your cholesterol why do you care? what you can do !

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