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 —

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 :

• · Cholestyramine
• · Colestipol.

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.