Sunday, June 24, 2012

Diabetes, Residual Risk and Dysfunctional triglycerides

Diabetes, Dysfunctional Triglycerides and Residual risk
Question
A lady  ,who is taking a statin , ask if she was completely protected from having a heart attack or stroke.
The answer is no.

Discussion
Taking statin medications have been very effective at reducing  but not eliminating the risk of developing cardiovascular disease. This leaves some thing called Residual Risk.
This Residual risk is an area of active research and is focused on correcting low HDL cholesterol and/or elevated triglycerides levels. We have discussed low HDL previously and the problems associated with efforts to increase it.
See the June 4 , 2012 post

HDL Cholesterol - Is More Better ?


Please review the two previous post below and we will start discussing the hope of reducing Triglycerides and reducing the problem of Residual Risk.

Have fun , be Smart and improve your under standing of Triglycerides
David Calder,MD

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*Elevated Triglyceride levels increase the risk of Stroke in postmenopausal
 women     April 12 , 2012

Dyslipidemia , especially elevated Total cholesterol ,LDL cholesterol  and decreased HDL, are well  established risk factors for the development of atherosclerotic heart disease .

They have not served as well as a marker of increased risk for ischemic stroke.

 However  medications such as Statins , which primarily lower LDL and total cholesterol , have demonstrated a significant reduction in stroke risk. This was well demonstrated in the CARDS study( lancet364(Aug.21,2004):685-696 ) which found a 48% reduction in stroke in patients with Type 2 diabetes taking 10 mg of atorvastatin ( lipitor).


I read an article this morning in the April issue of * STROKE that may help in our understanding of some of the risk factors for ischemic stroke in women. This article has a complicated title, Lipid and Lipoprotein Biomarkers and the Risk of Ischemic Stroke in Postmenopausal Women , and was  also not a quick easy read. This study was a prospective case study comparing 972 women with ischemic stroke to 972 matched control subjects.

Bottom line
  Elevated baseline triglyceride levels above the mean Triglyceride level of 140 mg/dl was a significant marker of increase risk of ischemic stroke in post menopausal women.


 Two other associated risk markers involve precursors to LDL cholesterol ;
  VLDL particle Size and IDL number,


Physiology
Our liver produces VLDL ( very low density lipoprotein ) which is altered to IDL ( intermediate density lipoprotein ) and to the end product LDL( low density lipoprotein ) . Elevated triglyceride levels have an unfavorable effect on this process resulting in smaller more dense higher risk LDL particles.


 LIVER  produces ----------------> VLDL ------> IDL------> LDL
 Elevated Triglycerides effect- ->  size of             number of         smaller dense  higher risk LDL particles


Comment
     This article helps point the finger at elevated Triglyceride levels as being a risk factor for 
       stroke in postmenopausal women 


       It  also helps explain how elevated triglycerides effect the size and  and possible the 
       number of  LDL particles to increase someones increased risk for stroke and heart disease . 

       It also improves our understanding of the benefits of Statins , like lipitor and others , in 
       reducing stroke risk.
      


 Have fun, be smart and pay attention to your Triglyceride test results
 David Calder,MD
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*Dec2011

What is Non-HDL cholesterol ? Why should I care ?

We have discussed using LDL cholesterol and Apo b test  to help evaluate  our risk for developing heart disease. Today we are discussing another tool  that is gaining in popularity , Non-HDL Cholesterol .

 Non -HDL Cholesterol  is based on a simple idea . Elevated levels of any thing other than HDL is not in our best interest.

 Calculation is easy;
      Total cholesterol - HDL  =  Non - HDL Cholesterol

 Recommended  Target Goals by;    ADA ( American Diabetes association )
                                                          ACC ( American college of cardiology )


                              LDL            Apo b          Non-HDL cholesterol
                                mg/dl           mg/dl               mg/dl

no risk factors        <100            <90                 <130
+ 1 risk factor         <70             <80                 < 100


  risk factors include High Blood Pressure ,smoking , family history of premature heart disease.

  This is an easy test to do on your own lab.  and may help you and you physician make management decisions
                          Have  fun      Dr. Calder

3 comments:

  1. Many falsely believe that heart disease and heart attacks cannot be prevented. Exercising regularly, eating a well-rounded diet and avoiding smoking are easy steps you can take to reduce your chances of developing heart disease. Thanks.
    Regards,
    hcg1234

    ReplyDelete
  2. The research concluded that adding turmeric to a high fat meal actually lowered insulin levels and triglycerides by one-third.


    what are triglycerides ?

    ReplyDelete
  3. We have discussed using LDL cholesterol and Apo b test to help evaluate our risk for developing heart disease. Today we are discussing another tool that is gaining in popularity , Non-HDL Cholesterol . Online Pharmacy

    ReplyDelete

Your comments and questions are appreciated. David Calder,MD