ADVICE TO DIABETICS AND CAD in HYPERLIPOPROTEINEMIAS with Complete Drug Treatment

ADVICE TO DIABETICS AND CAD (CORONARY TERY DISEASE) PATIENTS

  • Sodium reduction in diet
  • Weight loss
  • Combined weight loss and sodium reduction.

Weight loss

  • By exercise
  • By diet control
  • Drugs for obesity Lifestyle changes Control blood sugar Control blood pressure Control lipids.

Dietary advice ,

  • Rich in fruits
  • Rich in vegetables
  • ow fat dairy products Low salt intake
  • Whole grains
  • Poultry: – White of egg, discard yellow – Chicken without gravy
  • – Baked products
  • -Sweet beverages eat – Mutton ravy dishes
  • confectionaries – Chocolates, cakes, pastries, : cofees, fudge.
  • meat-based diet is high in atherogenic factors a d low in protective factors.
  • plant-based diet is low in coronary toxic mat­:er and high in coronary protective factors.

HYPERLIPOPROTEINEMIAS Chart —

HYPERLIPOPROTEINEMIAS  1 HYPERLIPOPROTEINEMIAS  2 HYPERLIPOPROTEINEMIAS  3 HYPERLIPOPROTEINEMIAS  4

Non-vegetarian diet is poison for the heart

  • · Dietary cholesterol, saturated fats and total fats are high in meat and animal products
  • · Meat is rich in oxidants which oxidize LDL cho-
  • lesterol to atherogenic form
  • Meat has no dietary fiber.

Vegetarian diet is the best medicine for the heart.

  • · Plant-based diet has no cholesterol, is low in to­tal fat and saturated fats.
  • · It is rich in dietary fiber.
  • · It is rich in antioxidants which fight degenera­tion and disease.
  • · It improves the protective function of endothe­lium of coronaries and other organs.
  • · It reverses atherosclerosis.

Functional foods

  • · Foods containing substances which prevent dis-
  • ease and promote health.
  • Plant based diet are functional foods They are protective because they have :
  • · Phytochemicals
  • · Isoflavonoids
  • · Lignans
  • · Carotenoids
  • · Retinols
  • · Lycopene
  • · Geninstein.

Lifestyle changes in diabetes and CAD can bring about

  • · Improvement in coronary artery vasomotor tone.
  • · Reduce platelet clumping
  • · Reduce blood viscosity
  • · Endothelial stability
  • · Prevent inflammation of lining of blood vessels
  • · Improve collateral circulation
  • · Regression of atherosclerosis.

Foods to be avoided

  • · Alcohol
  • · Smoking
  • · Meat
  • · Fast foods
  • · Snacks.

Recommended supplements

  • · Vitamin C 1000 mgjday
  • · Vitamin E 400 IUjday
  • · Folate 1 mgjday (reduces homocysteine levels)
  • · Fish oil 3 g/day
  • · Selenium 100 – 200 ~g/day
  • · Multivitamin – without iron
  • · Replace animal protein with SOY protein.
Risk factors:
  • Diabetes mellitus (or other disease equivalent: PAD, AAA)
  • Tobacco abuse
  • Hypertension
  • Male >45, female >55
  • Family history of premature heart disease (male <55, female <65)
  • HDL <45 mg/dL

FREDERICKSON CLASSIFICATION OF

HYPERLIPOPROTEINEMIAS

Class I

  • · Chylomicrons increased
  • · TG (Triglyceride) increased
  • · Pancreatitis present
  • · Also called familial chylomicronemia.

Class IIa

  • · LDL increased
  • · Cholesterol increased
  • · Coronary atherosclerosis
  • · Molecular defect apoB100
  • · Also called familial hypercholesterolemia.

Class lIb

  • · LDL and VLDL increased
  • · Cholesterol increased
  • · CAD present
  • · Also called familial combined hyperlipidemia.

Class III

  • · Chylomicrons and VLDL increased
  • · TG increased
  • · Cholesterol increased
  • · CAD present
  • · Apo E molecular defect
  • · Also called familial dysbetalipoproteinemia.

Class IV

  • · VLDL increased
  • · Also called hypertriglyceridemia.

Class V

  • · Chylomicrons and VLDL increased
  • · TG increased
  • · Also called familial hypertriglyceridemia.

SECONDARY CAUSES OF DYSLIPIDEMIAS

  • · Hypothyroidism
  • · Nephrotic syndrome
  • · Porphyria
  • · Alcoholism
  • · Obesity
  • · DM Type II
  • · Cushing syndrome
  • · Pregnancy
  • · Autoimmune diseases
  • · Acromegaly.

Drugs which cause hyperlipidemia

  • · Thiazides
  • · Cyclosporin
  • · Tegretol
  • · Steroids
  • · Beta blockers.

Important references

  • · Third report of National Cholesterol Education Pro­gram Adult Treatment Panel III (NCEP-ATP III).
  • · Guidelines of ADA American Diabetes Association.
  • · DASH Dietary Approaches to Stop Hypertension Clinical Trial.

Major drugs for Hyperlipidemias

HMG Co-A reductase inhibitors:

  • · Atorvastatin
  • · Lovastatin
  • · Pravastatin
  • · Simvastatin.

Fibric acid derivatives:

  • · Gemfibrozil
  • · Fenofibrate.

Cholesterol absorption inhibitors:

  • • Ezetimibe.

Bile acid sequestrants :

Nicotinic acid:

  • • Susta.ined release nicotinic acid.

Fish oil:

  • Omega 3 fatty acids – PUFA.
Side effects of drugs Statins  :
  • · Myalgias
  • · Arthralgias
  • · Dyspepsia
  • ·Increased SGPT.

Bile acid sequestrants

  • · Constipation
  • · Increased TG
  • ·Distension of abdomen.

Nicotinic acid

  • · Flushing
  • · Increased glucose
  • · Increased uric acid
  • · Deranged LFT
  • ·GI upset.

Fibrates

  • Myalgia
  • Dyspepsia
  • · Increased SGPT Gall stones.

fish oils

  • Bad odour Dyspepsia Diarrhoea.

Ezetimibe

  • Increased SGPT.
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