|
:: Cholesterol ::
High cholesterol
Overview Cholesterol is a waxy substance found in your blood. Your body needs cholesterol to build healthy cells, but high levels of cholesterol can increase your risk of heart disease. With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke.
High cholesterol can be inherited, but it's often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol.
Symptoms High cholesterol has no symptoms. A blood test is the only way to detect if you have it.
When to see a doctor Ask your doctor if you should have a cholesterol test. Children and young adults with no risk factors for heart disease are usually tested once between the ages of 9 and 11 and again between the ages of 17 and 19. Retesting for adults with no risk factors for heart disease is usually done every five years. If your test results aren't within desirable ranges, your doctor might recommend more-frequent measurements. Your doctor might also suggest more-frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as smoking, diabetes or high blood pressure.
Causes Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. There are different types of cholesterol, based on what the lipoprotein carries. They are: * Low-density lipoprotein (LDL). LDL, or "bad" cholesterol, transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow. * High-density lipoprotein (HDL). HDL, or "good" cholesterol, picks up excess cholesterol and takes it back to your liver. A lipid profile also typically measures triglycerides, a type of fat in the blood. Having a high triglyceride level can also increase your risk of heart disease. Factors you can control — such as inactivity, obesity and an unhealthy diet — contribute to high cholesterol and low HDL cholesterol. Factors beyond your control might play a role, too. For example, your genetic makeup might keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.
Risk factors Factors that can increase your risk of bad cholesterol include:
* Poor diet. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers and microwave popcorn, can raise your cholesterol level. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will also increase your cholesterol. * Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol. * Lack of exercise. Exercise helps boost your body's HDL, or "good," cholesterol while increasing the size of the particles that make up your LDL, or "bad," cholesterol, which makes it less harmful. * Smoking. Cigarette smoking damages the walls of your blood vessels, making them more prone to accumulate fatty deposits. Smoking might also lower your level of HDL, or "good," cholesterol. * Age. Because your body's chemistry changes as you age, your risk of high cholesterol climbs. For instance, as you age, your liver becomes less able to remove LDL cholesterol. * Diabetes. High blood sugar contributes to higher levels of a dangerous cholesterol called very-low-density lipoprotein (VLDL) and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.
Complications
Development of atherosclerosis Open pop-up dialog box High cholesterol can cause a dangerous accumulation of cholesterol and other deposits on the walls of your arteries (atherosclerosis). These deposits (plaques) can reduce blood flow through your arteries, which can cause complications, such as:
* Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you might have chest pain (angina) and other symptoms of coronary artery disease. * Heart attack. If plaques tear or rupture, a blood clot can form at the plaque-rupture site — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you'll have a heart attack. * Stroke. Similar to a heart attack, a stroke occurs when a blood clot blocks blood flow to part of your brain.
Prevention The same heart-healthy lifestyle changes that can lower your cholesterol can help prevent you from having high cholesterol in the first place. To help prevent high cholesterol, you can:
* Eat a low-salt diet that emphasizes fruits, vegetables and whole grains * Limit the amount of animal fats and use good fats in moderation * Lose extra pounds and maintain a healthy weight * Quit smoking * Exercise on most days of the week for at least 30 minutes * Don't drink alcohol at all * Manage stress
What to Expect With Heart Medication
:: Some Certified Cholesterol Medications :: Sometimes, a healthy diet and regular exercise just aren't enough to attain healthy cholesterol levels. This is often the case when high cholesterol is caused by genetic factors, and in these situations, medications can help. Statins are usually the first choice because they also reduce your risk for heart attack and stroke. Other types of medications that may be prescribed include selective cholesterol absorption inhibitors, resins (also known as bile acid sequestrant or bile acid-binding drugs), and lipid-lowering therapies such as fibrates, niacin, and omega-3s.
Cholesterol Treatment: Supplements Several nutritional supplements have been shown to be beneficial in improving cholesterol levels.
How can high cholesterol be controlled? Nearly 1/3 of all adults in the U.S. have high cholesterol levels, according to the Centers for Disease Control (CDC). High cholesterol can put people at risk for heart disease, heart attacks, and death. Cholesterol levels can be lowered with regular exercise, weight loss, and a healthy diet that is low in cholesterol and saturated fats. But in some cases, diet and exercise are not enough and cholesterol-lowering medications may be needed. This slideshow will discuss the basics of cholesterol and the types of drugs prescribed to treat high cholesterol.
What is cholesterol? Cholesterol is a waxy, fat-like substance in the blood that is made by the body's liver and helps your body produce hormones, vitamin D, and to digest fat. The other source of cholesterol is from the diet in foods like egg yolks, fatty meats, and cheeses. You only need a small amount to regulate the body processes, and when there is excess cholesterol in the blood, it can build up on the walls of the blood vessels, in deposits called plaque. Plaque can contribute to the narrowing and blockages of arteries that can lead to heart disease.
What are LDL cholesterol, HDL cholesterol, and triglycerides? There are different types of cholesterol. Most of your body's cholesterol is low density lipoprotein (LDL) cholesterol, also referred to as "bad" cholesterol because it can lead to plaque buildup in the arteries, which leads to heart disease and stroke. High-density lipoprotein (HDL) cholesterol is called the "good" cholesterol because it absorbs "bad" cholesterol and carries it back to the liver, which helps remove it from your body. This can reduce your risk of heart disease and stroke. Triglycerides are a type of fat found in your blood. High triglycerides combines with low HDL cholesterol or high LDL cholesterol can increase your risk for heart attack and stroke.
