7. biochemistry of lipoprotein & dyslipidemia

7/25/2019 7. Biochemistry of Lipoprotein & Dyslipidemia

1/79

BIOCHEMISTRYLIPOPROTEIN &

DYSLIPIDEMIA

BY

Dr.Liniyanti D.Oswari, MNS,MSc.


2/79

Learning O!ecti"es

T# $n%erstan% te 'i(i% & 'i(#(r#tein)eta#'is) in te #%y.

Rec#gni*e te signi+cance # %ys'i(i%e)ia in

Ater#sc'er#sis #n C-D & CHD, inc'$%ing ter#'e # HDLC as a (r#tecti"e ris/ act#r #rC-D &CHD

Rec#gni*e te re'ati#nsi( %ys'i(i%e)ia wit

centra' #esity & Ins$'in resistance E0a)ine recent c'inica' tria's # %ys'i(i%e)ia

as it re'ates t# te (re"enti#n an% treat)ent

# C-D & CHD


3/79

Li(#(r#teins

C'$sters # 'i(i%s ass#ciate% wit(r#teins tat ser"e as trans(#rt "eic'es

#r 'i(i%s in te 'y)( an% '##%


4/79

Li(#(r#teins

Cy'#)icr#ns

-LDL 1 -ery '#w %ensity 'i(#(r#tein

IDL 1 Inter)e%iate %ensity'i(#(r#tein

LDL 1 L#w %ensity 'i(#(r#tein

HDL 1 Hig %ensity 'i(#(r#tein


5/79

Disting$ise% y si*ean% %ensity

Eac c#ntains%i2erent /in%s an%a)#$nts # 'i(i%s an%(r#teins Te )#re 'i(i%, te

'#wer te %ensity

Te )#re (r#tein, teiger te %ensity

Li(#(r#teins


6/79

LipoproteinsClass Size (nm) Lipids MajorApoproteins

Chylomicra 100-500 Dietary T !-"#$C-%%$&

'LDL 0-#0 &ndoeno*sT

!-100$C-%%$&

%DL +5-50 C&s , Ts !-100$ &

LDL 1#-+# C&s !-100

DL 5-15 C&s A$C-%%$&

Lp (a) +5-0 C&s !-100 ,lycoproteins


7/79

Li(i%s 345 in P'as)a

Li(#(r#teinsLi(i% Cy'#)icr#

n-LDL IDL LDL HDL

C#'ester#' 6 77 89 :;


8/79

Te Origins & Ma!#r?$ncti#ns # Li(#(r#teins


9/79

?$ncti#ns # Cy'#)icr#ns Ma%e y intestina' ce''s

M#st # 'i(i% is trig'yceri%e

Litt'e (r#tein A(#AI, A(#AII, A(#B:=, A(#C

De'i"er atty aci%s "ia 'i(#(r#tein'i(ase


10/79

Cy'#)icr#n re)nants Li(#(r#tein (artic'e tat re)ains

ater a cy'#)icr#n as '#st )#st

# its atty aci%sTa/en $( y 'i"er

C#ntents re$se% #r recyc'e%


11/79

?$rter De'i"ery # Li(i%s in

B#%y Li"er

Syntesi*es & )eta#'i*es 'i(i%s

@Centra' c#))an% center #rre'ati#n # 'i(i% )eta#'is)

Ma/es a%%iti#na' 'i(#(r#teins


12/79


13/79

E0#gen#$s Patway # Li(i%Meta#'is)

Vessel

wall

CholestAA

.A

/$

lycerol


14/79

En%#gen#$s Patway # Li(i%Meta#'is)


15/79

Li"erLi"er

En%#gen#$s & E0#gen#$s S#$rces #C#'ester#'

?eca' i'eaci%san% ne$tra'ster#'s

E0#gen#$s

E0trae(atic

tiss$es

En%#gen#$s

DietaryDietaryc#'ester#'c#'ester#'

38>>1;>> )g%ay538>>1;>> )g%ay5 Intestine

A%a(te% r#) Ca)(e PC, Har"ey RA. Biochemistry. 7n% e%. Pi'a%e'(ia Li((inc#tt Ra"en, >7;7=;;;Finserg HN, F#'%erg I. In Harrisons Principles of Internal Medicine.


