YOUR CHOLESTEROL
WHY DO YOU CARE?
WHAT YOU CAN DO!
WHAT IS CHOLESTEROL?
A FAT THAT CIRCULATES IN YOUR BLOODSTREAM
SOMETHING THAT CLOGS ARTERIES LEADING TO HEART ATTACKS, STROKES, GANGRENE, ETC.
FRAMINGHAM STUDY1948 IN SUBURBAN BOSTON
MEASURED BLOOD LEVELS OF CHOLESTEROL ETC.
LEARNED THAT IT WAS ASSOCIATED WITH CORONARY HEART DISEASE AND STROKE
GOOD VS. BADCHOLESTEROL TRAVELS IN BLOOD WITH PROTEIN
LDL= LOW DENSITY LIPOPROTEIN (BAD)
HDL=HIGH DENSITY LIPOPROTEIN (GOOD)
THE WAR WITHINLDL TRIES TO INJECT THE CHOLESTEROL INTO THE ARTERY WALL TO BLOCK IT
HDL TRIES TO COLLECT LOOSE CHOLESTEROL AND PREVENT BLOCKAGE
THE NUMBERSTHE “LIPID PANEL”
TOTAL CHOLESTEROL
LDL CHOLESTEROL
HDL CHOLESTEROL
TRIGLYCERIDES
RATIOS
NCEP ATP IIINATIONAL CHOLESTEROL EDUCATION PROGRAM
NATIONAL HEART, LUNG AND BLOOD INSTITUTE (NHLBI)
ADULT TREATMENT GUIDELINES-2004, TO BE UPDATED IN 2011
THE NUMBERSLDL IS MOST SIGNIFICANT
<130 IS RECOMMENDED
<100 IS OPTIMAL
<70 IS TARGET IF YOU HAVE HEART DISEASE, DIABETES, OR CHRONIC KIDNEY DISEASE
ATP III GUIDELINESTREAT LDL TO REACH GOALS
WEIGHT REDUCTION
EXERCISE
LOWER SATURATED FAT IN DIET
MEDICATIONS
ATP III GUIDELINESDIET FOR LOWERING LDL:
REDUCE SATURATED FAT TO <7% OF TOTAL CALORIES
TOTAL FAT <25%
LESS RED MEAT AND EGGS
MORE VEGETABLES, FIBER, FISH AND CHICKEN
THE PLATE DIETDIVIDE PLATE INTO THREE PARTS
ONE HALF IS FRUITS/VEGGIES
ONE QUARTER MEAT
ONE QUARTER CARBS (STARCH)
ATP III GUIDELINESLDL LOWERING:
DIET
EXERCISE
LOSE WEIGHT
THE NUMBERSHDL: THE GOOD CHOLESTEROL
HDL IS PROTECTIVE
>45 IS IDEAL
<40 IS TROUBLE
RAISING HDLQUIT SMOKING
EXERCISE, EXERCISE
MEDICATION
TRIGLYCERIDES
THINK OF IT AS SUGAR/STARCH THAT BECOMES FAT EVENTUALLY
< 150 NORMAL
150-199 HIGH
>199 NEEDS HELP!
LOWER TRIGLYCERIDE
QUIT SMOKING
REDUCE ALCOHOL INTAKE
REDUCE CARBS
LOSE WEIGHT
MEDICATION
METABOLIC SYNDROME
HIGH TRIGLYCERIDE
LOW HDL
INSULIN RESISTANCE
HIGH RISK FOR DEVELOPING DIABETES AND HEART DISEASE
METABOLIC SYNDROME
CAUSE: OBESITY AND HIGH CARBOHYDRATE DIET
TREATMENT:
LOSE WEIGHT
LESS CARBS
EXERCISE
DO YOU SEE A TREND?
THE BOTTOM LINE:
EXERCISE
LOSE WEIGHT
REDUCE FATS
REDUCE CARBS
FRAMINGHAM STUDY
IDENTIFIED RISK FACTORS FOR CORONARY HEART DISEASE:
CHOLESTEROL, AGE, SEX, BLOOD PRESSURE, SMOKING
2 & 10 YEAR RISK PREDICTION
FRAMINGHAM STUDY
74 YEAR OLD MALE WITH:
CHOLESTEROL 200, HDL 45, NON-SMOKER WITHOUT DIABETES, BP 140/80 TREATED
RISK OF HEART ATTACK IN 2 YEARS IS ONLY 3%
FRAMINGHAM STUDY
74 YEAR OLD MALE WITH:
CHOLESTEROL 200, HDL 45, SMOKER WITH DIABETES, BLOOD PRESSURE 160 DESPITE MEDICATION
RISK OF HEART ATTACK IN 2 YEARS IS UP TO 24%!
FRAMINGHAM STUDY
IT’S NOT JUST THE CHOLESTEROL THAT DETERMINES YOUR RISK
CHOLESTEROL IS A MAJOR MODIFIABLE RISK FACTOR FOR HEART DISEASE EVEN AT AGE 75
MEDICATIONSHELP LOWER CHOLESTEROL WHEN DIET & EXERCISE ARE NOT ENOUGH
NOT WELL STUDIED > AGE 75
SIDE EFFECTS CONCERN MANY PATIENTS
MANY PROVEN TO HELP
MEDICATIONSSTATINS LOWER LDL: CRESTOR SIMVASTATIN, LIPITOR
SOME GET MUSCLE ACHES
LIVER PROBLEMS RARE
PROOF:LOWER RISK OF HEART ATTACK AND STROKE
FIBRATESTRICOR, FENOFIBRATE, TRILIPEX
LOWER TRIGLYCERIDE AND RAISE HDL
NOT MUCH PROVEN BENEFIT IN PREVENTING DISEASE
MEDICATIONSFISH OIL-OTC AND LOVAZA
LOWER LDL, RAISE HDL, LOWER TRIGLYCERIDE
LITTLE PROVEN BENEFIT BUT NOT TOXIC AT ALL
BURPING-FREEZE THE PILLS!
MEDICATIONSNIACIN
B VITAMIN
RAISES HDL, LOWERS LDL AND TRIGLYCERIDE
FLUSHING
BENEFIT QUESTIONABLE
MEDICATIONSFAT BINDERS THAT WORK IN YOUR INTESTINE
WELCHOL, QUESTRAN, ZETIA
FEW SIDE EFFECTS
LOWER LDL BUT LITTLE PROVEN BENEFIT
CONCLUSIONCHOLESTEROL IS ONE MODIFIABLE RISK FACTOR FOR HEART DISEASE
DIET AND EXERCISE CRUCIAL
MEDICATIONS MAY HELP