CONTACTS
SUBJECTS
Endocrinology Review HDL Failing Rise With Hiking Mileage
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 5 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Sarah proposes telephone meeting with Carl Grunfeld.
040902 -
040903 - 210415 0900
040905 - ..
040906 - This implements planning with Doctor Pellegrini on 210407 0930, to
040907 - schedule meeting with Endocronology.
040909 - ..
040910 - Find out why HDL went up to 83 hiking 11 - 15 mpd, and now won't rise
040911 - above 60....
040912 -
040913 -
040914 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
040915 -
040916 -
040918 - ..
040919 - DHAEPA fish oil
040920 -
040921 - 3000 4000 mg per day available at Costco, but too expensive
040922 - right now.
040924 - ..
040925 - Doctor Grunfeld seemd to say he is about 73; he was an intern at
040926 - Massechutes General hospital in the early 1970s, and at that time
040927 - worked with Doctor Simpson, who was a Resident Fellow, several years
040928 - older than Doctor Grunfeld. Actually, Doctor Simpson is now 79, since
040929 - he was 78 in 2020.
040931 - ..
040932 - Doctor Grunfeld collaborated with Doctor Feingold on HDL issues for
040933 - over 20 years. Doctor Feingold has retired.
040935 - ..
040936 - Doctor Simpson's progress notes report he could not find an
040937 - "HDL-positive cardiologist" to consult on the case, reported on 171011
040938 - 1000. ref SDS 2 HQ89
040940 - ..
040941 - Today, Doctor Grunfeld seemed to say that he and Doctor Feingold
040942 - notified manufacturer representatives that drugs being tested in
040943 - clinical trials to raise HDL, would not be effective treating
040944 - atherosclerosis, because while HDL was increased, the "Return
040945 - Cholesterol Transport" (RCT) was not effective, reviewed previously on
040946 - 131125 0005. ref SDS 1 8638 and ref SDS 1 KG9F
040947 -
040948 -
040950 - ..
040951 - He will order another lab at the VA to test inflammation.
040952 -
040953 -
040954 - carl.grunfeld@ucsf.edu
040956 - ..
040957 - He wants current NMR results - order from HTC.
040958 -
040959 -
040960 - [On 210420 0826 ordered NMR lipid test from Labcorp.
040961 - ref SDS 6 0488
040962 -
040963 - [On 210515 1631 blood draw NMR lipids by Labcor at John
040964 - Muir Urgent Care in Walnut Creek on Treat and Cherry Lane.
040965 - ref SDS 7 I436
040966 -
040968 - ..
040969 - After the call research found...
040971 - ..
040972 - The Effect of Inflammation and Infection on Lipids and Lipoproteins
040973 -
040974 - Kenneth R Feingold, MD and Carl Grunfeld, MD, PhD
040975 -
040976 - Last Update: January 8, 2019.
040977 -
040978 - https://www.ncbi.nlm.nih.gov/books/NBK326741/#:~:text=Decreased%20HDL%20Levels,triglycerides%2C%20and%20free%20fatty%20acids.
040980 - ..
040981 - ABSTRACT
040983 - ..
040984 - Chronic inflammatory diseases, such as rheumatoid arthritis,
040985 - systemic lupus erythematosus, and psoriasis and infections,
040986 - such as periodontal disease and HIV, are associated with an
040987 - increased risk of cardiovascular disease. Patients with these
040988 - disorders also have an increase in coronary artery calcium
040989 - measured by CT and carotid intima media thickness measured by
040990 - ultrasound. Inflammation and infections induce a variety of
040991 - alterations in lipid metabolism that may initially dampen
040992 - inflammation or fight infection, but if chronic could
040993 - contribute to the increased risk of atherosclerosis. The most
040994 - common changes are decreases in serum HDL and increases in
040995 - triglycerides.
040997 - ..
040998 - On 200221 0800 during meeting in Orthopedics, Doctor Thuillier advised
040999 - that PRP treatments injecting concentrated platelets into feet and
041000 - knee injuries not only generates collagen that heals wounds to prevent
041001 - pain, so that hiking can occur, the concentrated platelets also
041002 - prevent inflammation that occurs with painful injuries, which
041003 - otherwise blocks the liver from producing HDL. ref SDS 4 WY8H
041005 - ..
041006 - Article continues...
041007 -
041008 - The increase in serum triglycerides is due to
041009 - both an increase in hepatic VLDL production and secretion and a
041010 - decrease in the clearance of triglyceride rich lipoproteins.
041011 - The mechanisms by which inflammation and infection decrease HDL
041012 - levels are uncertain. There is also a consistent increase in
041013 - lipoprotein (a) levels due to increased apolipoprotein (a)
041014 - synthesis. LDL levels are frequently decreased but the
041015 - prevalence of small dense LDL is increased due to cholesterol
041016 - ester transfer protein (CETP) mediated exchange of
041017 - triglycerides from triglyceride rich lipoproteins to LDL
041018 - followed by triglyceride hydrolysis. In addition to affecting
041019 - serum lipid levels, inflammation also adversely effects
041020 - lipoprotein function. LDL is more easily oxidized as the
041021 - ability of HDL to prevent the oxidation of LDL is diminished.
041022 - Moreover, there are a number of steps in the reverse
041023 - cholesterol transport pathway that are adversely affected
041024 - during inflammation. The greater the severity of the
041025 - underlying inflammatory disease, the more consistently these
041026 - abnormalities in lipids and lipoproteins are observed.
041027 - Treatment of the underlying disease leading to a reduction in
041028 - inflammation results in the return of the lipid profile towards
041029 - normal. The changes in lipids and lipoproteins that occur
041030 - during inflammation and infection are part of the innate immune
041031 - response and therefore are likely to play an important role in
041032 - protecting the host. The guidelines for the management of
041033 - lipid disorders and the standard risk calculators for
041034 - predicting cardiovascular disease (ACC/AHA, Framingham, etc.)
041035 - underestimate the risk in patients with inflammation. It has
041036 - been recommended to increase the calculated risk by
041037 - approximately 50% in patients with severe inflammatory
041038 - disorders. The treatment of lipid disorders in patients with
041039 - inflammatory disorders is similar to patients without
041040 - inflammatory disorders. Of note statins, fibrates, and fish
041041 - oil have anti-inflammatory properties and have been reported to
041042 - have beneficial effects on many of these inflammatory
041043 - disorders.
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