16/79

En%#gen#$s & E0#gen#$sC#'ester#'

C#'ester#' is #taine% r#) en%#gen#$s an% e0#gen#$s s#$rces.

En%#gen#$s c#'ester#' is syntesi*e% in a'' tiss$es, $t (ri)ari'yte 'i"er, intestine, a%rena' c#rte0, an% re(r#%$cti"e tiss$es,inc'$%ing te ('acenta. E0#gen#$s c#'ester#' is as#re% y teintestine r#) %ietary an% i'iary s#$rces an% trans(#rte% t# te

'i"er.> t# ;>> )g # c#'ester#' %ai'y.8,:A((r#0i)ate'y >> )g # c#'ester#' is secrete% y te 'i"er int#

te i'e. T$s, a((r#0i)ate'y > t# > )g # c#'ester#' (er%ay (asses tr#$g te intestines,:# wic a#$t ;>> )g (er %ayis as#re%.9 Beca$se ('as)a c#'ester#' 'e"e's are )aintaine%witin a re'ati"e'y narr#w range in ea'ty in%i"i%$a's, a re%$cti#nin te a)#$nt # %ietary c#'ester#' 'ea%s t# increase% syntesis inte 'i"er an% intestine.7


17/79

C#'ester#' As#r(ti#n in te Intestine

#$$$ m%

&esins

Plant stanols NPC


18/79

There are several stepsinvolved in the absorption of

cholesterol from the intestinallumen. C#'ester#' tat is as#re% r#) te intestina'

'$)en c#)es r#) tw# s#$rces %ietary c#'ester#'an% i'iary c#'ester#' 3wic is y ar te greater #

te tw# in J$antity5. C#'ester#' is e)$'si+e% y i'e aci%s an% (ac/age%

in 'i(i% )ice''es.

Tese 'i(i% )ice''es are trans(#rte% t# te r$s

#r%er # !e!$na' enter#cytes. At te r$s #r%er # te enter#cyte, te

c#'ester#' is re'ease% r#) te 'i(i% )ice''e an%ten enters te enter#cyte.


19/79

-eryL#wDensity

Li(#(r#teins 3-LDL5 Ma%e y 'i"er

C#ntains 'arge a)#$nts #trig'yceri%e

De'i"ers atty aci%s t# ce''s

M#re %ense tan cy'#)icr#ns

A it )#re (r#tein 3=45 A(#B>, A(#C, A(#E


20/79


21/79


22/79

VLDL life cycle


23/79

Inter)e%iateDensity

Li(#(r#teins 3IDL5 Li(#(r#tein tat res$'ts r#) '#ss # atty

aci%s r#) -LDL

Ma!#r 'i(i% is c#'ester#' esters Pr#teins si)i'ar t# -LDL $t greater

(ercentage 3, A(#C, A(#E

Ta/en $( y 'i"er #r re)ain in circ$'ati#n C#n"erte% t# '#w%ensity 'i(#(r#teins

3LDL5


24/79

L#wDensity Li(#(r#teins

3LDL5 @Ba% c#'ester#' )a!#r 'i(i% in LDL De'i"ers c#'ester#' r#) 'i"er t# ce''s

Ce'' )e)ranes H#r)#ne (r#%$cti#n Pr#tein 37 Bin%s t# s(eci+c LDL rece(t#r

LDL rece(t#rs Me)rane#$n% (r#teins tat in% LDL,

ca$sing te) t# e ta/en $( & %is)ant'e%


25/79

E2ect # Diet #n LDLC#ncentrati#ns

Increase LDL S?As

Transatty aci%s Hig c#'ester#'

