TOTAL CHOLESTEROL (lipid profile test).pptx

This is a document about total cholesterol i.e. lipid profile test. Anyone can use as class notes also

1. TOTAL CHOLESTEROL Dhurgadharshini , Pharm D – 1 st Yr.

2. INTRODUCTION Cholesterol is a type of fat, found in our blood. It is found in our body and also come from the food we eat(animal products). It is made by liver and is also used by the liver to make bile, which helps in the digestion of foods. Cholesterol is also needed to make certain hormones and to produce vitamin D.

3. STRUCTURE OF CHOLESTEROL

4. FUNCTIONS OF CHOLESTEROL Its main function is to maintain the integrity and fluidity of cell membranes. T o serve as a precursor for the synthesis of substances that are vital for the organism including steroid hormones, bile acids, and vitamin D.

5. METABOLISM OF CHOLESTEROL Biosynthesis of cholesterol generally takes place in the endoplasmic reticulum of hepatic cells and begins with acetyl- CoA, which is mainly derived from an oxidation reaction in the mitochondria . Triglycerides and cholesterol combine to form chylomicrons. Chylomicrons enter the circulation and travel to peripheral sites. In peripheral tissues, free fatty acids are released from the chylomicrons to be used as energy, converted to triglyceride or stored in adipose.

6. WHY IT’S DONE High cholesterol usually causes no signs or symptoms. A complete cholesterol test is done to determine whether your cholesterol is high and to estimate your risk of heart attacks and other forms of heart disease and diseases of the blood vessels . Cholesterol testing evaluates the risk for artherosclerosis , myocardial occlusion, and coronary artherial occlusion. It is a part of lipid profiles. Elevated levels are major component in the hereditary hyperlipoprotenemias .

7. Cholesterol determinations are also frequently a part of thyroid function, liver function, renal function, and diabetes mellitus studies. It is also used to monitor effectiveness of diet, medications, lifestyle changes and stress management. A complete cholesterol test includes the calculation of four types of fats in your blood : Total Cholesterol - This is a sum of your blood's cholesterol content. HDL - As we know earlier. LDL – As we know earlier. Tryglycerides - As we know earlier.

8. WHO SHOULD GET CHOLESTEROL TEST? According to the National Heart, Lung and Blood Institute (NHLBI), a person's first cholesterol screening should occur between the ages of 9 and 11 and then be repeated every five years after that . The NHLBI recommends that cholesterol screenings occur every 1 to 2 years from men ages 45 to 65 and women ages 55 to 65. People over 65 should receive cholesterol test annually. More-frequent testing might be needed if your initial test results were abnormal or if you already have coronary artery disease.

9. VALUES FOR CHOLESTEROL Normal : less than 200 mg/ dL . Boderline : 200 to 239 mg/ dL . High : at or above 240 mg/ dL .

10. PRE-TEST INSTRUCTIONS You're generally required to fast, consuming no food or liquids other than water, for nine to 12 hours before the test. Some cholesterol tests don't require fasting. A normal diet should be consumed for 7 days. The patient should abstain from alcohol for 48 hours before testing. Drugs like contraceptive pills should be avoided prior to test as they alter the cholesterol levels.

11. DURING THE PROCEDURE A cholesterol test is a blood test, usually done in the morning if you fast overnight. Blood is drawn from a vein, usually from your arm . Before the needle is inserted, the puncture site is cleaned with antiseptic and an elastic band is wrapped around your upper arm. This causes the veins in your arm to fill with blood . After the needle is inserted, a small amount of blood is collected into a vial or syringe. The band is then removed to restore circulation, and blood continues to flow into the vial. Once enough blood is collected, the needle is removed and the puncture site is covered with a bandage.

12. HOW DO YOU CALCULATE TC? HDL + LDL + 20% triglycerides = total cholesterol . LDL = 100 HDL = 70 Triglycerides = 150 100+70+(150/5) 100+70+30 = 200mg/ dL

13. AFTER THE PROCEDURE Cholesterol levels >200mg/ dL should be retested and the results averaged. If the two results differ by >10%, a third test should be done. Once hypercholesterolemia has been established, the diet should be lower in animal fats and should replace saturated fats with polyunsaturated fats. Fruits, vegetables and whole-grain products should be increased. Atleast 6months of dietary therapy should be tried before intiating cholesterol-reducing drug therapy. Drug therapy involves statins(lovastatin, simvastatin, fluvastatin ), clofibrate,etc .

14. Lovastatin – Adults(20mg/day). Childrens (10mg/day). Simvastatin – Usual dose range(5-40mg/day). Initial(10-20mg/day). Patients at high CHD risk(start 40mg/day). Fluvastatin - Adults—80 milligrams (mg) once a day. Children 10 to 16 years of age—80 mg once a day . Clofibrate - Adults—1.5 to 2 grams a day. This is divided into two to four doses. Children—Dose must be determined by your doctor.

15. Once low level of cholesterol has been established, the following alterations has to be taken, Eat heart-healthy foods( Reduce saturated fats, Eliminate trans fats, Eat foods rich in omega-3 fatty acids, Increase soluble fiber, Add whey protein). Exercise on most days of the week and increase your physical activity Quit smoking  Drink alcohol only in moderation. Drugs to increase the cholesterol levels are : Beta Blockers. Prednisone. Amiodarone. Cyclosporine. Anabolic Steroids. Protease Inhibitors. Diuretics.

16. CLINICAL IMPLICATIONS Elevated cholesterol levels occur with the following conditions: Hyperlipoprotenemia , cholestasis, hepatocellular disease, nephrotic syndrome, chronic renal failure, hyperthyroidism, poorly controlled diabetes mellitus, alcoholism, glycogen storage disease(von gierke’s disease), werner’s syndrome, diet high in cholesterol and fats, obesity. Decreased cholesterol levels occur in the following conditions: Severe hepatocellular disease, malabsorption syndrome, malnutrition, hyperthyroidism, chronic anemias, conditions of acute illness, severe burns, chronic obstructive lung disease and mental retardation.