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Hyperlipidemia
Chapter 22
VIDEO
There are four principal lipoprotein classes:
1. Chylomicrons are derived from intestinal
absorption of exogenous (dietary) triglyceride.
•
2. Very low density lipoprotein (VLDL) is
synthesized in the liver and is the primary transport
mechanism for endogenous triglyceride.
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Low-density lipoprotein (LDL) represents the final
stage in the catabolism of VLDL and is the principal
carrier of cholesterol.
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High-density lipoprotein (HDL) is involved in the
reverse transport of cholesterol and is typically
studied as two separate subfractions: HDL2 and the
more dense HDL3.
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Hyperlipidemias
Hyperlipidemia indicates elevated blood
triglyceride and cholesterol.
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Hypertriglyceridemia denotes only elevated
triglyceride concentration.
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Hypercholesterolermia implies only elevated blood
cholesterol concentration.
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Hyperlipidemias
•Hyperlipoproteinemia
or dyslipoproteinemia
denotes elevated lipoprotein concentrations.
Hyperlipoproteinemia is associated with genetic
abnormalities or may be secondarily related to an
underlying disease such as diabetes mellitus.
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Principle Concerns with CAD: (see NCEP
standards, p.168)
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Hypertriglyceridemia > 200 mg/dl
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Hypercholesterolemia >240 mg/dl
•HDL-C –
recommended > 40 mg/dl men; 50 mg/dl women
•LDL-C – recommended < 100 mg/dl; > 160 is high.
Effects on the Exercise Response
Generally, dyslipidemia does not alter the exercise
response to a single session of exercise unless the
dyslipidemia is longstanding and has led to CAD or
secondary illness.
•Medical management of dyslipidemia is needed
before beginning an exercise program.
• Because dyslipidemic clients may have prescribed
medications for other conditions, the type and dose of
these medications should be noted before the person
undergoes exercise testing or exercise training
•
Effects of Exercise Training
Benefits include:
• Triglyceride concentrations are generally lower.
•Reduced blood lipids following a meal (postprandial
lipemia)
•Reduced numbers of LDL-C that poses the higher
CVD risk (small molecules)
•HDL cholesterol (HDL-C) concentrations are
typically higher (but not always).
• Enzyme activity in the metabolism of lipoproteins is
increased.
** These exercise training changes will enhance reverse
cholesterol transport and can be augmented further by a lowfat diet, weight loss, and reduction in adiposity.**
Management and Medications
Therapies with diet, weight loss, and exercise are
adjunctive to pharmacological therapy and are
extremely important for the following reasons:
• Low-fat and high-carbohydrate diets lower HDL-C
and increase triglyceride concentrations; however,
exercise diminishes these effects of diet on HDL-C
and triglyceride concentrations.
• Low-calorie diets that cause weight loss decrease
total cholesterol and LDL-C, and increase HDL-C
(variant changes in different patients).
Drug use and interactions are very complicated. You should
review medications and interactions when considering an
exercise program. (see p.171)
Recommendations for Exercise Testing
•If
the dyslipidemia condition is congenital, but the
patient does not have any signs or symptoms of some
other primary condition, exercise testing can follow
normal protocols used for populations at risk for
CAD.
•The Primary Objectives of Exercise Testing are:
1)
2)
3)
Diagnose CAD
Determine Functional Capacity
Determine appropriate intensity range for aerobic
training.
Recommendations For Exercise Programming
• Presently available information suggests that there
may be different energy expenditure thresholds for
different lipids and lipoproteins.
1) Triglyceride concentrations are lower in
hypertriglyceridemic men after two weeks of aerobic
exercise (45 min/day) on consecutive days
2) HDL-C concentrations are frequently increased by
exercise regimens requiring 1000 to 1200 kcal of energy
expenditure/wk (minimal training period of 12 wk).
Recommendations For Exercise Programming (see Table
22.2, p.172)
The primary goal for exercise training is to expend
calories by exercise training with exercise that is:
• performed at moderate intensities (40-80% of maximal
functional capacity),
performed often (preferably > 5 days/wk),
• performed once a day, although exercising twice a day
may be necessary to increase total energy expenditure
and may be useful in persons with time constraints or
severe exercise intolerance from chronic disease or
morbid obesity.
•May also incorporate resistance training as an adjunct
fitness exercise
•
End of Presentation