Hyperlipoproteinemia medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 17: Line 17:
* [[Omega-3 fatty acids]]
* [[Omega-3 fatty acids]]


{|class="wikitable" border="1" style="text-align:center; width:700px;"
{|class="wikitable" border="1" style="width:650px"
|-style="background:#CDC9C9"
|-style="background:#CDC9C9"
|''' Drug '''
|''' Drug '''
Line 25: Line 25:
|''' Side Effects '''
|''' Side Effects '''
|''' Contraindications '''
|''' Contraindications '''
|-
|-
| '''Omega-3 fatty acids'''
| '''Omega-3<br>fatty acids'''
|  
|  
* ↓ hepatic [[lipogenesis]]
↓ hepatic [[lipogenesis]]<br>↓ plasma [[lipoprotein lipase]] activity<br>↑ hepatic mitochondrial and peroxisomal [[beta-oxidation]]<br>Inhibition of acyl CoA:1,2-[[diacylglycerol acyltransferase]] enzyme<br>[[EPA]] and [[DHA]] are poor enzyme substrates for [[triglyceride]] synthesis in [[liver]] and inhibits esterification of other fatty acids
* ↓ plasma [[lipoprotein lipase]] activity.
* ↑ hepatic mitochondrial and peroxisomal [[beta-oxidation]]
* Inhibition of acyl CoA:1,2-[[diacylglycerol acyltransferase]] enzyme
* [[EPA]]and [[DHA]] are poor enzyme substrates for [[triglyceride]] synthesis in [[liver]] & inhibits esterification of other fatty acids.
|  
|  
* 3 g/day of EPA and DHA is under FDA's "[[Generally Recognized As Safe]]" category. <ref name="pmid16825676">{{cite journal| author=Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B et al.| title=n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. | journal=Am J Clin Nutr | year= 2006 | volume= 84 | issue= 1 |pages= 5-17 | pmid=16825676 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16825676  }} </ref>
3 g/day of EPA and DHA<ref name="pmid16825676">{{cite journal| author=Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B et al.| title=n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. | journal=Am J Clin Nutr | year= 2006 | volume= 84 | issue= 1 |pages= 5-17 | pmid=16825676 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16825676  }} </ref>
* Higher doses increases risk of bleeding
|  
|  
* ↓ [[VLDL]] <ref name="pmid6736254">{{cite journal| author=Nestel PJ, Connor WE, Reardon MF, Connor S, Wong S, Boston R| title=Suppression by diets rich in fish oil of very low density lipoprotein production in man. | journal=J Clin Invest | year= 1984 | volume= 74 | issue= 1 | pages= 82-9 | pmid=6736254 | doi=10.1172/JCI111422 | pmc=PMC425187 | url=}} </ref>, <ref name="pmid11303007">{{cite journal| author=Durrington PN, Bhatnagar D, Mackness MI, Morgan J, Julier K, Khan MA et al.| title=An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. |journal=Heart | year= 2001 | volume= 85 | issue= 5 | pages= 544-8 | pmid=11303007 | doi= | pmc=PMC1729738 | url= }}</ref>
↓ [[VLDL]]<ref name="pmid6736254">{{cite journal| author=Nestel PJ, Connor WE, Reardon MF, Connor S, Wong S, Boston R| title=Suppression by diets rich in fish oil of very low density lipoprotein production in man. | journal=J Clin Invest | year= 1984 | volume= 74 | issue= 1 | pages= 82-9 | pmid=6736254 | doi=10.1172/JCI111422 | pmc=PMC425187 | url=}} </ref>, <ref name="pmid11303007">{{cite journal| author=Durrington PN, Bhatnagar D, Mackness MI, Morgan J, Julier K, Khan MA et al.| title=An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. |journal=Heart | year= 2001 | volume= 85 | issue= 5 | pages= 544-8 | pmid=11303007 | doi= | pmc=PMC1729738 | url= }}</ref>
* ↓ serum triglyceride by ≥ 50%
↓ [[TG]] by ≥ 50%
|  
|  
* [[Bleeding]] at high doses  
[[Bleeding]], at high doses<br>Fishy smell, can be reduced by
* Fishy smell, Can be reduced by
*freezing of medication
** Freezing of medication
*trying different formulation
** Trying different formulation
*taking medication with food
** Taking medication with food
[[Nausea]]
* [[Nausea]]  
(approximately 4 % of individuals at < 3 gm/d, and 20% at > 4gm/d experiences git side-effects)<ref name="pmid16825676">{{cite journal| author=Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B et al.|title=n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. | journal=Am J Clin Nutr | year= 2006 |volume= 84 | issue= 1 | pages= 5-17 | pmid=16825676 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16825676  }} </ref>
|
|
* Hypersensitivity
Hypersensitivity
 
|}
|}


Revision as of 22:39, 26 October 2012

Lipoprotein Disorders Microchapters

Patient Information

Overview

Causes

Classification

Hyperlipoproteinemia
Hypolipoproteinemia

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hyperlipidemia requires early detection, careful evaluation and aggressive treatment with combination of therapeutic lifestyle changes and lipid-lowering drug therapies to reduce the risk of cardiovascular and cerebrovascular complications.

Medical Therapy

Medical Therapy in Adults

Medical Therapy in Children and Adolescents

  1. Drug therapy
  2. Adjuvant therapies

Pharmacotherapy

Drug Mechanisms of Benefit Dosage Advantages Side Effects Contraindications
Omega-3
fatty acids

↓ hepatic lipogenesis
↓ plasma lipoprotein lipase activity
↑ hepatic mitochondrial and peroxisomal beta-oxidation
Inhibition of acyl CoA:1,2-diacylglycerol acyltransferase enzyme
EPA and DHA are poor enzyme substrates for triglyceride synthesis in liver and inhibits esterification of other fatty acids

3 g/day of EPA and DHA[1]

↓ VLDL[2], [3] ↓ TG by ≥ 50%

Bleeding, at high doses
Fishy smell, can be reduced by

  • freezing of medication
  • trying different formulation
  • taking medication with food

Nausea

Hypersensitivity

Trial supportive data

AIM HIGH study

References

  1. ↑ Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B; et al. (2006). "n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review". Am J Clin Nutr. 84 (1): 5–17. PMID 16825676.
  2. ↑ Nestel PJ, Connor WE, Reardon MF, Connor S, Wong S, Boston R (1984). "Suppression by diets rich in fish oil of very low density lipoprotein production in man". J Clin Invest. 74 (1): 82–9. doi:10.1172/JCI111422. PMC 425187. PMID 6736254.
  3. ↑ Durrington PN, Bhatnagar D, Mackness MI, Morgan J, Julier K, Khan MA; et al. (2001). "An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia". Heart. 85 (5): 544–8. PMC 1729738. PMID 11303007.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Hyperlipoproteinemia_medical_therapy&oldid=782176"