DYSLIPIDEMIA

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DYSLIPIDEMIA
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LIPOPROTEINS

• Pathophysiology of lipoproteins
• Micelle structures with apolipoprotiens
  surrounding a lipid core
• Core contains TG, phospholipid cholesterol
• 4 classes of lipoproteins
• Chylomicrons intestinal absorption of dietary
  TG
• VLDL primary transport for TG
• LDL principle carrier of cholesterol
• HDL reverse transport of cholesterol

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LIPOPROTEINS

• A variety of factors can alter cholesterol and TG
  transport
• Environmental
• Genetic
• Gender and age
• Smoking habits
• Body fat distribution
• Diet
• Medications

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DYSLIPIDEMIA

• Dyslipidemia (elevated blood lipid and
  lipoproteins s) has several forms
• Hyperlipidemia elevated blood TG cholesterol
• Hypertriglyceridemia elevated TG only
• Hypercholesterolemia only elevated blood
  cholesterol concentrations
• Hyperlipoproteinemia elevated lipoprotein
  concentrations

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Dyslipidemia Exercise

• Generally, dyslipidemia does not alter the
  exercise response
• Regular participation in physical activity can
  manifest beneficial changes
• Lowering TG concentrations
• Increase HDL concentrations
• Increase in enzyme activity in lipoprotein
  metabolism (LPL, HL)
• Exercise can (in)directly improve profiles

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Management Medications

• Diet, weight loss and drug therapy are the
  mainstay of treatment, while exercise training is
  used as adjunctive therapy
• Lipid-lowering medications
• Nicotinic acid niacin suppresses VLDL synthesis
• Bile acid-binding resins lowers LDL (Lipitor,
  Metaprol, Cholestyramine)
• Fibric acid derivatives increase enzyme
  activity (Gemfibrozil)

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Management Medications

• Lipid-lowering medications, cont.
• HMG CoA inhibitors inhibit cholesterol
  synthesis (Lovostatin, Provostatin)
• Other medications to be aware of
• Beta blockers increase TG, decrease HDL
• Diuretics increase Chol, VLDL, LDL TG
• Insulin therapy decrease TG and increase HDL
• Estrogens increase HDL, VLDL, TG

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Recommendations for Exercise Testing and
Programming

• Primary objectives of testing are to uncover
  hidden CAD, determine functional capacity,
  determine appropriate intensity range
• GOAL for programming expend calories by aerobic
  exercise training
• 40-70 of maximum
• performed preferably 5 days/week
• Increase duration instead of intensity