Slide 1HyperlipidemiaSlide 3Slide 4Slide 5High LDL Cholesterol StatisticsLow HDL CholesterolCholesterol transport: LipoproteinsLipoproteinsApolipoproteinsCholesterol MetabolismTreatment for high cholesterolTreatment for high cholesterol: DrugsSlide 14LipoproteinsSlide 16Slide 17Slide 18Slide 19Slide 20Slide 21Slide 22STRRIDE resultsSlide 24Slide 25Slide 26Slide 27Slide 28Sarzynski, et al. 2015 Atherosclerosis ConclusionOverall Summary: Exercise and LipidsDyslipidemiaLecture 1HyperlipidemiaKnow your numbers!Age-adjusted trends in the prevalence of serum total cholesterol ≥200 mg/dL in adults ≥20 years of age by sex, race/ethnicity, and survey year (National Health and Nutrition Examination Survey 2007–2008, 2009–2010, and 2011–2012). Dariush Mozaffarian et al. Circulation. 2015;131:e29-e322Copyright © American Heart Association, Inc. All rights reserved.High LDL Cholesterol Statistics•About 33.5% of American adults have high LDL– 1 out of 3 have it under control–Less than half with high LDL get treatmentRace or Ethnic Group Men (%) Women (%)Non-Hispanic Blacks 34.4 27.7Mexican Americans 41.9 31.6Non-Hispanic Whites 30.5 32.0All 32.5 31.0Low HDL CholesterolCholesterol transport: Lipoproteins•Composed of lipids, protein, cholesterol•Different types and subclasses – vary in atherogenicity size  densityApoproteins: 1) solubilize lipids 2) contain cell-targeting signalsLipoproteinsAPO-B containing LipidsAPO-A-1 containing LipidsApolipoproteins•Apo A-1– Major protein found on HDL –promotes cholesterol efflux from tissues to the liver for excretion = reverse cholesterol transport•Apo B–Apo B-100, Apo B-48 (chylomicrons)–found on LDL, VLDL, IDL and Chylomicrons–synthesized in liver (LDL, VLDL, IDL) and gut (chylo)–associated with atherosclerosis–considered a good indicator of heart disease riskCholesterol MetabolismTriglycerides (storage form of fat LPL= lipoprotein LipaseTreatment for high cholesterolDiet1) Soluble fiber (5-10g/d): Oatmeal, apples, barley, prunes, kidney beans2) Omega-3 fatty acids (2 servings/wk): Mackrel, salmon, Albacore tuna, Halibut, Lake trout, sardines, flaxseed, canola oil3) Nuts (1.5oz/d): almonds, walnuts, hazelnuts, pistachios, pecans4) Olive oil (2tbsp/d): EVOO5) Plant sterols/stanols: beans, peanut butter, oranges, apples, avocados, fortified foodsTreatment for high cholesterol: DrugsStatins (Crestor, Lipitor)–HMG-CoA reductase inhibitors •reduces cholesterol production in the liver–decrease LDL and TG, may slightly increase HDL–Side effects: constipation, nausea, diarrhea, stomach pain, muscle soreness, muscle pain, muscle weakness–5-10% of patients on statins report muscle complaints-Evidence for the effect of exercise training on lipidsLecture 2LipoproteinsAPO-B containing LipidsAPO-A-1 containing LipidsSmaller LDL is more atherogenic!!!Change (mg/dL)Significance17Studies of a Targeted Risk Reduction Intervention Through Defined Exercise (STRRIDE)Participants: 40-65 years old, men and women (n=168, 80% white, 48% female)mild-moderate dyslipidemiaRandom assignment to 4 groups:ControlLow/Mod=12mi/wk, 40-55% VO2peakLow/Vig = 12mi/wk, 65-80%High/Vig = 20mi/wk, 65-80% ramp-up then 6 months = 8 monthsKraus, Houmard, and Duscha. NEJM 2002;347;1483-92Studies of a Targeted Risk Reduction Intervention Through Defined Exercise (STRRIDE)Kraus, Houmard, and Duscha. NEJM 2002;347;1483-92Studies of a Targeted Risk Reduction Intervention Through Defined Exercise (STRRIDE)Kraus, Houmard, and Duscha. NEJM 2002;347;1483-92Studies of a Targeted Risk Reduction Intervention Through Defined Exercise (STRRIDE)Kraus, Houmard, and Duscha. NEJM 2002;347;1483-92STRRIDE results•STRRIDE studies observed many positive changes in lipid variables that are not part of the typical lipid profile (i.e. particle size)–high intensity/volume: •decreased small LDL concentration •LDL and IDL particle concentration •greatest increases in HDL•6 studies evaluating the effect of exercise training on plasma lipids•Divided into 10 exercise dose groups (KKW)–KKW=kcal/kg body weight/wk–ranged from 4-23KKW•Adjusted for age, sex, race, BMI, baseline cholAll women/lower exercise volumeSarzynski, et al. 2015 AtherosclerosisSarzynski, et al. 2015 AtherosclerosisSarzynski, et al. 2015 AtherosclerosisSarzynski, et al. 2015 AtherosclerosisSarzynski, et al. 2015 AtherosclerosisConclusion•Most training studies showed training decreased TG by ~ _________ mg/dl•Most studies show a modest increase in HDL (______mg/dl)•Some studies showed a small decrease in LDL•But there were changes in LDL size that indicate a less atherogenic profileOverall Summary: Exercise and Lipids•Most studies show a decrease in TG with exercise training ( _______mg/dL)•Most studies show an increase in HDL with exercise training (_______ mg/dL)•Need high intensity, may be a better effect in obese•While not all studies show a decrease in LDL with exercise training, there appear to be significant changes in LDL particle sizes–Less