Let

1
Lets Talk About Cholesterol

• Emily Lundstrom, R.Ph., Pharm.D.
• Melissa Kalb, RD, LD
• August 8, 2007

2
Outline

• Discuss the different types of cholesterol
• Identify healthy cholesterol levels
• Provide an overview of medications used to treat
  abnormal cholesterol levels
• Discuss options for a low cholesterol diet

3
What is cholesterol?

• Fat-like, waxy substance
• Cholesterol comes from two sources
• The food you eat and your liver

4
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

5
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

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LDLThe Lousy Cholesterol

• Contributes to build up of fat deposits in
  arteries
• Decreases blood flow to
• the heart
• Want this to be low
• Lowered by diet, exercise, and most medications

7
HDLThe 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

8
Triglycerides

• Most common type of fat in the body
• Comes mostly from diet
• Things that increase triglycerides

9
What Level of Cholesterol is good?

• Total cholesterol lt200
• Triglycerides lt150
• HDLHappy Cholesterol gt40
• LDLLousy Cholesterol lt100?
• LDL goal depends on other health conditions or
  risk factors

10
Medications

• Statins
• Bile acid binders
• Nicotinic acid (Niacin)
• Fibric Acids
• Cholesterol absorption inhibitors
• Fish Oil

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Statins

• Lipitor (atorvastatin)
• Zocor (simvastatin)
• Pravachol (pravastatin)
• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Mevacor (lovastatin)

Indicates generic available
12
Statins

• 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

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Bile Acid Binders

• LDL Triglycerides HDL
• Mix powders with
• water, juice, or food
• Space from other
• medications
• Side effects
• Constipation, nausea,
• gas

• Questran (cholestyramine)
• Colestid (colestipol)
• Welchol (colesevelam)

Indicates generic available
14
Nicotinic Acid (Niacin)

• HDL Triglycerides LDL
• Vitamin B3
• May cause flushing and itching
• Take with food
• Niacor, Niaspan, Slo-Niacin OTC

Indicates generic available
15
Fibric Acids

• Triglycerides HDL LDL
• Take with food
• Side effects
• Nausea, diarrhea,
• constipation
• May cause muscle
• pain or weakness

• Lopid
• (gemfibrozil)
• Tricor or Triglide
• (fenofibrate)

Indicates generic available
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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

17
Fish Oil
Triglycerides

• Omacor
• Rx only
• FDA Approved
• Expensive
• Now called Lovaza

• Omega-3 Supplement
• Over-the-counter
• Not FDA Approved
• Inexpensive

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Two-In-One

• Combination medications available
• Vytorin
• (simvastatin ezetimibe)
• Advicor
• (lovastatin Niaspan)
• Pravigard PAC
• (pravastatin aspirin)

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References

• American Heart Association. Accessed at
  http//www.americanheart.org
• 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
  2852486-97.

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References

• 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.

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Low Cholesterol Diet

• Melissa Kalb, RD, LD

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Therapeutic Lifestyle Changes (TLC)

• 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

23
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

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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

25
Cholesterol

• 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.

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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.

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Total fat intake

• 25 to 35 of total calories
• Including heart-healthy fats

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Fiber

• 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

29
Meat Alternatives

• Meat and cheese can be high in saturated fats
• Items to try soy burgers, and beans in
  casseroles

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Weight Loss and Exercise

• Following lifestyle changes
• Speak with your health care team to determine an
  exercise plan

31
Healthy Lifestyle and Medication

• Do I need to follow a healthy lifestyle if I am
  taking my medication?

32
Questions???

• Emily Lundstrom, Pharm.D.
• emily.lundstrom_at_osumc.edu
• Chris Green, Pharm.D.
• christopher.green_at_osumc.edu
• Melissa Kalb, RD, LD
• melissa.kalb_at_osumc.edu