inta/e

Liesty'e act#rs

Fenetics

Decrease LDL Hig P?A %iet

K8 atty aci%s Dietary +er

Liesty'e act#rs

Fenetics

LDL O i% ti %


26/79

LDL O0i%ati#n an%Ater#sc'er#sis

M i A i


27/79

Mecanis) # Ater#genicDys'i(i%e)ia

Ins$'in resistanceincrease% NE?Aan% g'$c#se $0 t#'i"er

Ins$'inresistance an%%ecrease% a(#B %egra%ati#n

Ins$'inresistancean%%ecrease%LPL

IR i)(airs

LDLR

Increase%-LDL

FCHL

DM

Metabolics!ndrome


28/79

Increase% Ater#genicity # S)a''Dense LDL

Direct "ssociation L#nger resi%ence ti)e in

('as)a tan n#r)a' si*e%LDL %$e t# %ecrease%rec#gniti#n y rece(t#rs in'i"er

Enance% interacti#n witsca"enger rece(t#r(r#)#ting #a) ce''#r)ati#n

M#re s$sce(ti'e t# #0i%ati#n%$e t# %ecrease%

anti#0i%ants in te c#re Enter an% attac )#re easi'y

t# arteria' wa'' En%#te'ia' ce'' %ys$ncti#n

In%irectAss#ciati#n nverse relationship

#ith HDL Mar$er for

athero%enic T&remnantaccumulation

nsulin resistance


29/79

HigDensity Li(#(r#teins

3HDL5 @F##% c#'ester#' )a!#r 'i(i% is (#s(#'i(i% Li(#(r#tein )a%e y 'i"er tat circ$'ates in te

'##% t# c#''ect e0cess c#'ester#' r#) ce''s L#west 'i(i%t#(r#tein rati#

Pr#tein 39>45 A(#A, A(#C, A(#E

Re"erse c#'ester#' trans(#rt Sa'"age e0cess c#'ester#' r#) ce''s Trans(#rte% ac/ t# 'i"er


30/79

HDL Meta#'is)

E % C t i


31/79

ey En*y)es an% C#act#rs inLi(i% Meta#'is)

HMFC#A re%$ctasere%$ces HMFC#A t# )e"a'#nic aci%in te rate'i)iting ste( # c#'ester#' i#syntesis3)ain'y 'i"er an% intestine5

Li(#(r#tein Li(ase %igests TF c#re # CMC an% -LDL

He(atic Li(asec#n"ersi#n # IDL t# LDL CETPtransers c#'estery' esters r#) HDL t# #ter

'i(#(r#teins in e0cange #r TF LCAT3'ecitin c#'ester#' acy' transerase5 c#n"ersi#n #

c#'ester#' t# c#'ester#' esters A(#'i(#(r#tein A)a!#r (r#tein # HDL acti"ating )any

reacti#ns A(#B)a!#r (r#tein # -LDL, IDL, an% LDL

A(#CII an% A(# E #taine% r#) HDL y CMC an% -LDL#r acti"ati#n # LPL an% rece(t#r rec#gniti#n res(ecti"e'y


32/79


33/79

Gy D#es HDLC Pr#tectGy D#es HDLC Pr#tect

HDLC

Pr#tecti#nagainst #0i%ati#n

M#%$'ati#n #en%#te'ia' $ncti#n

Pr#tecti#n # te "esse' wa''

C#'ester#'

acce(t#r

C#'estery'ester

%#n#r

Re"erse

C#'ester#'Trans(#rt 3RCT5

En%#te'ia' re(air

Antitr#)#tic

Antiina))at#ry


34/79

E2ects # Diet #n HDLC#ncentrati#n

Gat raises HDL ncertain i '#w car#y%rate %iets

#2er (r#tecti#n

Hig M?A inta/e

Liesty'e act#rs 3 E0ercise5

Fenetic act#rs in$ence HDL

Hig Density Li(#(r#tein &


35/79

Hig Density Li(#(r#tein &Ater#sc'er#sis

Re"erse c#'ester#' trans(#rt

Maintenance # en%#te'ia' $ncti#n

Pr#tecti#n against tr#)#sis Git "po "'iniits generati#n # ca'ci$)

in%$ce% (r#c#ag$'ant acti"ity #n erytr#cytesy stai'i*ing ce'' )e)rane

L#w '##% "isc#sity "ia (er)itting re% ce''