The most common type of steroid in the body. Cholesterol has a reputation for being associated with an increased risk for heart and blood vessel disease. However, cholesterol is essential to the formation of bile acids, vitamin D, progesterone, estrogens (estradiol, estrone, estriol), androgens (androsterone, testosterone), mineralocorticoid hormones (aldosterone, corticosterone), and glucocorticoid hormones (cortisol). Cholesterol is also necessary to the normal permeability and function of the membranes that surround cells. A diet high in saturated fats tends to increase blood cholesterol levels, whereas a diet high in unsaturated fats tends to lower blood cholesterol levels. Although some cholesterol is obtained from the diet, most cholesterol is made in the liver and other tissues. The treatment of elevated cholesterol involves not only diet but also weight loss, regular exercise, and medications.
Cholesterol Levels: What the Numbers Mean
What Is Cholesterol? Cholesterol is a natural substance made by the body. Most of the cholesterol in our bloodstream (75%) is produced by the liver, and the remaining 25% comes from the foods we eat. We all know that elevated blood cholesterol levels are not good for your health, but the right levels of cholesterol actually play a vital role in maintaining cell membranes and synthesizing hormones. The Centers for Disease Control reports that one-third of adults have high cholesterol levels.
High Cholesterol Symptoms Usually, high cholesterol does not produce any symptoms and you may not know your blood cholesterol is too high. Too much cholesterol can build up in your arteries, causing atherosclerosis, or hardening of the arteries. This restricts blood flow through the arteries and can lead to serious medical problems such as heart attack or stroke.
Cholesterol Testing The American Heart Association recommends all adults over age 20 should have their cholesterol levels checked every four to six years. Cholesterol screening is done with a blood test that measures three things.
What Appears on Cholesterol Screenings * High-density lipoprotein (HDL) cholesterol ("good" cholesterol) * Low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) * Triglycerides
LDL Cholesterol: 'Bad' Cholesterol Low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol, is the type that tends to deposit on the walls of the arteries. White blood cells combine with the LDL cholesterol, forming artery-narrowing plaque, which restricts blood flow. The optimal level of LDL cholesterol for most people is 100 mg/dL or lower. If you have heart disease, you may need to strive for LDL levels of 70 mg/dL or lower.
HDL Cholesterol: 'Good' Cholesterol Not all cholesterol is bad. High-density lipoprotein (HDL) cholesterol is considered "good" cholesterol because it actually works to keep the LDL, or "bad" cholesterol from building up in your arteries. The higher the HDL, the better. HDL levels of 60 mg/dL and higher can help reduce your risk for heart disease. Conversely, HDL levels of 40 mg/dL and lower are considered a high risk factor for developing heart disease.
Triglycerides Triglycerides are a type of fat found in the blood. Normal levels of triglycerides are 150 mg/dL and lower. Levels higher than that can raise your risk for heart disease and metabolic syndrome, which also is a risk factor for heart disease, diabetes, and stroke.
Risk Factors for High Triglycerides * Obesity * Diabetes * Smoking * Alcohol abuse * Inactivity/Lack of exercise
Total Cholesterol A cholesterol test will measure the total cholesterol in your blood, and your total cholesterol levels are made up of a combination of your LDL, HDL, and VLDL (very low density lipoprotein, another "bad" cholesterol) levels. A total cholesterol score of 200 mg/dL or lower is considered optimal. Levels above 200 mg/dL are considered high and can mean you are at greater risk for developing heart disease.
Cholesterol Ratio When your health-care professional orders your blood cholesterol levels to be checked, he or she will interpret and discuss the results such as your cholesterol ratio and total cholesterol numbers (HDL, LDL, and VLDL), and what they each mean.
To calculate your cholesterol ratio, divide your total cholesterol number by your HDL cholesterol number. For example, if you have a total cholesterol score of 200 and an HDL score of 40; divide 200 by 40 and this equals a ratio of 5 to 1. The lower the ratio, the lower your risk of heart disease. Doctors recommend keeping your ratio 5 to 1 or lower. The optimal ratio is 3.5 to 1. While this ratio can be helpful in assessing risk for heart disease, your doctor will take into account your entire cholesterol profile and tell you what treatment is best for you.
Cholesterol in Food Cholesterol in food is not the same as the cholesterol in your blood. For most people, the cholesterol in foods you eat has a minimal effect on your blood cholesterol levels. However, about 30% of people are "responders," whose blood cholesterol levels can spike following a meal high in cholesterol. “Responders” should avoid foods high in saturated fats and trans fats, such as oil, fatty meats, full fat dairy products, egg yolks, and many fast foods.
Cholesterol and Family History Eating foods high in cholesterol and saturated fat is not the only cause for high cholesterol levels in some people. For many, genetics are to blame. A genetic condition called familial hypercholesterolemia can cause high blood cholesterol levels.
What Boosts Your Risk? There are several risk factors for high cholesterol.
High Cholesterol Risk Factors * Diets high in trans fats, saturated fats, and cholesterol * Being overweight or obese * Sedentary lifestyle Other risk factors you cannot control include age (risk increases as we age), gender (women's risk for high cholesterol increases postmenopause), and family history.
Cholesterol and Gender Women generally have higher levels of HDL, or "good," cholesterol because the female hormone estrogen tends to raise HDL levels. This is why most women tend to have lower cholesterol levels than men. That is, until menopause, after that, triglyceride levels start to rise. As women approach menopause it is important to eat a healthy diet, and maintain a healthy weight to help manage blood cholesterol levels.
Cholesterol and Children Hardening of the arteries (atherosclerosis) actually begins in childhood, and may play a role in development of heart disease in adulthood. Children with parents or grandparents with coronary atherosclerosis or any form of heart disease or heart attack, or whose parents have high blood cholesterol should have their cholesterol levels checked. The American Heart Association recommends children should be encouraged to exercise regularly, maintain a healthy weight, eat a healthy low fat diet with plenty of fruits and vegetables, and treat high blood pressure and diabetes (if the child has been diagnosed).
