mg per day in divided doses 1 to 4 times daily. Side effects include hypotension,
bradycardia, congestive heart failure (CHF), edema, and dermatitis.
Section III. ANTIHYPERLIPIDEMIC AGENTS
3-12. REVIEW OF ATHEROSCLEROSIS
Atherosclerosis is a condition in which lipid (fat) deposits form on the inside of the
arteries causing a decrease in the flow of blood through the arteries. The make up of
these deposits is mostly cholesterol as a consequence of genetic and dietary factors
which result in too much cholesterol. The arteries of most concern are the coronary
arteries (those that supply the heart) and the carotid arteries (those that supply the
brain). Hyperlipidemia is a condition of high levels of cholesterol, triglycerides, and /or
lipoprotein in the blood. The higher the levels in the blood, the greater the risk that they
will deposit on the inside of arteries. Several studies have shown a correlation between
cholesterol levels and premature heart disease. Studies have shown that each 1%
reduction in serum cholesterol correlates with a 2% decline in the risk of myocardial
infarction. For example, a 25% reduction in cholesterol will reduce the risk of
myocardial infarction by 50%. Diet, exercise, antihyperlipidemic drugs, and surgery are
the most common treatments. If a patient has high cholesterol only, and no evidence of
atherosclerosis, the treatment of the hyperlipidemia is referred to as primary prevention.
If the patient already has atherosclerosis, treatment is known as secondary prevention.
a. Cholesterol: A fat-related compound. It is a normal constituent of bile and a
principal constituent of gallstones. In body metabolism cholesterol is important as a
precursor of various steroid hormones such as sex hormones and adrenal corticoids.
Cholesterol is synthesized by the liver. It is widely distributed in nature, especially in
animal tissue such as glandular meats and egg yolk.
b. Triglyceride (TG): A compound of three fatty acids esterified to glycerol. A
neutral fat, synthesized from carbohydrate, stored in adipose tissue. It releases free
fatty acids into the blood on being hydrolyzed by enzymes.
Lipoproteins: Fat with protein. Major carrier of lipids in the plasma.
(1) Chylomicron: Particle of fat - lipoproteins - appearing in the lymph and
blood after a meal rich in fat. These particles are composed largely of triglycerides with
lesser amounts of phospholipids, cholesterol, esters, and protein. About 2 to 3 hours
after a fat meal, the chylomicrons cause lactescene (milkiness) in the blood plasma; this
is termed alimentary lipemia.
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