INTRODUCTION Cholesterol Treatment —
High cholesterol and lipid levels can increase your risk for developing heart attacks, strokes, blindness, impotence, senility, and other diseases.
Please see my blog on: cholesterol is a risk factor for heart attacks and strokes – cardiovascular disease
Conservative Care (lifestyle changes) for Cholesterol Treatment:
the cornerstone of lipid lowering involves A combination of:
achieving an ideal body weight
appropriate food type types consumption (Reducing saturated fat, increasing non-saturated fat, increasing vegetables, fruits, grains)
Exercise (aerobic and resistance)
The benefits of such lifestyle modifications usually become evident within 6 to 12 months. However, the success of lipid lowering with lifestyle modification varies widely
additional methods of decreasing lipid risk which are conservatives include:
Certain dietary supplements
When should lipid lowering begin:
Conservative measures should be instituted as soon as risk is appreciated to begin.
Goals in cholesterol treatment:
The decision to begin medications is much more complex than the decision to begin conservative care. The decision to begin this treatment is made on a case-by-case basis, taking into account risk which you might have based on your family history, past medical history, and lipid levels.
Significant lipid lowering is beneficial in reducing risk in people with risk for coronary heart disease, dementia, peripheral vascular disease, stroke, and other vascular related health problems. People to have some of these diseases should automatically begin medications for cholesterol lowering. In many cases, such as diabetes, these medicines have additional positive effects that decreasing risk from disease from their cholesterol-lowering properties. People who have a heart attack (myocardial infarction or MI) and also coronary artery disease should begin lifestyle modifications and lipid lowering drugs right away. Goals for these populations of patients vary depending upon many circumstances, the important issue is that lipid lowering medications are begun if they can be tolerated.
CVD vs no CVD
A target LDL cholesterol level below 70 to 80 mg/dL is recommended for people who have CVD or people who also have other diseases ( people with diabetes and possibly for most people who smoke).
These general guidelines may be modified by other individual factors.
People without CVD or other significant risks for cardiovascular disease. Decisions as to when to treat such patients are somewhat controversial. Many physicians believe that the overwhelming factors relate to past medical history, family history, social history, and lipid levels. Other doctors make recommendations, based on the global risk of developing CVD as predicted by as risk calculator and recommend a 7.5 percent or 10 percent risk of developing CVD over 10 years as the threshold for deciding to treat cholesterol when other factors are not extreme. For example, in this group, very high cholesterol would be enough of a risk to initiate therapy. The initial treatment choice is almost always a Staten.
High triglycerides do not present the same type of risk for cardiovascular disease that cholesterol does. Triglycerides present special and important risks when they are very high, or in special groups such as diabetics.
Diabetes mellitus —
People with diabetes (type 1 or 2) are at significantly elevated risk of heart disease. Thus, I recommend an LDL level target of below 70 mg/dL for such people. There or manufacturers which can influence this goal, especially potential side effects. This decision is fluid.
The decision to treat high cholesterol levels in an elderly person depends upon the individual’s chronological age (age in years) and physiologic age (health, fitness).
HIGH CHOLESTEROL TREATMENT OPTIONS — Lipid levels can be lowered with lifestyle changes, medications, or a combination of these approaches.
Medications – decisions in cholesterol treatment —
There are many medications available to help lower elevated levels of LDL cholesterol and triglycerides, but only a few for increasing HDL cholesterol. Each category of medication targets a specific lipid and varies in how it works, how effective it is, and how much it costs. I attempt to make my recommendations taking these factors into account along with your specific medical diseases, and history of pharmacological experience.
Statins are currently the most powerful drugs which lower LDL cholesterol and are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death These drugs work by decreasing liver production of cholesterol, most importantly LDL. Statins can lower triglycerides and raise HDL cholesterol levels. The servility of this group of medications to affect HDL varies widely. Statins may prevent heart attacks and strokes in more ways than just lowering cholesterol levels. This is especially true in high-risk diseases such as diabetes and coronary artery disease.
Statins work better if they are taken at bedtime, since LDL cholesterol is normally produced by your liver during your sleep cycle.
Statins have potential significant side effects, and can damage your liver and muscles, which can result in kidney damage. For this reason, careful control of stands makes sense. Some groups of people have much more risk than others in the use of this class of medications. Certain food products can reduce the effectiveness of this medication including grapefruit juice, and grapefruits.
— Ezetimibe (brand name: Zetia) works by decreasing the body’s ability to absorb cholesterol from food as well as decreasing your ability to produce LDL cholesterol. It lowers LDL cholesterol levels when used alone, but it is not very effective by itself. Its effectiveness is markedly magnified when it is used with a Staten. Zetia has relatively few side effects.
There are no studies showing that people who take Ezetimibe, either alone or in combination with other cholesterol-lowering medications, have fewer heart attacks or strokes than those who do not take the drug. For this reason, I normally use Zetia for people who have difficulty lowering LDL cholesterol with a relatively low dose of Staten.
