Let’s Talk About
Cholesterol
Emily Lundstrom, R.Ph., Pharm.D.
Melissa Kalb, RD, LD
August 8, 2007
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
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
arteries
• Decreases blood flow to
the heart
• Want this to be low
• Lowered by diet, exercise, and most
medications
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
Triglycerides
• Most common type of fat in the body
• Comes mostly from diet
Things that increase triglycerides
What Level of Cholesterol is good?
•
•
•
•
Total cholesterol
Triglycerides
HDL—”Happy” Cholesterol
LDL—”Lousy” Cholesterol
<200
<150
>40
<100?
* LDL goal depends on other health
conditions or risk factors
Medications
•
•
•
•
•
•
“Statins”
Bile acid binders
Nicotinic acid (“Niacin”)
Fibric Acids
Cholesterol absorption inhibitors
Fish Oil
“Statins”
• Lipitor® (atorvastatin)
• Zocor® (simvastatin)*
• Pravachol® (pravastatin)*
• Crestor® (rosuvastatin)
• Lescol® (fluvastatin)*
• Mevacor® (lovastatin)*
*Indicates generic available
“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
Bile Acid Binders
•
LDL
Triglycerides
• Mix powders with
water, juice, or food
• Space from other
medications
• Side effects:
• Constipation, nausea,
gas
HDL
• Questran®
(cholestyramine)*
• Colestid®
(colestipol)
• Welchol®
(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
• Lopid®
• Take with food
• Side effects:
(gemfibrozil)*
• Nausea, diarrhea,
• Tricor® or Triglide®
constipation
(fenofibrate)
• May cause muscle
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
Triglycerides
Omacor®
•
•
•
*
Omega-3 Supplement
Rx only
• Over-the-counter
FDA Approved
• Not FDA Approved
• Inexpensive
$$ Expensive $$
Now called Lovaza®
Two-In-One
• Combination medications available:
• Vytorin®
• (simvastatin + ezetimibe)
• Advicor®
• (lovastatin + Niaspan)
• Pravigard PAC®
• (pravastatin + aspirin)
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; 285:2486-97.
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.
Low Cholesterol Diet
Melissa Kalb, RD, LD
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
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
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.
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
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
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?
Questions???
Emily Lundstrom, Pharm.D.
emily.lundstrom@osumc.edu
Chris Green, Pharm.D.
christopher.green@osumc.edu
Melissa Kalb, RD, LD
melissa.kalb@osumc.edu