Lipid Management: From Basics to Clinic PDF
Preview Lipid Management: From Basics to Clinic
Lipid Management Hussein Yassine Lipid Management From Basics to Clinic 1 3 Editor Hussein Yassine University of Southern California Lipid Clinic Los Angeles California USA ISBN 978-3-319-11160-5 ISBN 978-3-319-11161-2 (eBook) DOI 10.1007/978-3-319-11161-2 Library of Congress Control Number: 2014955344 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Dedication This book is dedicated to my father, Naji, my mother Amne, and my wife Diala for their love and unwavering support. To my daughters Leen and Lara, may the love of science bring you joy! Hussein Yassine, February 2015 v Preface Over the last two centuries, the role of lipids in the etiology of cardiovascular has garnered significant attention, and in particular, the role of cholesterol on the de- velopment of atherosclerosis. The first studies involving cholesterol and cardiovas- cular disease date back to the early 1900s when Anichkov (an army pathologist) provided rabbits with high cholesterol diets and observed stiffening of their artery walls. In the 1950s, Ancel Keys reported in the Seven Countries study findings relating low fat intake and an association of low mortality form cardiovascular dis- ease. His observations were misinterpreted into high carbohydrate diets that were particularly enriched with simple sugars. Together with sedentary life styles, large portion sizes, these changes contributed in part to the obesity epidemic that peaked toward the end of the twentieth century. The first lipid lowering medication, nia- cin, was discovered serendipitously after it was tested on a rabbit schizophrenia model. One of the side effects observed was lowering of cholesterol. In the 1960s, the coronary drug project ushered the first clinical trial for lipid lowering therapies featuring niacin use for the prevention of heart disease. Although immediately after the study the two groups did not statistically differ in heart disease rates, 20 years later, the participants assigned to niacin demonstrated a survival advantage. In the late 70s, a Japanese microbiologist Akira Endo first discovered natural products with a powerful inhibitory effect on cholesterol synthesis in a fermentation broth of Penicillium citrinum, during his search for antimicrobial agents. Concomitantly, Brown and Goldstein (later earning the Nobel Prize for their work in 1985) showed that HMG-co reductase inhibition represented the rate limiting step in cholesterol synthesis. These exciting basic and translational studies led to the production of statins. The first of many statin trials to come was the 4S study conducted in Scan- dinavian countries in the late 1980s and showed a significant reduction in cardio- vascular events in participants assigned to statin therapy. Importantly, many later trials confirmed the benefits of statins in lowering heart disease risk. On another front, the publication of the Lyon Heart study (Mediterranean diet) in the mid-90s transformed our understandings of the dietary components that protect against heart disease. In that study, participants randomized to good fat (olive oil, nuts) survived longer following coronary bypass surgery than individuals kept on their regular diet. Several Mediterranean dietary studies have been conducted since confirming vii viii Preface a distinct role for fats in the pathogenesis of heart disease, and shedding light into healthy and less healthy fats. In this book, we attempt to provide both basic concepts and clinical approaches to understanding and managing lipid related disorders that confer increased cardio- vascular risk. The first 5 chapters cover basic aspects of lipoprotein metabolism. The remaining chapters focus on management of the patient with lipid disorders. In the first chapter, we go over the basics of lipoprotein metabolism inside the cell and how lipids are packaged in the circulation into lipoproteins. The second chapter fo- cuses on genetic disorders of lipoprotein metabolism with an emphasis on Familial Hyperlipidemia, a common lipid disorder associated with increased heart disease risk. In the third chapter, we discuss the pathophysiology of atherosclerosis, focus- ing on the roles of lipids and inflammation. Dr. Abela and his colleagues discuss their land mark studies into the role of cholesterol crystals in inducing inflamma- tion in the artery wall. In the third Chapter, Drs. Toledo-Corral, Alderete and Goran report to us important findings from their recent studies on the mechanisms linking obesity to atherosclerosis, particularly