Why High Cholesterol Matters High cholesterol puts you at risk for heart disease and stroke, leading causes of death in the U.S. High levels of LDL ("bad") cholesterol can contribute to plaque buildup on the walls of the arteries, narrowing the arteries and restricting blood flow. If some of this plaque breaks off and gets stuck in a narrowed artery, it can block the artery and cut off blood supply to the heart or brain, resulting in heart attack or stroke.
: Cholesterol Drugs ::
What types of cholesterol drugs are available? Numerous types of cholesterol drugs are available in the U.S., including statins (HMG CoA reductase inhibitors), nicotinic acid (niacin), fibric acid derivatives (fibrates), bile acid sequestrants, cholesterol absorption inhibitors and omega-3 fatty acids. These medications can help lower LDL ("bad") cholesterol levels, and increase HDL ("good") cholesterol levels. Different medications may also be combined to do both at the same time.
What are statins? Statins are a class of drugs that work by lowering blood cholesterol levels, and reducing the production of cholesterol by the liver by blocking an enzyme. Statins are used to reduce high cholesterol levels, and also to prevent and treat hardening of the arteries (atherosclerosis) that can cause chest pain, heart attacks, strokes, peripheral vascular disease and intermittent claudication (cramping leg pain) in at-risk patients. Risk factors for atherosclerosis include: * high LDL ("bad") cholesterol levels or low HDL ("good") cholesterol levels * high blood pressure * a family history of early heart attacks * smoking * increasing age * diabetes * insulin resistance * obesity * lack of physical activity * unhealthy diet The next several slides are examples of statins currently prescribed to lower cholesterol.
atorvastatin (Lipitor) Drug Class: Statins Prescription: Yes Generic: No Preparations: Tablets of 10, 20, 40, and 80 mg. Prescribed for: Atorvastatin (Lipitor) lowers the LDL ("bad") cholesterol and triglycerides and can raise your HDL ("good") cholesterol. This can lower the risk for heart attack, stroke, certain types of heart surgery, and chest pain in patients who have heart disease or risk factors for heart disease such as age, smoking, high blood pressure, low HDL, or family history of early heart disease. Side effects: Atorvastatin (Lipitor) is generally well-tolerated. Minor side effects include diarrhea, constipation, nausea, upset stomach, gas, fatigue, heartburn, headache, muscle and joint pain, and changes in some blood tests. Atorvastatin (Lipitor) may cause liver and muscle damage (rhabdomyolysis).
rosuvastatin (Crestor) Drug Class: Statins Prescription: Yes Generic: No Preparations: Tablets of 5, 10, 20, and 40 mg. Prescribed for: Rosuvastatin (Crestor) is used for the reduction of blood total cholesterol, LDL cholesterol and triglyceride levels, and to increase HDL cholesterol levels, to reduce the chances of developing problems like heart disease and strokes. Side effects: The most common side effects of rosuvastatin (Crestor) are headache, depression, nausea, vomiting, stomach pain, indigestion, diarrhea, constipation, muscle aches or pains, joint pain, and sleep problems (insomnia or nightmares). The most serious side effects are liver failure, muscle breakdown (rhabdomyolysis), and kidney failure.
simvastatin (Zocor) Drug Class: Statins Prescription: Yes Generic: Yes Preparations: Tablets of 5, 10, 20, 40, and 80 mg. Prescribed for: Simvastatin (Zocor) is used for reducing total cholesterol, LDL cholesterol, and triglycerides, and for increasing HDL cholesterol in patients with coronary heart disease, diabetes, peripheral vessel disease, or history of stroke or other cerebrovascular disease. Side effects: The most common side effects of simvastatin (Zocor) are headache, nausea, vomiting, diarrhea, abdominal pain, muscle pain, heartburn, gas, bloating, indigestion, constipation, headache, joint pain, skin rash, sleep problems (insomnia), cold symptoms (stuffy nose, sneezing, or sore throat), and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown.
pravastatin (Pravachol) Drug Class: Statins Prescription: Yes Generic: Yes Preparations: Tablets of 10, 20, 40, and 80 mg.
Prescribed for: Pravastatin (Pravachol) is used for the reduction of total and LDL cholesterol as well as triglycerides, and to increase HDL cholesterol. It has been suggested that pravastatin may reduce the occurrence of heart attacks, strokes, and death caused by coronary artery diseas Side Effects: The most common side effects of pravastatin (Pravachol) are headache, nausea, vomiting, diarrhea, muscle pain, skin rash, dizziness, and abnormal liver tests. The most serious potential side effects are liver damage and muscle inflammation or breakdown.
lovastatin (Mevacor) Drug Class: Statins Prescription: Yes Generic: Yes Preparations: Tablets of 10, 20, and 40 mg. Prescribed for: Lovastatin (Mevacor) is used to treat high LDL cholesterol. Effectiveness of the medication in lowering cholesterol is dose-related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made. A reduction in LDL cholesterol level can be seen two weeks after starting therapy. Side Effects: Side effects of lovastatin (Mevacor) are rare. Minor side effects include constipation, diarrhea, gas, heartburn, indigestion, stomach pain, nausea, headache, muscle pain, joint pain, back pain,and sleep problems (insomnia). Major side effects include abdominal pain or cramps, blurred vision, dizziness, itching, chest pain, muscle pain or cramps, rash, or yellowing of the skin or eyes.
fluvastatin (Lescol) Drug Class: Statins Prescription: Yes Generic: Yes Preparations: Tablets of 20 and 40 mg. Prescribed for: Fluvastatin (Lescol) is used to treat high LDL cholesterol. Effectiveness of the medication in lowering cholesterol is dose-related. Blood cholesterol is checked at regular intervals during treatment so that dosage adjustments can be made. Side effects: Side effects of fluvastatin (Lescol) are rare. Minor side effects include stomach upset, constipation, diarrhea, gas, heartburn, headache, and insomnia. Major side effects include abdominal pain or cramps, blurred vision, dizziness, itching, muscle pain or cramps, rash, or yellowing of the skin or eyes.
