HDL/LDL Flashcards
All Lipoproteins Contain the following
- Triglicerides
- Esterfied and Unesterfied Cholesterol
- Phospholipids
- Proteins
function of lipoproteins
Transport lipids in plasma for metabolic purpose
cholesterol
essential for biological function as structural component of biological membranes
as a precursor for steroid hormones and other essential functions.
*essential for healing process
HDL relationship to exercise
potentially increases HDL
exercise most if not every day at a high enough intensity to see benefits (ACSM guideline - only applies to healthy people)
5 major lipoprotein categories
- Chylomicrons
- VLDL’s
- IDL’s
- LDL’s
- HDL’s
How do Lipoproteins differ?
- Size
- Density
- Quantity of ingredients
triglyceride
1 glycerol (sugar)
3 FFA (saturated, unsaturated)
Lipid Production and Synthesis of Cholesterol
intestine
- Triglycerides accumulate from dietary fat
- Transported in LDL and HDL as well as Chylomicrons and VLDL
Lipid Production and Synthesis of Cholesterol
exogenous
Cholesterol production from consumption of fat
Lipid Production and Synthesis of Cholesterol
Liver
Synthesizes carbohydrates (Glycerides) that are not used for fuel with free fatty acids to form Triglycerides
lipid production and synthsis of cholesterol
endogenous
cholesterol synthesis from other sources
Cost of CHD
$50,000,000,000 to $100,000,000,000 per year in lost wages and medical treatment
Total cholesterol classifications
- Desirable <200 mg/dL
- Borderline-high 200-239 mg/dL
- High ≥ 240 mg/dL
risk factors for CAD
- Male ≥ 45 years
- Female ≥ 55 years
- Family history of CHD
- Smoker
- Hypertension
- Diabetes
- Total Cholesterol
- HDL ≤ 40 mg/dL
What reduces 1 risk factor for CHD?
HDL ≥ 60 mg/dL
recommended follow up care (1993)
< 200 mg/dL
Repeat within 5 years
recommended follow up care (1993)
200-239 mg/dL without CHD or 2 risk factors
Dietary info and recheck annually
recommended follow up care (1993)
total cholesterol 200-239 mg/dL without CHD or 2 risk factors
Lipoprotein analysis and further action based on LDL-cholesterol level
**this is now the standard of care**
Classification based on
LDL levels
LDL Classifications
- Optimal: < 100
- Desirable: 100-129
- Borderline-high risk: 130-159
- High risk: 160-189
- Very high risk: ≥ 190
Why look at HDL and LDL levels for risk of CHD?
A substantial amount of persons with CHD have total cholesterol in normal range
HDL guidelines
2001
< 40 mg/dL low
> 60 mg/dL high
Increasing HDL and Lowering Triglicerides
Public Health approach to treatmen
- Obesity
- Smoking
- Sedentary life-style
Services of Health Professionals
Dietitians/Nutritionists
Exercise Physiologists
Health Educators
research on puberty and HDL
- Boys and girls have similar HDL levels
- Puberty boys Increase testosterone and decrease HDL
- Exercise and Ethanol raise HDL
HDL- The Clinical Implications of 1989 study
Conclusion not enough evidence showing increase HDL decrease risk CHD
Acute Effects of Exercise on HDL, LDL, and Triglicerides
- Triglyceride- reduction 18-24h post exercise, especially in trained endurance athletes
- HDL- Increases similar to triglyceride reduction
- LDL- Reduced with prolonged exercise
Physical Fitness Vs Physical Activity and CAD risk factors
Physical activity must be at high enough intensity to impact physical fitness level in order to effect CAD risk factors
Physical Activity and Cardiovascular Health NIH Consensus Conference (1996)
- 12 week exercise- increases HDL levels
- Endurance exercise
- decreases in systolic and diastolic BP in Hypertensive persons
- improved insulin sensitivity
- lowers risk of clotting factors
- Moderate activity 30 minutes most days but preferably all days of the week
Increased intensity- Benefits and Risks NIH
- Lowers cardiovascular morbidity and mortality rates
- Increase risk of injury
- Discontinuation of activity
- Acute cardiac events during activity
Frequency, Intensity, Duration, Mode or FITT
How often should you get:
- high intensity and duration
- low intensity and duration
High intensity and duration- 3X/week
Low intensity and duration- daily
Frequency, Intensity, Duration, Mode or FITT
endurance vs. strength
Endurance- variety of activities produce similar benefits
Strength- further research is necessary but initial studies suggest benefits for reducing risk of CHD especially in elderly
Cardiac Rehabilitation Referral and Enrollment Rates
group centers
- 10 to 25% of persons with CHD
- Lower for women than men
- Lower for non-whites than whites
Cardiac Rehabilitation Referral and Enrollment Rates
home based programs
Less hospital time combined with in home follow-up
cardiac rehab benefits
- Lower incidence of rehospitalization
- Lower charges per hospitalization
Diet and exercise study: What were the changes in HDL, LDL, and total cholesterol?
Men and Women with HDL’s below 35mg/dL and LDL’s above 130mg/dL
Diet group, Diet and Exercise group, control group
- Decrease in total cholesterol and LDL’s for both treatment groups
- Significant increase in HDL’s in Diet and Exercise group
CHD
Initial LDL level: > 100 mg/dL
- minimal goal
- treatment
- ≤ 100 mg/dL
- dietary therapy with CHD
CHD
Initial LDL level: ≥ 130 mg/dL
- minimal goal
- type of therapy
- minimal goal: ≤ 100 mg/dL
- drug therapy
1993 treatment guidelines
LDL ≥160 mg/dL w/o CHD or two risks
- minimal goal
- treatments
- goal: < 160 mg/dL
- treatments: dietary
1993 treatment guidelines
≥130 mg/dL LDL w/ CHD or two risks
minimal goal
treatments
- goal: < 130 mg/dL
- treatment: dietary
1993 treatment guidelines
LDL ≥190 mg/dL w/o CHD or two risks
minimal goal
treatments
- goal: < 160 mg/dL
- treatment: drug
1993 treatment guidelines
≥160 mg/dL w/ CHD or two risks
minimal goal
treatments
- goal: < 130 mg/dL
- treatment: drug