in the youth. In the fourth chapter, I discuss recent findings from studies aimed at raising HDL cholesterol but failing to improve outcomes, reviewing basic concepts of HDL metabolism. In the fifth chapter, we provide our approach to managing patients at risk for heart disease incorporating the recent AHA/ACC 2013 guidelines. We then present ten chapters that discuss the management of patients with lipid disorders and at risk for cardiovascular disease. In Chap. 6, Dr. Allevato discusses the latest evidence on dietary intervention tri- als that confer cardiovascular benefits with a focus on the Mediterranean diet. In Chap. 7, Drs. Abou Assi and Jordanov discuss statins, from trials to side effects and intolerance. Given the importance of statins as cornerstone therapies in the man- agement of hyperlipidemia, Chaps. 9, 10, and 11 review the use of statins in three conditions: chronic kidney disease, non-alcoholic fatty liver and heart failure. In Chap. 12, Dr. Goldberg summarizes the evidence and use of non-statin therapies. In Chap. 13, Dr. Klapper reviews the use LDL apheresis as a modality to treat refrac- tory dyslipidemias or severe familial hypercholesterolemias. Dr. Dube, a leading expert in the treatment of dyslipidemia in HIV presents the latest guidelines and approaches to treatment of dyslipidemia in HIV. Finally, Dr. Wong in Chap. 15 pro- vides a concise summary on the new and emerging therapies for the treatment of hyperlipidemias. This book is intended for the public, scholars and physicians with interest in lipids. We hope that by coupling of basic concepts and management ap- proaches to lipid disorders, we will assist the provider in making the best decisions in diagnosing and treating their patients. Contents 1 Basics in Lipoprotein Metabolism ........................................................... 1 Hussein Yassine, Keenia Tappin and Muhammad Jawad Sethi 2 Genetics of Lipid Disorders . ..................................................................... 17 Marija Stojanova Jordanov 3 Lipid and Inflammation in Atherosclerosis ............................................ 37 Imad Ahmado, Oliver G. Abela, Muhamad Adeeb Safiia, Abed Janoudi and George S. Abela 4 Dyslipidemia: Relationship to Insulin Resistance, Fatty Liver, and Sub-Clinical Atherosclerosis .................................................. 65 Claudia M. Toledo-Corral, Tanya L. Alderete and Michael I. Goran 5 Is Low HDL Cholesterol a Marker or a Mediator of Cardiovascular Disease? ........................................................................... 81 Hussein Yassine 6 Title: Approach to the Patient with Lipid Disorders ............................. 91 Kelsey Michiko Shikuma Lee and Hussein Yassine 7 The Effects of Diet in Hyperlipidemia ..................................................... 113 Joseph Michael Allevato and Imelda Allevato 8 Statins ......................................................................................................... 123 Marija Stojanova Jordanov and Hiba Abou Assi 9 Non-Alcoholic Fatty Liver Disease (NAFLD): The Lipid Disease of the Liver and the Effect of Statins ......................................... 149 Mazen Noureddin, David Alexanian and Neil Kaplowitz ix x Contents 10 The Role of Statins in Heart Failure ..................................................... 175 Allen Kuo and Michael Fong 11 Statins in Chronic Kidney Disease ......................................................... 187 Sahar H. Koubar 12 Non-Statin Treatment of Dyslipidemia ................................................. 201 Stanley J. Goldberg 13 LDL Apheresis ......................................................................................... 233 Hedyeh Shafi, Holli M. Mason and Ellen Klapper 14 Dyslipidemia in HIV ............................................................................... 241 Michael P. Dubé 15 New and Emerging Therapies for Hyperlipidemia .............................. 257 Michael J. Wong Index ................................................................................................................. 267 About the Editor Hussein Yassine, MD is an Assistant Professor of Medicine-Endocrinology at the University of Southern California, where he directs the lipid clinic. His research focuses on cholesterol transport in cardiovascular disease. He was the winner of several research and teaching awards including the Department of Veterans Affairs VISN 18 Outstanding Research Award, and the Endocrine Society Presidential Award. xi
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