%e#r)ai'ity

Anti#0i%ant (r#(erties)ay e re'ate% t#en*y)es ca''e% (ara#0#nase


36/79

Dyslipidemia Characteristics

E'e"ate% trig'yceri%es

P#st(ran%ia' 'i(e)ia

S)a'' %ense LDL 3ty(e B5

E'e"ate% LDL

L#w HDL c#'ester#'

E'e"ate% T#ta'

C#'ester#'

Nat$re Me%icine 7>>


37/79

Ins$'in Resistance an%Dys'i(i%e)ia

Fat CellsFat Cells

TT

Apo !Apo !

'LDL'LDL

LiverLiver

%%

%ns*lin%ns*lin

..A..A

C& (C&T/) TC& (C&T/) T

(lipoprotein(lipoprotein

oror

hepatic lipase)hepatic lipase)

KidneyKidney

Apo A-1Apo A-1

(LDL

LDL

C&C&

(C&T/)(C&T/)

TT

HDL

SD

LDL

(hepatic lipase)(hepatic lipase)


38/79

D!slipidemia in

Diabetesncreased

"po )

Tri%l!cerides (LDL

LDL and

*mall DenseLDL

Decreased

HDL

"po "'


39/79

Ins$'in Resistance

Ass#ciate% C#n%iti#ns


40/79

Small dense LDL

-LDL< gi"es rise t#s)a'' %ense LDL

Increase TFC#'

c#ntent tr#$gCETP

Increase%e'i(i%ati#n ye(atic 'i(ase


41/79

Low HDL-cholesterol HDL8, 'arger wit a(#

A, CII, & CIII

HDL7, 'argest, wita%%iti#na' a(# E.

Best negati"e c#rre'ateCAD

Oter $ncti#nsattri$te% t# HDL

iniits )#n#cytece)#ta0is, LDL#0i%ati#n

T$'en/# 7>>7 N$c'ear Car%i#'#gy 68=


42/79

Low HDL-cholesterol


43/79

Low HDL-cholesterol

C+T,

inhibitor

L#w HDLc#'ester#'

Increase% cata#'is) # s)a'' %enseHDLL#w HDL c#'ester#' y #t c#ntentan% (artic'es


44/79

Hig trig'yceri%es

P#st(ran%ia''i(e)ia

S)a'' %ense LDL3ty(e B5

L#w HDL

c#'ester#'")C"'1

C+T,

-iacin

*tatin

Fibrate


45/79

C$rrent C'assi+cati#ns ?a)i'ia' Hy(erc#'ester#'e)ia 1 Hig

LDLC 3Ty(e IIA5 P#'ygenic ?a)i'ia' Hy(erc#'ester#'e)ia ?a)i'ia' C#)ine% Hy(er'i(i%e)ia 1

Hig LDLC an%#r ig TF 'e"e's

?a)i'ia' Dys'i(i%e)ias 1Hig TF an% '#wHDL

?a)i'ia' Dyseta'i(#(r#teine)ia 3Ty(eIII5


46/79

Tangier Disease Fenetic %is#r%er res$'ting in

(r#%$cti#n # a$'ty HDL (artic'es

tat cann#t ta/e $( c#'ester#'r#) ce''s

Hig ris/ #r %e"e'#(ing

car%i#"asc$'ar %isease


47/79

I)age c#$rtesy # te Internet Str#/e Center at Gasingt#nni"ersity www.str#/ecenter.#rg

