Transcript Cholesterol-- Knowledge is Power!

Janice Herbert-Carter, MD, MGA, FACP
Associate Professor of Medical Education
Objectives
 At the conclusion of the session, participants will be
able to :
 Define types of cholesterol and lipids and categorize
levels as low, normal or high
 Discuss the importance of cholesterol in health and
disease
 List at least three types of medications to treat high
cholesterol
 Describe a diet and exercise plan to manage high
cholesterol.
What is cholesterol?
 Cholesterol is a waxy lipid (fat) that is naturally
produced in the liver and also found in foods and
combines with protein to make particles.
 Some of those particles are small and dense (LDL);
some are big and fluffy (HDL). LDL is more dangerous
because the small particles can squeeze into the
linings of the heart and blood vessels and set up shop.
What is cholesterol?
 LDL Low density lipoprotein = BAD cholesterol

Carries cholesterol FROM the liver through the blood and
then it can clog up blood vessels
 HDL High density lipoprotein = GOOD cholesterol

Carries cholesterol TO the liver where it can be used up to
form bile and then excreted out of the body through the
intestine
What good does it do?
 Basis for making:
 Vitamin D

Maintains calcium, bone health, and more
 Cortisol
 Maintains sugar levels in the blood
 Aldosterone
 Regulates salt and water balance
 Estrogen, testosterone
 Maintains female and male functions
 Bile acids
 For digestion
What harm does it do?
 Too much LDL can promote
ATHEROSCLEROSIS/“hardening of the arteries”
 High LDL can collect in cells in the lining of arteries
and form PLAQUE
What harm does it do?
 Plaque can obstruct the flow of blood leading to
decreased oxygen and nutrients to vital organs,
especially the heart = Coronary Artery Disease/
Ischemic Heart Disease
 CAD/IHD can lead to chest pain (angina pectoris) and
heart attacks (myocardial infarction /MI)
What harm does it do?
Blood vessels in other organs can suffer from
atherosclerosis/ischemia too
 Brain  Stroke
 Legs  Peripheral arterial disease, claudication (pain
with walking)
 Genital area  Impotence
 Abdomen  Pain with eating
What should my cholesterol be?
What should my cholesterol be?
 Total Cholesterol
 <200 Desirable
 200-239 Borderline high
 240 High
 HDL Cholesterol
 <40 Low
 60 High
What should my cholesterol be?
 LDL Cholesterol
 <100 Optimal
 100-129 Near optimal/above optimal
 130-159 Borderline high
 160-189 High
 190 Very high
What should my cholesterol be?
 If you have extra risk factors for CAD, you want you BAD
cholesterol even lower.
 Major Risk Factors That Modify LDL Goals*
 Cigarette smoking
 Hypertension (BP 140/90 mmHg or on antihypertensive
medication)
 Low HDL cholesterol (<40 mg/dL)†
 Family history of premature CHD (CHD in male first degree relative
<55 years; CHD in female first degree relative <65 years)
 Age (men 45 years; women 55 years)
 * Diabetes is a CHD risk equivalent.
 † HDL 60 mg/dL counts as a “negative” risk factor; its presence removes
one risk factor from the total .
What should my cholesterol be?
 Risk Category LDL Goal (mg/dL)
 CHD and CHD risk equivalents <100
 Multiple (2+) risk factors <130
 Zero to one risk factor <160
Triglycerides
 Another important lipid (fat)
 By itself, it doesn’t cause heart attacks but is associated
with cholesterol and with diabetes
What if my cholesterol is high?
 The condition with high levels of cholesterol and/or
triglycerides is called hyperlipidemia
 Some of the cause of hyperlipidemia is based on
lifestyle, diet, etc. which you can do something about.
 Some is based on genetics (family history) and you
can’t change that.
What if my cholesterol is high?
 What you CAN do is live a healthy lifestyle to lower
cholesterol and minimize other risk factors for heart
disease:
 Don’t smoke
 Maintain a healthy weight
 Control high blood pressure
 Control diabetes
 Hyperlipidemia may be treated with diet, exercise, and
medications.
Diet & Exercise
 If your cholesterol is high :
 Overall, a low fat, low calorie diet will benefit you.
