenofibrate) is the drug of choice to lower fasting triglycerides. (Ref. Hari-18th ed., Pg- 1996)

b. Other drugs that lower triglycerides include statins, nicotinic acid, and high doses of omega-3 fatty acids. (Ref. Hari-18th ed., Pg- 1997)

2. LDL Cholesterol (Ref. Hari-18th ed., Pg- 1996)

a. Statins (HMG-CoA reductase inhibitors), which produce a 20–60% lowering of LDL cholesterol, are the first choice for medication.

b. Side effects are rare and include an increase in hepatic transaminases and/or myopathy.

c. Ezetimibe. The cholesterol absorption inhibitor ezetimibe should be the second choice.

d. Cholestyramine and Colestipol. The bile acid sequestrants cholestyramine and colestipol are more effective than ezetimibe but must be used with caution in patients with the metabolic syndrome because they can increase triglycerides. In general, bile sequestrants should not be administered when fasting triglycerides are >200 mg/dL.

e. Nicotinic acid has modest LDL cholesterol–lowering capabilities (<20%).

f. Fibrates are best employed to lower LDL cholesterol when both LDL cholesterol and triglycerides are elevated. Fenofibrate may be more effective than gemfibrozil in this group.

3. HDL

Nicotinic acid is the only currently available drug with predictable HDL cholesterol-raising properties. (H-18th Pg- 1997)

Saroglitarzar = α and γ PPAR receptor agonist.

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