QCan see te ('ate'etaggregati#n in res(#nse t# te#a) ce'' ce)ica's an% tiss$e%a)age

QTe ('ate'ets wi'' acti"ate tec#ag$'ati#n casca%e, res$'tingin te (r#%$cti#n # +rinstran%s wic tra( ('ate'ets,re% an% wite '##% ce''s #"er

te area tr#)$sQIn 'arger "esse's, it ta/es'#nger t# %e"e'#( a tr#)$sig en#$g t# c#)('ete'y'#c/ te "esse' s# y#$ get

warning signs 3TIA, A5 #str#/e an% MIQThis process happensever!#here brain/ heart0


48/79

I)age c#$rtesy # teInternet Str#/e Center at

Gasingt#n ni"ersity www.str#/ecenter.#rg


49/79

Car%i#"asc$'ar %isease

3C-D5 Fenera' ter) #r a'' %iseases # te

eart an% '##% "esse's

Ater#sc'er#sis is te )ain ca$se # C-D Ater#sc'er#sis 'ea%s t# '#c/age #

'##% s$(('y t# te eart, %a)age#cc$rs 3c#r#nary eart %isease, CHD5 Car%i# eart -asc$'ar '##% "esse's

C#r#nary Heart Disease


50/79

M-S


51/79

Li(#(r#teins an%

car%i#"asc$'ar %isease 3C-D5ris/ LDL is (#siti"e'y ass#ciate% wit

C-D

HDL is negati"e'y ass#ciate% witC-D


52/79

A P'et#ra # N#nLi(i% Mar/ers #Ris/


53/79

Ater#sc'er#sis Is an Ina))at#ryDisease

Liy et a'.Liy et a'. CirclationCirclation7>>79


54/79

Ater#sc'er#sis Is an Ina))at#ryDiseaseO0i%ati#n # '#w%ensity 'i(#(r#tein 3LDL5

initiates te ater#sc'er#tic (r#cess in te"esse' wa'' y acting as a (#tent sti)$'$s #rte in%$cti#n # ina))at#ry gene (r#%$cts in"asc$'ar en%#te'ia' ce''s. By acti"ating te

n$c'ear act#r B 3N?B5 transcri(ti#n act#r,#0i%i*e% LDL 3#0LDL5 sti)$'ates increase%e0(ressi#n # ce''$'ar a%esi#n )#'ec$'es.

Tere are se"era' %i2erent ty(es # a%esi#n

)#'ec$'es wit s(eci+c $ncti#ns in teen%#te'ia'1'e$/#cyte interacti#n Te se'ectinsteter an% tra( )#n#cytes an% #ter'e$/#cytes. I)(#rtant'y, "asc$'ar ce'' a%esi#n

)#'ec$'es 3-CAMs5 an% interce''$'ar a%esi#n

Ater#sc'er#sis Is an Ina))at#ry


55/79

Ater#sc'er#sis Is an Ina))at#ryDisease

O0LDL a's# a$g)ents e0(ressi#n # )#n#cyte

ce)#attractant (r#tein < 3MCP


56/79

,rimar! ,ro'inamator! C!to$inese%/ L'1/ T-F'0

L'56Messen%er7

C!to$ineC"M'1C"M'1

*electins/ H*,s/*electins/ H*,s/

etc.etc.

,roinammator!,roinammator!8is$ Factors8is$ Factors

+ndotheliumand othercells

C8,*""

CirculationCirculation

A%a(te% r#) Liy an% Ri%/er.A%a(te% r#) Liy an% Ri%/er. CirclationCirclation.


