Let Talk About Cholesterol by jennyyingdi


									   Let’s Talk About
Emily Lundstrom, R.Ph., Pharm.D.
       Melissa Kalb, RD, LD
         August 8, 2007
• Discuss the different types of
• Identify healthy cholesterol levels
• Provide an overview of medications
  used to treat abnormal cholesterol
• Discuss options for a low cholesterol
      What is cholesterol?
• Fat-like, waxy substance
• Cholesterol comes from two sources
   • The food you eat and your liver
Why do we need cholesterol?
• Some is needed for bodily functions
  • To make cells and some hormones

• Too much cholesterol
  • Clogs arteries
  • Causes heart attack or stroke
       Types of Cholesterol
• LDL Cholesterol-”Lousy” Cholesterol
• HDL Cholesterol-”Happy” Cholesterol
• Triglycerides
• Which is the most important?
  • LDL
  • HDL & Triglycerides are a close 2nd and 3rd
LDL—The “Lousy” Cholesterol
• Contributes to build up of fat deposits in
• Decreases blood flow to
  the heart
• Want this to be low
  • Lowered by diet, exercise, and most
 HDL—The “Happy” Cholesterol
• Helps carry “bad” cholesterol away from
  arteries to liver
• The higher the better!
• How can you raise your HDL?
  • Exercise
  • Some medications help
  • Eating properly may help
• Most common type of fat in the body
• Comes mostly from diet
   Things that increase triglycerides
What Level of Cholesterol is good?

•   Total cholesterol         <200
•   Triglycerides             <150
•   HDL—”Happy” Cholesterol   >40
•   LDL—”Lousy” Cholesterol   <100?

* LDL goal depends on other health
  conditions or risk factors
•   “Statins”
•   Bile acid binders
•   Nicotinic acid (“Niacin”)
•   Fibric Acids
•   Cholesterol absorption inhibitors
•   Fish Oil
• Lipitor® (atorvastatin)
• Zocor® (simvastatin)*
• Pravachol® (pravastatin)*
• Crestor® (rosuvastatin)
• Lescol® (fluvastatin)*
• Mevacor® (lovastatin)*
                            *Indicates generic available
     LDL           Triglycerides    HDL

• Well tolerated
  • Could experience headache, constipation,
    stomach cramps or gas
• A small number of patients experience
  muscle pain or weakness
• Will require liver tests
• Most need to be taken before bed
             Bile Acid Binders
•      LDL           Triglycerides           HDL

• Mix powders with              • Questran®
  water, juice, or food           (cholestyramine)*
• Space from other              • Colestid®
  medications                     (colestipol)
• Side effects:                 • Welchol®
    • Constipation, nausea,       (colesevelam)
                                *Indicates generic available
      Nicotinic Acid (Niacin)
     HDL       Triglycerides          LDL

• Vitamin B3
• May cause flushing and itching
• Take with food
• Niacor®*, Niaspan®*, Slo-Niacin®*          OTC
                         *Indicates generic available
             Fibric Acids
    Triglycerides     HDL               LDL

• Take with food       • Lopid®
• Side effects:            (gemfibrozil)*
   • Nausea, diarrhea,
     constipation      • Tricor® or Triglide®
• May cause muscle        (fenofibrate)
 pain or weakness
                         *Indicates generic available
Cholesterol Absorption Inhibitors
• Zetia® (ezetimibe)
• Stops cholesterol
  absorption from food
• Does not have to be taken with food
• Often combined with a “statin”    LDL
• Side effects:
  • headache, abdominal pain, diarrhea
                  Fish Oil


        Omacor®          Omega-3 Supplement
•   Rx only            • Over-the-counter
•   FDA Approved       • Not FDA Approved
•   $$ Expensive $$    • Inexpensive
*   Now called Lovaza®
• Combination medications available:
• Vytorin®
  • (simvastatin + ezetimibe)
• Advicor®
  • (lovastatin + Niaspan)
• Pravigard PAC®
  • (pravastatin + aspirin)
• American Heart Association. Accessed at
• National Heart, Lung, and Blood Institute. Accessed
  at http://www.nhlbi.nih.gov/
• Expert Panel on Detection, Evaluation, and Treatment
  of High Blood Cholesterol in Adults. Executive
  Summary of The Third Report of The National
  Cholesterol Education Program (NCEP) Expert Panel
  on Detection, Evaluation, And Treatment of High
  Blood Cholesterol In Adults (Adult Treatment Panel
  III. JAMA. 2001; 285:2486-97.
• Grundy SM, Cleeman JI, Merz CN et al. Implications
  of recent clinical trials for the National Cholesterol
  Education Program Adult Treatment Panel III
  guidelines. Circulation. 2004; 110: 227-39.
Low Cholesterol Diet

  Melissa Kalb, RD, LD
    Therapeutic Lifestyle Changes
•   Limit saturated fats and trans fats
•   Limit cholesterol
•   Eat more omega-3 fats
•   Monitor total fat intake
•   25-35 grams of fiber per day
•   Include meat alternatives
•   Weight loss
•   Exercise
          Saturated Fats
• Generally from animal or dairy sources
  • Also from coconut and palm oils

• Items to limit = marbled meat, poultry
  skin, bacon, sausage, whole milk,
  cream, butter
              Trans Fats
• Process that turns an unsaturated
  (healthier fat) into saturated fats

• Items to limit = stick margarine,
  shortening, some fried foods, and
  packaged foods made with
  hydrogenated oils
• TLC goal = 200 milligrams per day
• American Heart Association = 300
  milligrams per day

• Items to avoid – egg yolks, fatty meat,
  whole milk, cheese, shrimp, lobster,
  and crab.
           Omega-3 Fats
• These fats may help to reduce your risk
  of heart disease

• Good sources = salmon, tuna,
  mackerel, walnuts, canola soybean and
  flaxseed oil.
          Total fat intake
• 25% to 35% of total calories
• Including heart-healthy fats
• Goal = 20 – 30 grams per day
• Soluble fiber – helps to lower LDL
  (“bad”) cholesterol
  • Sources: oats, beans, peas, citrus fruits,
    strawberries, apple pulp
• Insoluble fiber – helps to decrease your
  cardiovascular risk
  • Sources: whole wheat bread, wheat
    cereals, cabbage, carrots, cauliflower,
    apple skin
        Meat Alternatives
• Meat and cheese can be high in
  saturated fats

• Items to try = soy burgers, and beans
  in casseroles
   Weight Loss and Exercise
• Following lifestyle changes

• Speak with your health care team to
  determine an exercise plan
Healthy Lifestyle and Medication

• Do I need to follow a healthy lifestyle if
  I am taking my medication?
Emily Lundstrom, Pharm.D.

    Chris Green, Pharm.D.

   Melissa Kalb, RD, LD

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