What are fibric acid derivatives (fibrates)? Fibrates aim to lower blood triglyceride levels by 35 to 50 percent and raise HDL ("good") cholesterol levels by 5 to 20 percent. Fibrates work by reducing the amount of triglycerides produced by the liver, and increasing the rate at which the triglycerides are removed from the bloodstream.
While they can increase HDL cholesterol, fibrates do not work to lower LDL ("bad") cholesterol and are often combined with statins to accomplish this. Fibrates are also prescribed to help prevent heart attacks in at-risk patients with high blood triglycerides and low HDL cholesterol.
fenofibrate (Tricor) Drug Class: Fibrates Prescription: Yes Generic: Yes Preparations: Tablets of 54 and 145 mg. Prescribed for: Fenofibrate (Tricor) is used along with a non-drug program (including diet changes) to treat elevated cholesterol and triglyceride levels. Side effects: Common side effects of fenofibrate (Tricor) include stomach pain or upset, back pain, constipation, headache, dizziness, trouble sleeping, or runny or stuffy nose. Muscle damage may occur, and muscle pain, tenderness, weakness and fever should be reported promptly to your physician. Decreased sexual drive, yellowing of the eyes or skin (jaundice), and stomach pain may occur and also should be reported.
gemfibrozil (Lopid) Drug Class: Fibrates Prescription: Yes Generic: Yes Preparations: Tablet of 600 mg. Prescribed for: Gemfibrozil (Lopid) is used for persons with either low HDL cholesterol and/or high triglyceride concentrations to reduce the risk of heart attacks. It also is used in persons with very high triglyceride levels that are at risk for pancreatitis (inflammation of the pancreas). Side effects: Side effects of gemfibrozil (Lopid) include upset stomach, stomach/abdominal pain, diarrhea, tiredness, nausea, vomiting, headache, dizziness, drowsiness, joint pain, loss of interest in sex, impotence, difficulty having an orgasm, numbness or tingly feeling, unusual taste, cold symptoms (stuffy nose, sneezing, sore throat), depression, blurred vision. Less common side effects are muscle aches, pains, weakness, or tenderness.
What are bile acid sequestrants? The liver produces bile acids (a main component of your digestive enzymes secreted by the liver) using cholesterol. Bile acid sequestrants bind bile acids in the intestine causing bile acids to be excreted in the stool. This causes the liver to use more of the blood cholesterol to make more bile acids, and in turn, lower blood cholesterol levels. Bile acid sequestrants used alone, mildly lower LDL cholesterol. They are commonly used in combination with other classes of cholesterol drugs to more effectively lower LDL cholesterol levels.
colesevelam (Welchol) Drug Class: Bile acid sequestrants Prescription: Yes Generic: No Preparations: Tablet of 625 mg, or oral suspension 3.75 gram packet and 1.875 gram packet Prescribed for: Colesevelam (Welchol) is used to treat high blood cholesterol levels, especially high levels of LDL cholesterol. It does not lower cholesterol as much as the statin class of drugs, but when used in combination with a statin, it lowers cholesterol levels further than the statin alone. Colesevelam (Welchol) also is used in combination with other drugs for treating type 2 diabetes such as metformin (Glucophage), sulfonylureas, or insulin to further lower blood sugar levels. Side effects: Colesevelam (Welchol) usually is well-tolerated. Patients may experience constipation, upset stomach, indigestion, nausea, vomiting, gas, headache, stomach pain, diarrhea, feeling weak or tired, muscle pain, runny nose, sore throat, or flu symptoms.
colestipol (Colestid) Drug Class: Bile acid sequestrants Prescription: Yes Generic: Yes Preparations: Tablet of 1 gm. Granules in 5gm packets or bulk. Prescribed for: Colestipol (Colestid) is used for the treatment of high cholesterol in conjunction with dietary control; for the treatment of diarrhea due to increased intestinal bile acids after some types of surgery; for the treatment of itching associated with partial obstruction to the flow of bile due to liver disease. Side effects: Side effects of colestipol (Colestid) include constipation, stomach upset, heartburn, indigestion, belching, gas, diarrhea, nausea, loss of appetite, aggravated hemorrhoids or rectal irritation, change of taste, headache, or itching. If patients experience unusual bruising or bleeding, severe stomachaches, or vomiting they should notify their physicians.
cholestyramine (Questran) Drug Class: Bile acid sequestrants Prescription: Yes Generic: Yes Preparations: Powder Prescribed for: Cholestyramine is used for reducing cholesterol levels in the blood, to relieve the itching of liver and biliary disease, and to treat overdoses of digoxin or thyroid hormone. Side effects: The most common side effects are constipation, stomach/abdominal pain, bloating, nausea, vomiting, diarrhea, weight loss, loss of appetite, excessive gas (flatulence), hiccups, a sour taste in your mouth, skin rash or itching, irritation of your tongue, itching or irritation around your rectal area, muscle or joint pain, dizziness, spinning sensation, or ringing in your ears. Long-term use of cholestyramine may cause a deficiency of vitamins A, D, E, and K.