57/79

LDL an% ater#sc'er#sis


58/79

Rec#))en%e% '##% 'i(i%sT#ta' c#'ester#' V7>>

)g%L

LDL c#'ester#' V)g%L

HDL c#'ester#' W89 )g%LTrig'yceri%es V7>> )g%L


59/79

Desira'e B'##%

C#'ester#' N#r)a' V 7>> )g%' 39.7

))#'L5

B#r%er'ine 7>>786 )g%' #r39.7))#'L5

Hy(erc#'ester#'e)ia W 7:> )g%'

#r W ))#'L5


60/79

Desira'e Le e's LDL & HDL


61/79

Desira'e Le"e's LDL & HDLC#ntin$e%

LDLC 3Past5 V )g%' 37>>< V >5

LDLCt#ta' c#'ester#' 3HDLC X .7TF5

HDLC 3Past5 W89 )g%' 37>>5

HDLC W > )g%' wi'' negate #ne ris/act#r

Desira'e Le"e's Trig'yceri%e


62/79

Desira'e Le"e's Trig'yceri%eC#ntin$e%

N#r)a' TF V 7>> )g%'

B#r%er'ine ig 7>>:>>)g%'

Hig :>>>> )g%'

-ery Hig W >> )g%'

Life st!le is a Driver of C(D


63/79

Cr#niceart ai'$re

Arryt)iaArteria' & "en#$s

tr#)#siscar%iac & cerera' e"ents

Ater#sc'er#sisAter#sc'er#sis

Hy(ertensi#nDiaetes

Dys'i(i%ae)ia

Oesity

StressS)#/ing

Pysica'inacti"ity

E0cessi"e##% inta/eLife st!le

intervention

8is$ factormodi9cation

Life st!le is a Driver of C(D


64/79

Definition:(NCEP)National Cholesterol Education Program (2001)

At least 3 of

Abdominal obesity: waist circumference> 102 cm (M)

> 88 cm (F)

Hypertriglyceridemia > 150 mg/dl

Low HDL cholesterol< 40 mg/dl (M)

< 50 mg/dl (F)

Hypertension (> 130/85 mm Hg)

Impaired Fasting Glucose or Type 2 diabetes (> 100

mg/dl)

(ATP III. JAMA 285:2486, 2001)

PathogenesisoftheMetabolic


65/79

Pathogenesis of the MetabolicSyndrome

Ty(e 7Diaetes

Hy(ertensi#n

Dys'i(i%e)ia

Centra'#esity

Ins$'inResistan

ce

Pat#(ysi#'#gy # te )eta#'ic syn%r#)e


66/79

&eilly * &ader+$$,-

Eckel et al +$$

,la:ue rupture;thrombosis

Cardiovascular events

"therosclerosis

nsulin resistance

T% Metabolic s!ndrome

HDL

),

nammator! mar$ers

Pat#(ysi#'#gy # te )eta#'ic syn%r#)e'ea%ing t# ater#sc'er#tic C- %isease

A%i(#cyte M#n#cyte

)acr#(a

&enetic variation+nvironmental facto

A%#)ina'#esity Cyt#/inesA%i(#/ines


67/79

Treat)entTreat)ent

NCEP ATPIII g$i%e'ines M#%i+cati#n # 'i(i%s an% )a!#r ris/

act#rs See Ta'e


68/79


69/79


70/79


71/79

Dr$gs Nic#tinic Aci% 3/iaspan)

Bi'e Aci% SeJ$estrants 3c#'estyra)ine

an% c#'esti(#'5 HMF C#A Re%$ctase Iniit#rs

3'#"astatin, (ra"astatin, si)"astatin5

?iric Aci% Deri"ati"es 3C'#+rate,ge)+r#*i'5

Pr#$c#'


72/79


73/79

Treat)ent N$triti#n Tera(y

Tera(e$tic Liesty'e Canges 3TLC5%e"e'#(e% as c#)(#nent # ATPIII M#%i+cati#ns in at, c#'ester#' Ric in r$its, "egeta'es, grains, +er Li)it s#%i$) t# 7:>> )g Inc'$%e stan#' esters See Ta'e