 Overall, more exercise will benefit you.
 Overall, a healthy diet and increased exercise will cause
weight loss, which will benefit you.
Diet & Exercise
 But remember,
 Just because a food is high in cholesterol does not mean
you must avoid it completely.
 If you eat less cholesterol, your body (liver) will just
make more.
 Not all overweight people have high cholesterol and not
all thin people have normal cholesterol.
Emphasize!
 LOTS of FIBER!!!!
(especially soluble
fiber)
 Fruits and veggies–
 Whole grains
 brown rice, whole wheat
breads, whole grain
cereals
 Beans, peas
Why fiber?
 Insoluble fiber speeds up the movement of food
through the intestines and promotes regularity.
Insoluble fiber can be found in whole-grain foods,
wheat bran, many vegetables, and fruit with skin.
 Soluble fiber -- also called viscous fiber -- dissolves
when mixed with water and becomes a gel-like
substance, slowing down the movement of food
through the small intestine. Sources of soluble fiber
include oats, peas, beans, apples, and citrus fruits
Emphasize!
 Fish, poultry without skin, lean meats,
 Low-fat or non-fat dairy
 milk, yogurt, cheese
Emphasize!
 Healthy oils/fats
 Olive oil, canola oil, peanut
oil
 Nuts, especially walnuts,
almonds, hazelnuts, pecans,
pistachios, some pine nuts,
and peanuts
 “Omega 3” fat in salmon,
mackerel, sardines, herring,
anchovies, albacore tuna,
and lake trout
 But watch the total calories!
 Baked, broiled, roasted,
boiled, grilled food without
added fat
Minimize!
 Saturated fats
 Cream, butter, lard,
coconut oil, palm oil
 Trans fats
 Stick margarine,
processed foods
 High fat meat
 Full-fat dairy
 Egg yolks
 Fried foods
Exercise– how does it help?
 Increases HDL (good cholesterol) and decreases LDL
(bad cholesterol).
 Helps move cholesterol from the blood (and blood-
vessel walls) to the liver. From there, the cholesterol is
converted into bile acids (for digestion) or excreted.
Exercise
 The American Heart Association recommends
moderate intensity exercise such as walking briskly,
bike riding, swimming, dancing
Exercise
The intensity may be moderate, but
the amount of time you spend
exercising, has to be pretty high. The
American Heart Association
recommends 30 minutes per day at
least 5 days a week, or 60 minutes a
day if you're also trying to lose
weight. You can get your exercise in
10 minutes increments, as long as it
adds up to 30 minutes a day.
Is this how you feel about exercise?
Exercise tips
 Find an activity you love.
 Finding a buddy to exercise with can be helpful, for
moral support and to help make it more fun.
 Even better, find several activities you love, so you can
vary your routine. This helps you exercise more than
one set of muscles, and enjoy different work-out
environments.
 http://www.tapmania.com/video.htm
Lipid-lowering medications
Medication/
examples
How it works
Possible side
effects
Do NOT take…
Statins: Lipitor,
Zocor, Crestor
Work in liver to prevent
cholesterol formation
Muscle , liver
problems
Are pregnant, have
liver ds.
Zetia
Prevent cholesterol
absorption from intestine
Muscle,
stomach, back,
joint pain
Resins: Colestid,
Questran
Liver uses up more
cholesterol to make more
bile
GI discomfort
(N&V,
constipations,
abdominal pain)
Fibrates: Lopid,
Niacin
Lower TGs and raise HDL
Niacin may
cause flushing,
itching, GI
upset, liver ds.
Dietary supplement
niacin is different
form prescription
niacin
What about supplements?
 Psyllium = soluble fiber
 Metamucil
 Fish oil capsules
 Contain DHA and EPA (omega 3)
 Garlic
 Research is not definite yet but it may help, and it adds
flavor to food!
Want more info?
 http://www.nhlbi.nih.gov/health/public/heart/chol/c




hol_tlc.pdf
http://www.webmd.com/cholesterolmanagement/default.htm
http://www.heart.org/HEARTORG/Conditions/Choles
terol/Cholesterol_UCM_001089_SubHomePage.jsp
http://www.emedicinehealth.com/understanding_cho
lesterol-lowering_medications/article_em.htm
http://health.howstuffworks.com/diseasesconditions/cardiovascular/cholesterol/foods-thatlower-cholesterol.htm