Bile acid sequestrates
— The most common of these is cholestyramine (questran) but also includes colestipol, and colesevelam These medications work by binding to bile acids in the intestine. Bile acids carry cholesterol which comes from food. By binding these bile acids, this class of medication decreases the amount of cholesterol you can absorb from food. These medications are mainly used to treat LDL cholesterol. They can be added to Statins, and at times they use them in place of Statins when patients cannot tolerate that class of medication. BAS’s have less systemic side effects than do Statins, that they can cause liver damage They can also cause nausea, bloating, cramping and other problems. Medications to help with constipation are frequently used. Bile acid sequestrates can prevent medications from being absorbed, by a process called chelation. Some of these medications include: oral contraceptives, dioxin (brand name: Lanoxin) and warfarin (brand name: Coumadin), BAS’s can also decrease or eliminate the absorption of fat-soluble vitamins (including vitamins A, D, K, and E). I normally recommend taking the BAS’s one hour before or two hours after any of these substances.
Nicotinic acid (Niacin) —
Nicotinic acid is a vitamin that is available in immediate-release, sustained-release, and extended-release formulations (table 1). The use of Nicotinic acid has been demonstrated to decrease HDL levels. Unfortunately, there have been more than one well done study to demonstrate that the use of these medications, though decreasing HDL cholesterol, increases cardiovascular and overall mortality. for this reason I rarely use them any longer, and I don’t feel that they are appropriate medications in almost all cases. Nicotinic acid (Niacin) can produce flushing (when the face or body turns red and becomes warm), itching, nausea, and numbness and tingling. They can also damage the liver, and produce other significant problems. For example, Niacin can worsen diabetes by decreasing the person’s use of insulin. It can worsened gout by increasing increase uric acid levels. and it can result in low blood pressure in people taking vasodilator medications such as nitroglycerin. It can worsen cardiovascular symptoms and heart disease in people with coronary artery disease or angina pectoris (chest pain). Nicotinic acid can also increase the risk of developing infections and bleeding.
Fibrate medications (gemfibrozil, fenofibrate and fenofibric acid) can lower triglyceride levels and raise HDL cholesterol levels. Fibrates are especially useful in people with elevated triglyceride and for diabetic patients. Like Statins, Fibrates can cause damage to muscles, resulting in muscle pain and weakness. This is especially true when they are used with Statins, and by people who suffer from kidney disease. Fenofibrate/fenofibric acid (brand names: Tricor, Triglide, Trilipex) are less likely to interact with Statins than gemfibrozil, and are safer in people who must use both medications.
Omega 3 fatty acids
Omega threes are a group of fatty acids, they are not a specific type of molecule.. The to Omega threes which are most important to our DHA and EPA, and their ratio is very important when used together. Oily fish, such as anchovies and tuna, and many instances of extra virgin olive oil , contain two important fatty acids, called DHA and EPA. Eating a diet that includes one to two servings of oily fish per week can reduce triglyceride levels and reduce the risk of death from coronary heart disease. These medications must be used with caution, since the fish they come from may have been contaminated with pesticides, hormones, and antibiotics. OEFA’s they also give you the stomach or intestinal upset and bad breath.
Soy protein —
Soy protein contains isoflavones, which mimic the action of estrogen. A diet high in soy protein can slightly lower levels of total cholesterol, LDL cholesterol, and triglycerides, and raise levels of HDL cholesterol. It is important to also use other sources of protein other than solely in your diet. Isoflavins may worsen breast cancer and other estrogen sensitive cancers.
A large trial showed that garlic is not effective in lowering
Plant stanols and sterols —
Plant stanols and sterols work at the level of the intestine by blocking the absorption of cholesterol. They are naturally found in some fruits, vegetables, vegetable oils, nuts, seeds, and legumes, and they can be purchased over-the-counter in various products such as take control Promise Active™ and Benecol , orange juice (Minute Maid Premium Heart Wise), rice milk (Rice Dream Heart Wise™), as well as dietary supplements (Benecol SoftGels and Cholest-Off). The margarine’s cost about five times what ordinary margarine’s cost. The benefit of these medications has not been proved, but theoretically they should help reduce coronary artery disease.
duration of cholesterol treatment —
dyslipidemia is frequently a lifelong process, and it is important to be determined and consistent when treating this process. It often takes 6 to 12 months before the effects of lifestyle modifications are noticeable, and three — six months before the full effects of medication treatment is absurd. Unlike blood pressure and diabetes medications, which are important to take every day, there are many regiments of taking medications for cholesterol and triglycerides. There can be reasons to take these medications on schedule such as every other day, on days when you’re not doing exercise. Nevertheless, it is very important to consistently treat you or risk factors for heart attacks and strokes
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