CHLORESTEROL
Cholesterol is a soft, waxy substance found in all parts of the body. This includes the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and also obtained from animal products in the diet.
Cholesterol is manufactured in the liver for normal body functions, including the production of hormones, bile acid, and vitamin D. It is transported in the blood to be used by all parts of the body. In foods, cholesterol is found in eggs, dairy products, meat, and poultry. Egg yolks and organ meats (liver, kidney, sweetbread, and brain) are high in cholesterol. Fish generally contains less cholesterol than other meats, but some shellfish are high in cholesterol. Foods of plant origin (vegetables, fruits, grains, cereals, nuts, and seeds) contain no cholesterol. (Source: Medline Plus, National Library of Medicine, 2008)
Cholesterol – treatment: The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, see the boxes below for your risk category. There are two main ways to lower your cholesterol:
- Therapeutic Lifestyle Changes (TLC)--includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
- Drug Treatment--if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.
TLC is a set of things you can do to help lower your LDL cholesterol. The main parts of TLC are:
- The TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power.
- Weight Management. Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
Physical Activity. Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
Foods low in saturated fat include fat-free or 1percent dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats, egg yolks, and full-fat dairy products.
Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans.
Cholesterol - Drug treatment
Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of drugs available for cholesterol lowering including statins, bile acid sequestrants, nicotinic acid, fibric acids, and cholesterol absorption inhibitors. Your doctor can help decide which type of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people. Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid lowers LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Cholesterol absorption inhibitorrs lower LDL and can be used alone or in combination with statin drugs.
Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.
Cholesterol – HDL: HDL stands for high density lipoprotein, a form of "good" cholesterol. Lipoproteins are proteins in the blood that move cholesterol, triglycerides, and other lipids to various tissues.
Cholesterol – LDL: Low-density lipoprotein test. The LDL test measures how much low-density lipoprotein (LDL) you have in your blood. LDL is a type of cholesterol . Too much LDL in the blood can clog arteries.
Cholesterol Lowering Agents: and Women: Some earlier studies had suggested that cholesterol-lowering agents do not provide the same benefits to women as they do to men. However, recent studies have suggested that lipid lowering agents may also be life saving in women, although perhaps not to the same degree as they are in men.
CHOLESTEROL (HIGH) – and Lifestyle modifications
Question: What Lifestyle Modifications improve Cholesterol Levels?
Currently, there is much controversy over the best balance of carbohydrates, fats, and protein. A number of dietary approaches for improving the cholesterol and heart health are available:
- The American Heart Association (AHA) Guidelines
- The Mediterranean Diet,
- Very low-fat diets, particularly the Ornish Program.
- The Dietary Approaches to Stop Hypertension (DASH) diet has been designed specifically to help people reduce blood pressure.
- The Atkins diet (severely restricts carbohydrates and substitutes protein).
CHOLESTEROL (HIGH) – and Exercise
Inactivity is one of the four major risk factors for coronary artery disease, on par with smoking, unhealthy cholesterol, and high blood pressure. In fact, studies suggest that people who change their diet in order to control cholesterol are successful in actually lowering their risk for heart disease only when they also follow a regular aerobic exercise program.
The following are some observations on the effects of exercise on coronary artery disease.
- People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people. Even moderate exercise reduces the risk of heart attack.
- Some studies suggest that for the greatest heart protection, it is not the duration of the exercise that counts but the total daily amount of energy expended.
- Burning at least 250 calories a day (the equivalent of about 45 minutes of brisk walking or 25 minutes of jogging) seems to confer the greatest protection against coronary artery disease, particularly by raising HDL (the so-called good cholesterol) levels. (It may take up to a year of sustained exercise for HDL levels to show significant improvement, but in terms of raising HDL levels, more is better.)
- Aerobic exercise also appears to open up the blood vessels and, in combination with a healthy diet, may improve blood-clotting factors.
- Resistance (weight) training offers a complementary benefit by reducing LDL (the so-called bad cholesterol) levels.
- Exercises that train and strengthen the chest muscles may prove to be very important for patients with angina.
CHOLESTEROL (HIGH) and Smoking
Cigarette smoking lowers HDL-cholesterol levels and is directly responsible for approximately 20% of all deaths from heart disease. The importance of breaking this habit cannot be emphasized enough.
CHOLESTEROL (HIGH) and Alcohol
The effects of alcohol on heart disease vary depending on consumption. Evidence now suggests that light to moderate alcohol consumption (one or two drinks a day) protects the heart. The benefits are strongest in people at high risk for heart disease and may be fairly small in those at low risk. Light to moderate alcohol intake may even reduce the risk of sudden cardiac death and also protect against coronary heart disease in people with adult-onset diabetes.
On the negative side, moderate consumption of alcohol, equal to or less than one drink a day, may produce a slight increase in the risk for breast cancer in women. Large amounts of alcohol can raise blood pressure, trigger irregular heartbeats, and damage the heart muscle. Binge drinkers have a significantly higher risk for a cardiac emergency. Pregnant women or those at risk for alcohol abuse should not drink alcohol.
CHOLESTEROL (HIGH) – and Drug Treatment:
Question: What are the Drug Therapies and the Other Treatments for Unhealthy Levels of Cholesterol?
Answer: Experts now recommend that drug treatments be tailored for raising or lowering specific lipids, depending on the patient's blood lipid picture:
- Three types of drugs, statins, resins, and probucol, target LDL. Statins have other benefits as well and are now the first choice for most people who require lipid-lowering therapy.
- Two others, fibrates and nicotinic acid, also lower triglycerides and increase HDL. [See Table Below.]
Considerations for Women. Some evidence has suggested that cholesterol-lowering agents do not provide the same benefits to women as they do to men. However, recent studies are finding that they are also life saving in women, although perhaps not to the same degree as they are in men.
Considerations for Children. Certain children over seven or eight years old with unhealthy cholesterol levels (LDL over 190 mg dl) may benefit from medications, particularly if they have a strong family history of heart disease. In such cases, the following may be helpful:
- Bile-acid binding agents may be a good choice, assuming the child has normal triglyceride levels. A multiple vitamin with folic acid and iron supplements may be needed in such cases.
- Nicotinic acid is an option for young people with high triglycerides.
- Statins may be used in adolescent boys, but their effect on pregnancy is not known so young women should avoid them.
Long-term safety of any cholesterol-lowering agents in children has not been tested.
Patients should discuss all options thoroughly with their physicians. Combinations are often used for patients with severe cholesterol profiles. The physician should periodically monitor the patient in order to check the drug's effectiveness and possible toxicity. It remains important, even when taking drugs, to maintain a healthy lifestyle.
| Effects of Medications on Different Lipids | ||||
| Drugs and Supplements | Effect on High LDL | Effect on Low HDL | Effect on High Triglycerides | Effect on Lp(a) |
| Statins | Lower | Modest increase | Lower | No change |
| Fibrates | May actually increase LDL in patients with high triglycerides. | Little effect | Lower | No change |
| Nicotinic acid (Niacin) | In combination with statins, may convert more dangerous LDL type to less dangerous. | Very strong increase | Drug of Choice for lowering triglycerides | |
| Bile acid-binding resins | Lowers LDL | No change | May increase triglycerides | No change |
| Estrogen Replacement | Increase | Can raise triglycerides. (Patch form may not have this effect.) | ||
Modified Citrus Pectin(MCP) |
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