What is nicotinic acid (vitamin B3 or niacin)? Nicotinic acid (vitamin B3 or niacin) is a B vitamin. Niacin is a common vitamin component of most balanced diets. However, the dose of niacin used to treat cholesterol is much higher than the average dietary intake. Nicotinic acid (niacin) is available in immediate release and sustained release preparations. Some nicotinic acid preparations are available over-the-counter but are not federally regulated. Nicotinic acid is used to increase HDL ("good") cholesterol (sometimes by as much as 30%). It is only mildly effective at lowering LDL ("bad") cholesterol and triglyceride levels.
niacin, nicotinic acid, vitamin B3
(Niacor, Niaspan, Slo-Niacin) Drug class: Nicotinic acid Prescription: Yes and over-the-counter (OTC) Generic: Yes Preparations: Tablets of 50, 100, 250, 500 and 750 mg. Capsules of 125, 250, 400, 500, 750 and 1000 mg. Prescribed for: Nicotinic acid (vitamin B3 or niacin) is used for treating niacin deficiency and elevated blood cholesterol and/or triglyceride levels and for increasing HDL cholesterol. Side effects: The most common side effects of nicotinic acid (vitamin B3 or niacin) are stomach upset, flushing or redness of skin on the face and neck, headache, itching, dizziness, lightheadedness, diarrhea, and tingling sensations of the extremities. Rare cases of liver failure or muscle injury have occurred from the use of nicotinic acid.
What are cholesterol absorption inhibitors? Cholesterol absorption inhibitors keep the body from absorbing cholesterol from the foods we eat. This class of drug blocks this absorption in the intestine as our foods are digested. Cholesterol absorption inhibitors are most effective at lowering LDL ("bad") cholesterol, but may also have a small effect on lowering triglycerides and raising HDL ("good") cholesterol levels.
ezetimibe (Zetia) Drug Class: Cholesterol absorption inhibitors Prescription: Yes Generic: No Preparations: Tablets of 10 mg. Prescribed for: Ezetimibe (Zetia) lowers blood cholesterol by reducing the absorption of cholesterol from the intestine. Used in combination with statins, it reduces levels of total cholesterol, LDL cholesterol, and triglycerides. It also may raise HDL cholesterol. Combining ezetimibe with a statin is more effective than either drug alone. Side effects: Ezetimibe (Zetia) usually is well-tolerated. Common side effects include diarrhea, abdominal pain, back pain, stomach or abdominal pain, joint pain, numbness or tingly feeling, tired feeling, headache, dizziness, depression, runny or stuffy nose, cold symptoms, or cough. Hypersensitivity reactions, including angioedema (swelling of the skin and underlying tissues of the head and neck that can be life-threatening) and skin rash occur rarely. Nausea, pancreatitis, muscle damage (myopathy or rhabdomyolysis), and hepatitis have been reported.
Combining drugs to fight high cholesterol. Because some medications are good at lowering LD ("bad") cholesterol, some are helpful in lowering triglycerides, and others can aid in raising HDL ("good") cholesterol levels, doctors frequently prescribe two medications from two different drug classes to work together. This can more aggressively lower LDL cholesterol and increase HDL cholesterol at the same time, for greater benefit to the patient.
ezetimibe/simvastatin (Vytorin) Drug Class: Combination cholesterol absorption inhibitor and statin Prescription: Yes Generic: No Preparations: Tablets of 10/10, 10/20, 10/40, 10/80 mg. (ezetimibe/simvastatin) Prescribed for: Ezetimibe/simvastatin (Vytorin) is a combination of ezetimibe (Zetia) and simvastatin (Zocor) that is used for treating high levels of cholesterol in the blood. Vytorin reduces total cholesterol and LDL cholesterol while it increases HDL cholesterol. Side effects: The most common side effects of ezetimibe/simvastatin (Vytorin) are headache, nausea, vomiting, diarrhea, muscle pain, back pain, joint pain, dizziness, depressed mood, memory problems, confusion, numbness or tingly feeling, trouble having an erection, sleep problems (insomnia), cold symptoms (stuffy nose, sneezing, sore throat), and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown.
amlodipine and atorvastatin (Caduet) Drug class: Combination calcium channel blocker and statin Prescription: Yes Generic: Yes Preparations: Tablets of 2.5/10, 2.5/20, 2.5/40, 5/10, 5/20, 5/40, 5/80, and 10/10, 10/20, 10/40, and 10/80 mg (amlodipine/atorvastatin) Prescribed for: Amlodipine and atorvastatin (Caduet) is used to treat high blood pressure (hypertension) or chest pain (angina) that occurs with high cholesterol or triglyceride levels. Side effects: Common side effects of amlodipine and atorvastatin (Caduet) include dizziness or lightheadedness as your body adjusts to the medication. Swelling hands/ankles/feet, tiredness, or flushing may also occur.
What are omega-3 fatty acids (omega-3 acid ethyl esters)? Omega-3 fatty acids (omega-3 acid ethyl esters) reduce the production of VLDL particles in the liver, and speed up the removal of triglycerides from the blood. It is unclear how omega-3's work, but they are often recommended for people with high cholesterol. Omega-3 fatty acids can be found in foods such as fatty fish (salmon, tuna, mackerel), but some people require a prescription dose.
omega-3-acid ethyl esters (Lovaza) Drug class: Omega-3 acid ethyl esters Prescription: Yes Generic: Yes Preparations: Capsules 1 gram Prescribed for: Omega-3-acid ethyl esters (Lovaza) is a combination of fatty acids used together with diet and exercise to help lower triglyceride levels in the blood. It is made of omega-3 polyunsaturated fatty acids, which are found in oil from fish, vegetables, and other plant sources. Side effects: Common side effects of omega-3-acid ethyl esters (Lovaza) include back pain, upset stomach, burping, skin rash, and unusual or unpleasant taste in your mouth.
How to Lower Cholesterol: Eat More Fiber Diets high in fiber can reduce LDL ("bad") cholesterol. High fiber diets also may help with weight loss, and being overweight is a contributing risk factor for high cholesterol. Foods high in fiber include fruits, vegetables, whole grains, legumes, and beans.
