Treatment of Heart Failure
Terms
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- Classic Angina
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-Occlusion of coronary arteries resulting from the formation of athersclerotic plaques
-Most common form of angina
-Symptoms occur during exertion/stress
-High Cholesterol= #1 Risk Factor - Variant Angina
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-Spontaneous vasoconstriction of coronary arteries
-Likely genetic in origin
-Symptoms occur at rest - Stable Angina
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Partial occlusion of coronary artery
Symptoms only during exertion - Unstable Angina
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Partial occlusion of coronary artery w/ sudden, intermittent vasoconstriction.
-Symptoms increase in frequency and begin to occur at rest - Normal Lipid Metabolism
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1-Chylomicrons transport cholesterol and triglycerides
2-Lipoprotein Lipase cleaves triglycerides from chylomicrons leaving cholesterol in liver
3-Liver packs cholesterol and triglycerides together as VLDL
4-Lipoprotein Lipase breaks down VLDL releasing triglycerides. Produces IDL which is taken up by liver or converted to LDL.
5-LDL delivers cholesterol to cells by binding to LDL receptor on cells
6-HDL is synthesized in the liver. Stimulates lipoprotein lipase and acquires cholesterol from other sites and returns it to the liver to be excreted - Hypertriglyceridemia
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Increased VLDL
-Some risk for coronary heart disease - Hypercholesterolemia
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Increased LDL
-HIgh risk for coronary heart disease - Tx of Hyperlipidemia
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1. Decrease the amount of lipid entering the blood (Diet)
2. Improve the clearance of lipid from the blood
-VLDL-->Lipoprotein Lipase
-LDL-->LDL Receptors - Drugs used for tx of hypertriglyceridemia
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Niacin
Fibric Acid Derivatives - Drugs used for Tx of hypercholesterolemia
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Bile-acid binding resins
Statins
Exetimibe
Combo Therapy - Niacin
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Used to treat hypertriglyceridemia
-Inhibits VLDL synthesis in liver
-Stimulates lipoprotein lipase acitivity (breakdown of VLDL)
-Increases HLD levels
-Net decrease in LDL - Fibric Acid Derivatives
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-Used to treat hypertriglyceridemia
-Inhibits VLDL synthesis in liver
-Stimulates breakdown of VLDL by lipoprotein lipase
-No change in LDL levels - Bile-Acid Binding Resins
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Colestipol
-Used to treat hypercholesterolemia
-Reduces LDL levels
-Prevents bile acid reabsorption
-Greater conversion of cholesterol to bile acids and lower liver cholesterol levels
-Lower cholesterol levels stimulate up-regulation of LDL receptors which increases LDL uptake from blood - Statins
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Atorvastatin (Lipitor)
-Used to treat hypercholesterolemia
-HMG-CoA Reductase Inhibitor
-Inhibits cholesterol synthesis in liver-->upregulation of LDL receptors, results in increased removal of LDL from blood.
--Side Effects--
Usually safe with mild GI effects
Low incidence of liver toxicitiy
Low incidence of rhabdomyolysis - Ezetimibe
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Zetia
-Used to treat hypercholesterolemia
-Inhibits intestinal cholesterol absorption
1.Reduces dietary cholesterol absorption
2.Reduces re-absorption of cholesterol secreted in bile
**May induce rhabdomolysis by itself or increase risk for statin-induced rhabdomyolysis