74/79

-utrient 8ecommendations of TLCDietTLC< Therapeutic lifest!leChan%es0

-utrient

8ecommended nta$e Sat$rate% at V ;4 # t#ta' ca'#ries P#'y$nsat$rate% at ( t# 4 # t#ta' ca'#ries M#n#$nsat$rate% at ( t# 7>4 # t#ta' ca'#ries T#ta' at 798>4 # t#ta' ca'#ries Car#y%rates 9>>4 # t#ta' ca'#ries ?ier 7>8> gra)s%ay Pr#tein A((r#0. > )g%ay T#ta' ca'#ries Ba'ance energy inta/e an%

e0(en%it$re t# )aintain

%esira'e #%y weigt (re"ent weigt gain

A"#i% Trans ?ats.

Increase Inta/e # O)ega 8 essentia' ?atty Aci%s


75/79

N$triti#n Tera(y Oter Increase s#$rces # s#'$'e +er

Increase inta/e # ('ant ster#'s

Geigt '#ss 1 BMI


76/79


77/79

Me%ica' Treat)ents

C#r#naryAngi#('asty

C#r#nary By(assS$rgery 3CABF5

Diet S$(('e)ents


78/79

(( Fish il source of ome%a'3 pol!unsaturated fatt! acids0

Sa')#n, a0see%, can#'a #i', s#yean #i' an% n$ts At ig %#ses W gra)s%ay re%$ces TF y iniiti#n # -LDLTF syntesis an%

a(#'i(#(r#tein B P#ssi'y %ecreases s)a'' LDL 3y iniiting CETP5 Se"era' st$%ies a"e s#wn '#wer ris/ # c#r#nary e"ents 7 ser"ings # +swee/ rec#))en%e% Par)ac#'#gic $se restricte% t# reract#ry y(ertrig'yceri%e)ia N$)er # $n%esira'e si%e e2ects 3)ain'y FI5

*o! S#$rce # (yt#estr#gens iniiting LDL #0i%ati#n 799> gra)s%ay re%$ce LDL y :=4 E2ecti"eness in (#st)en#(a$sa' w#)en is J$esti#na'e

&arlic Mi0e% res$'ts # c'inica' tria's In c#)inati#n wit +s #i' an% 'arge %#ses 36>>;.7 gra)s%5, %ecreases in LDL

#ser"e%

Cholesterol'lo#erin% Mar%arines Benec#' an% Ta/e C#ntr#' c#ntaining ('ant ster#'s an% stan#'s Iniit c#'ester#' as#r(ti#n $t a's# (r#)#te e(atic c#'ester#' syntesis 7>4 re%$cti#n in LDL an% TC #we"er n# #$tc#)e st$%ies AHA rec#))en%s $se #n'y in y(erc#'ester#'e)ia (ts #r t#se wit a car%iac

e"ent reJ$iring LDL treat)ent Oter agents inc'$%e s#'$'e +er, n$ts 3es(. wa'n$ts5, green tea

O"era'' a c#)inati#n %iet wit )$'ti('e c#'ester#''#wering agents ca$ses )$c)#re signi+cant LDL re%$cti#ns

Cholesterol Control =ith


79/79

Cholesterol Control =ithFoods and Herbs

?ier Decreases LDL increases HDL Carr#tsFra(er$it ?ier an% (ectin 3w#'e r$its

)#st ene+cia'5 A"#ca%# )#n#$nsat$rate% at Beans Hig in +er, '#w at c#ntain 'ecitin Pyt#ster#'s sesa)e, saZ#wer, s(inac, #/ra,

strawerries, sJ$as, t#)at#es, ce'ery, ginger. Siita/e )$sr##)s c#ntain 'entinan 3794

re%$cti#n in ani)a' st$%ies5 Far'ic, #ni#n #i' '#wers c#'. 884 O)ega 8 +s #i's Re% Yeast Rice a nat$ra' s$stance tat iniits

HMFC#A re%$ctase. Sa)e ingre%ient in L#"astatin.

7. biochemistry of lipoprotein & dyslipidemia

Documents