How to Lower Cholesterol: Know Your Fats The American Heart Association recommends that just 25% to 35% of your daily calories come from fats such as those found in fish, nuts, and vegetable oils. For healthy people, saturated fat should comprise no more than 7% of your total calories. On a 2,000 calorie-a-day diet, that’s about 140 calories (or 16 grams) worth of saturated fat. If you need to lower your LDL cholesterol, limit saturated fat to 5% to 6% of calories, or about 11 to 13 grams of saturated fat on a 2,000-calorie diet. Reduce trans fats to less than 1% of your total daily calories. This means avoiding fried foods and many junk foods.
How to Lower Cholesterol: Smart Protein To reduce cholesterol, limit red meat and eat more fish and lean poultry.
How to Prepare Healthy Proteins * Trim all fat from meats, and remove all skin from poultry before cooking. * Broil or bake, don't fry foods. * Drain fat from any meats before serving. * Avoid processed meats such as hot dogs or cold cuts, even those labeled "reduced fat," as many are still high in saturated fats and calories. * Oily fish such as salmon or trout are high in omega-3 fatty acids, which can reduce triglyceride levels and improve HDL ("good") cholesterol levels. * Soy proteins can also have a beneficial effect and help to reduce LDL ("bad") cholesterol and triglycerides, while raising HDL cholesterol levels.
How to Lower Cholesterol: Low-Carb Diet Low-carbohydrate diets may help improve HDL ("good") cholesterol levels. The National Institutes of Health conducted a study that found while both low-fat and low-carb dieters lost weight over the two-year study period, low-carb dieters also improved their HDL cholesterol levels. The problem with low-carb diets is that they may be difficult to adhere to. Consult your doctor about the best healthy eating plan to manage your cholesterol.
How to Lower Cholesterol: Lose Weight Losing weight can help lower your cholesterol. Being overweight or obese tends to increase your levels of LDL ("bad") cholesterol. Weight loss can help reduce LDL cholesterol and triglyceride levels, and raise your HDL ("good") cholesterol levels.
How to Lower Cholesterol: Quit Smoking Smoking is not only bad for your lungs; it also lowers your HDL ("good") cholesterol and increases your risk for heart disease and stroke. When you quit smoking, your HDL levels will rise. Discuss a smoking cessation program with your doctor.
How to Lower Cholesterol: Exercise Exercise can increase your HDL ("good") cholesterol by up to 6% and reduce your LDL ("bad") cholesterol by 10%. Just 40 minutes of exercise such as walking, swimming, or cycling three to four times per week can have an impact on blood cholesterol levels.
Nutritional Supplements That Help Lower Cholesterol * Fish oil can reduce triglycerides, and soy protein can slightly lower levels of LDL ("bad") cholesterol and triglycerides and raise HDL ("good") cholesterol. * Plant stanols and sterols naturally found in some fruits, vegetables, nuts, seeds, and legumes may help block absorption of cholesterol in the intestine. * Prescription nicotinic acid (niacin or vitamin B3) is often prescribed to improve cholesterol. Doses found in over-the-counter vitamin supplements are not sufficient to treat high cholesterol, and because of the potential for side effects, high doses should only be taken under a doctor's supervision.
Cholesterol Treatment: Herbal Remedies Garlic often is seen as a remedy to lower total cholesterol; however, a large trial showed garlic is not effective in doing so. Many other herbs and home remedies claim to reduce cholesterol as well.
Herbal Remedies Claimed to Treat Cholesterol * Guggulipid (guggulsterone) * Red yeast rice * Policosanol * Fenugreek seeds and leaves * Artichoke leaf extract * Yarrow * Holy basil * Ginger * Turmeric * Rosemary Many of these remedies are not proven to improve cholesterol levels, while others are still being researched. Consult your doctor before taking any herbal supplement as many may have side effects or interact with medications you may be currently taking.
Cholesterol Levels: How Low Should You Go? When seeking to lower your total cholesterol, what number should you aim for? * A total cholesterol score of 200 mg/dL is desirable. * Aim for an LDL ("bad") cholesterol level of 100 mg/dL or lower, and an HDL ("good") cholesterol level of 60 mg/dL or higher. * If you have high risk factors for heart disease or stroke, including high blood pressure, smoking, family history of heart disease, are over the age of 45 for men and age 55 for women, have low HDL cholesterol (below 40 mg/dL), and/or are obese or inactive, you may need to aim for LDL levels of 70 mg/dL or lower.
Can the Damage Be Undone? The good news is you may be able to reverse some of the damage from atherosclerosis (hardening of the arteries due to plaque buildup).
Reversing Cholesterol Damage * Dean Ornish, MD emphasizes a low-fat, vegetarian diet that has been shown to reverse artery blockages. * A study in the British Medical Journal showed a low-carb vegan diet lowered LDL cholesterol levels. * Regular exercise lowers your LDL ("bad") cholesterol and improves HDL ("good") cholesterol, in addition to strengthening your heart and cardiovascular system.
How to Lower Your Cholesterol & Save Your Heart
Simple Ways to Lower Cholesterol When you have high cholesterol level, it can help to change your diet and lifestyle to reduce your cholesterol range. Lowering cholesterol has been shown to decrease the risk of heart disease. Even if you are taking a medication to lower your cholesterol levels, diet and exercise in addition can lead to optimal heart and blood vessel health. The following tips include simple ways to be healthy.
Good and Bad Cholesterol Some cholesterol is necessary for proper body function. But dietary saturated fat and cholesterol both raise levels of LDL "bad" cholesterol. High levels of LDL cholesterol can cause plaque to build up in arteries, leading to heart disease and stroke. HDL is a "good" cholesterol in that it helps eliminate bad cholesterol from your blood. It is possible to lower LDL cholesterol and raise HDL cholesterol with your diet.
Portion Control: Use Your Hand Eating super-sized meals contributes to weight gain and high cholesterol. An easy way to practice portion control for a meal is to use your hand as a measuring instrument for portions. One handful is about the size of one portion of food.
Serve Up Heart-Healthy Food When it comes to fruits and vegetables, pick up the pace! Multiple servings throughout the day can help lower LDL "bad" cholesterol. Moreover, these foods have antioxidants that can be beneficial. Also, eating more vegetables and fruits often results in eating fewer high-fat foods. This can also lower your blood pressure and promote weight loss.
Think Fish For Heart Health Eating fish is especially heart healthy because many fish are high in healthy omega-3 fatty acids and low in saturated fat. It is the omega-3 fatty acids that help lower blood levels of triglycerides. Stick to fatty fish, which has more omega-3. Keep in mind that deep oil frying of any food diminishes its health benefits.
Start the Day With Whole Grains Oatmeal and whole-grain cereal have fiber and complex carbohydrates that help you to feel fuller for longer, so you'll be less inclined to overeat later in the day. These breakfasts help reduce LDL "bad" cholesterol and can help with your weight control.
Go Nuts for Cardiovascular Health Nuts help to lower cholesterol because they are high in monounsaturated fat. This form of fat lowers LDL "bad" cholesterol while maintaining HDL "good" cholesterol levels. This can lower the risk of heart disease. Only eat a handful, though, because nuts are high in calories, especially if they are coated in sugar or chocolate.
Unsaturated Fats Protect the Heart Our daily fat needs are only about a third of our daily calories. However, the form of fat makes a difference. Unsaturated fats (in canola, olive, and safflower oils) lower LDL "bad" cholesterol levels. Saturated fats (in butter and palm oil) and trans fats increase LDL cholesterol. All fats have calories. Moderation is the key.
Eat More Beans, Fewer Potatoes Carbohydrates are important for energy production. However, there are differences in the quality of carbohydrates, too. Whole grains like beans, quinoa, whole-wheat pasta, and brown rice are high in fiber that can help lower cholesterol. Whole grains also keep you feeling full longer. The carbohydrates in pastries, white rice, white bread, and potatoes boost blood sugar levels rapidly. This can lead you to feel hungry sooner, potentially leading to overeating.
Get Moving with Exercise! Short intervals of regular exercise can help lower triglycerides and raise HDL cholesterol. Exercise also improves cardiovascular health by helping you maintain an optimal body weight. It can help you stick to a healthy weight, which can lower your blood pressure and heart disease risk too. This is one non-medication option to lower cholesterol through diet.
Just Go for a Walk Walking is easy, healthy, and a good pair of shoes is your only requirement. This too Walking can lower your risk of stroke and heart disease, help you lose weight, maintain balance, and keep bones strong. Short walks are much better than no walks, so don't be afraid to start there. You can gradually work your way up to longer walks as your body builds strength.
Work Out Without Going to the Gym Any kind of cardiovascular activity can benefit your heart. But check with your doctor for guidelines. Simple activities that can be of benefit include gardening, dancing, or taking the stairs instead of the elevator. Even housework can qualify as exercise.
Take Control of Your Health Stay on track with a consistent program of cholesterol management and learn the tricks that maintain your health. Checking food labels for nutrition facts can be very helpful. It can also help to vary your exercise routine to keep you challenged and motivated.
What to Do When Eating Out When you eat out, be careful about the quality and quantity of your meal. Watch out for hidden salt, calories, and saturated fats. Don’t super-size your order. Choose broiled, baked, steamed, and grilled foods instead of fried. Ask for sauces on the side, so you can choose how much you want.
:: Watch for Hidden Traps :: Managing cholesterol with your diet begins at the grocery store. Look at nutrition labels. Check serving sizes. Does a single-serve package contain two servings instead of one? Choose foods that are low in saturated fat and have very little or no trans-fat.
Don't Stress Stress can raise your cholesterol level rapidly. It can also raise blood pressure, which may lead to heart and blood vessel disease. Stress reduction can be fun. Take a break from your usual routines of daily living. Simple and effective methods to reduce stress include meditation, biofeedback, and relaxation exercises.
Losing Means Winning Losing weight when you are overweight or obese lowers blood pressure, cholesterol, and triglycerides and decreases your risk of stroke and heart disease. An optimal body weight puts less stress on the heart. It also reduces the strain on joints and ligaments.
Follow Your Doctor's Advice Continue managing a normal cholesterol range for life with regular doctor checkups, exercise, and healthy food choices. These lifestyle changes can help you to reduce the risk of disease and promote longevity. Work with your health care professionals to get tips to improve your cholesterol by changing your routine.
How to Lower Your Cholesterol & Save Your Heart
:: Some Foods that Help Lower Cholesterol ::
The body already produces cholesterol on its own; the body requires this vital fat for the proper function of cell membranes. However, consuming foods and drinks high in cholesterol may give the body more than it needs, which poses an increased risk for heart disease, stroke, and other health ailments. The degree to which foods high in cholesterol raise blood cholesterol varies from person to person, but everyone can benefit from a balanced diet paired with daily exercise to maintain healthy levels. Some foods not only assist in lowering bad LDL cholesterol but also leave the good HDL cholesterol unaffected.
1. Almonds Rich in unsaturated fats, almonds work hard to raise healthy HDL cholesterol while lowering unhealthy LDL cholesterol. They also make LDL less likely to oxidize, which helps prevent build-ups in the arteries and restricted blood flow to the heart. When you snack on almonds, though, beware of their high calorie count.
2. Orange Juice Orange juice does great things for the body. Certain brands have a lot of phytosterols, plant-derived compounds known for lowering LDL cholesterol. Sterol-fortified margarine, soymilk, milk, cheese, and bread also have similar effects. An 8-ounce glass of OJ has healthy benefits, but it is important to check with a doctor to ensure the juice does not interfere with medications. Also check with your doctor if you have diabetes or pre-diabetes, as fruit juice can raise blood sugar levels.
3. Olive Oil This miracle oil will increase the good and decrease the bad -- all thanks to an abundance of antioxidants and healthy monounsaturated fats. Olive oil is also rich in phenols, plant substances that lower the risk of blood clots. If you need to adjust your diet, consider substituting two tablespoons of olive oil each day in place of another fat.
4. Steamed Asparagus Steaming vegetables enhances a vegetable's ability to bind to bile acids in the gut. Bound bile acids use up more cholesterol to produce bile, leaving fewer harmful fats floating around in your bloodstream. This is not just true for asparagus. Okra, carrots, beets, green beans, eggplants, and cauliflowers are all a bit more heart-healthy after a quick steam.
5. Oatmeal There is a reason breakfast is the most important meal of the day. Kickstarting your morning with a bowl of warm oatmeal incorporates some healthy elements into your diet, first thing. Whole grains are an ideal source of soluble fiber, and oats top the list. Soluble fiber is a gel that prevents cholesterol from being absorbed into the bloodstream. Eat anywhere from five to ten grams of soluble fiber each day at least one and a quarter cups of oatmeal to combat bad cholesterol. Adding toppings like chopped apples can further increase the fiber in your first meal.
6. Pinto Beans Pinto beans also contain a lot of soluble fiber. Simply adding a half cup of pinto beans daily can slow cholesterol absorption. Chili, tacos, and other traditional Mexican foods taste delicious with the healthful addition of pinto beans. If using canned instead of fresh beans, be sure to rinse them well to wash away the excess sodium.
7. Blueberries Blueberries are a nutritional superstar, and these benefits extend to cholesterol. The berries reduce levels of artery-clogging LDL, which may lower the risk of cardiovascular disease. Consume them frozen, freeze-dried, or fresh, and you are on your way to becoming healthier.
8. Tomatoes Kick unhealthy LDL cholesterol to the curb with lycopene-rich tomatoes. Lycopene not only lowers bad LDL cholesterol, but it may also modestly increase beneficial HDL cholesterol. Eat at least 25 milligrams of tomato products a day for several weeks to reap the benefits.
9. Avocados Avocados are full of heart-healthy monounsaturated fats -- the same fats that are in olive oil. Eating avocados may slowly lower LDL cholesterol and boost HDL cholesterol. Avocados also may reduce blood triglycerides. You can mash the creamy, mild treat into guacamole or spread it on a cracker, slice it onto sandwiches, or stir it into salads.
10. Chocolate Chocolate lovers everywhere, rejoice! In small doses, chocolate can be healthy for your heart. Dark chocolate is full of flavonoids, antioxidants that help lower bad cholesterol. Moreover, dark chocolate contains those beneficial monounsaturated fats. Always check the labels, though. For real benefits, ensure the chocolate is at least 70% cocoa. Otherwise, the snack contains too few healthy oleic acids for full benefits. Most people can benefit from up to one ounce of dark chocolate each day.
11. Barley Barley offers a big boost to your nutrient intake with generous amounts of antioxidants and magnesium. Studies show that barley's soluble fiber promotes digestive health while reducing the absorption of bad cholesterol. All that fiber can help you feel full and reduce hunger and cravings. Hulled barley is the healthiest kind and is considered a whole grain that can lower the likelihood of heart disease and other chronic conditions. Pearl barley is more commonly available and a healthy choice, as well. The popular cereal grain is easy to eat and can be used for soups, stews, snacks, and cereal bars.
12. Eggplant Eggplant is an excellent source of fiber, folic acid, and magnesium. Low in calories and rich in vitamins, eggplant juice has proven to lower bad cholesterol in recent studies. This nutrient-dense food has just 25 calories per 100 grams, and as long as it isn't covered in oil, it makes for a healthy meal. Eggplant dip, roast, pasta, and casserole are great ways to get more nutrients while controlling cholesterol levels. Eggplant also contains chlorogenic acid to aid the immune system.
13. Fruits Rich in Pectin Pectin is a natural fiber found in the peel and pulp of certain fruits. It's a favorite of jam and jelly makers, as heating pectin with a liquid causes it to thicken and form a gel. Some fruits, such as apples, pears, and plums, have higher pectin levels than others. The peels and pulp of citrus fruits also contain high amounts of pectin. Studies show that a rise in pectin consumption lowers total cholesterol. At least five servings of fruit a day, especially the high-pectin kinds, can bring down bad cholesterol and maintain adequate nutrient levels.
14. Soy Soy products made from high-protein soybeans include tofu, edamame, tempeh, and miso. Soy protein has only a small amount of saturated fat, as well as lots of fiber to aid digestion and lower the chance of cardiovascular disease. Research demonstrates that 25 grams of soy protein each day can lower LDL cholesterol by 3 to 4 percent. This helps prevent cholesterol from clogging up the arteries; switching to soy-based proteins even a few times a week can make a difference in your diet.
15. Fatty Fish Fish is a fantastic source of protein with lower fat content than other animal meat. Even fatty types of fish have health benefits thanks to an abundance of omega-3 fatty acids. These good fats are better for you than the unhealthy saturated fat in the majority of meat products. Salmon, tuna, and trout are a few examples; the healthy fats in these foods lower triglycerides and promote a healthy heart. Experts recommend enjoying baked or grilled fatty fish twice a week. Good choices are wild-caught salmon and sardines, as they're less likely to contain high levels of heavy metals relative to larger fish.
(With Thanx To Dr. Seher Anjum And Dr. Salma Anjum)
| | 
A