CHOLESTEROL 101: WHAT YOU NEED TO KNOW TO KEEP YOUR HEART HEALTHY. By: Camille Quiles, PharmD., RPh.

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1 CHOLESTEROL 101: WHAT YOU NEED TO KNOW TO KEEP YOUR HEART HEALTHY By: Camille Quiles, PharmD., RPh.

2 WHAT IS CHOLESTEROL?

3 CHOLESTEROL Waxy, fat-like substance found in all cells of the body Your body uses cholesterol to make: Hormones Vitamin D Substances that help digest foods (bile acids) Your body makes most of the cholesterol it needs The liver produces about 75% of the cholesterol circulating in your blood The other 25% comes from food. Cholesterol levels are high in more than 100 million Americans

4 TYPES OF CHOLESTEROL

5 THE GOOD, THE BAD, AND THE UGLY HDL Good Cholesterol LDL Bad Cholesterol Helps remove LDL cholesterol from the arteries Carries ¼ to 1 / 3 of blood cholesterol Healthy levels of HDL may help protect against heart attack and stroke Contribute to the development of plaque that narrows the arteries and makes them less flexible This is known as atherosclerosis If a clot is formed and blocks a narrowed artery, a heart attack and stroke can result.

6 TRIGLYCERIDES Another type of fat that stores excess calories as fat. Caused by being overweight or obese, physical inactivity, cigarette smoking, excessive alcohol, and a diet very high in carbohydrates. High levels associated with atherosclerosis and pancreatitis High levels combined with high LDL and/or low HDL increase your risk for heart attack and stroke

7 TOTAL CHOLESTEROL Total amount of cholesterol in your body Calculated by the following equation: TC = HDL + LDL + 20% triglyceride level A total cholesterol score of less than 200 is considered healthy in most cases.

8 CHOLESTEROL TESTING

9 WHY SHOULD I GET MY CHOLESTEROL CHECKED? Generally, there are no signs and symptoms of high cholesterol. Many people have never had their cholesterol checked, and do not know that they are at high risk. A simple blood test can be performed to tell you your cholesterol levels. High cholesterol puts you at higher risk for coronary artery disease, heart attacks, and strokes. It also appears to increase the risk of Alzheimer s disease.

10 HOW OFTEN SHOULD MY CHOLESTEROL BE CHECKED? American Heart Association recommends getting your cholesterol checked every 4 to 6 years. It is performed by a simple blood test, usually when you have fasted. The results should show your total, good, and bad cholesterols, as well as your triglycerides

11 CHOLESTEROL LEVELS

12 CHOLESTEROL IN FOOD

13 CHOLESTEROL IN FOOD Research shows that cholesterol we eat only have a small effect on blood cholesterol levels for most people. Only a few people are considered responders, whose blood levels spike up after eating these foods. Saturated fat and trans fats are bigger concerns Daily cholesterol limits: 300mg for healthy people 200mg for those a higher risk

14 CHOLESTEROL & FAMILY HISTORY

15 FAMILY HISTORY Some people inherit genes that can cause too much cholesterol production A combination of a diet high in saturated and trans fats and genetics can lead to cholesterol issues If your immediate family members (ie. parents and/or siblings) have a history of heart disease, you are at higher risk.

16 CHOLESTEROL & GENDER

17 FEMALES VS. MALES Before menopause, women usually have lower total cholesterol levels than men the same age. They also have higher levels of HDL (good) cholesterol After menopause, a woman s risk of developing high cholesterol begins to rise.

18 MY DOCTOR TOLD ME I HAVE HIGH CHOLESTEROL, WHAT SHOULD I DO?

19 LIFESTYLE MANAGEMENT Heart- Healthy Diet American Heart Association (AHA) recommends eating a dietary pattern that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts Limit red meat Limit sugary foods and beverages Exercise AHA recommends at least 40 minutes of aerobic exercise of moderate to vigorous intensity 3 to 4 times a week. Examples include brisk walking, swimming, bicycling, or a dance class

20 KNOW YOUR FATS Saturated Fat Comes from animal and some plant-based products Recommendations: For adults needing to lower their cholesterol: Should be no more than 5 to 6% of total calories For someone eating 2000 calories a day, that s about 11 to 13 grams of saturated fat For healthy Americans over age 2: Limit to less than 7% of total daily calories For someone eating 2000 calories a day, less than 16 grams should come from saturated fat.

21 KNOW YOUR FATS Trans Fat (aka partially hydrogenated oils ) Not a naturally occurring fat Created in an industrial process to make liquid vegetable oils more solid. Found in many fried foods and baked goods Ex. pastries, pizza dough, pie crust, cookies, crackers Raise bad cholesterol & lower good cholesterol levels Recommendation: Limit to less than 1% of total daily calories or eliminate entirely Required to be listed on the Nutrition facts label But may not be listed if less than 0.5 grams Look for partially hydrogenated oil in the ingredients list

22 KNOW YOUR FATS Unsaturated Fat 2 types: Polyunsaturated and Monounsaturated fats May help improve blood cholesterol when used in place of saturated and trans fats Found in: Fish (salmon, trout, herring) Avocados Nuts (almonds, walnuts) Liquid vegetable oils (olive, canola, soybean, sunflower) Recommendation: Majority of fats you eat should be mono- or polyunsaturated

23 QUIT SMOKING TOBACCO Smoking tobacco increases your chances for heart disease and stroke. When you stop smoking, your good cholesterol is likely to improve by as much as 10% Talk to your doctor about which options are available to help you quit State Wellness Center offers a tobacco cessation program

24 CHOLESTEROL MEDICATIONS

25 STATINS How do they work? Works in the liver to prevent formation of cholesterol Lowers the amount of cholesterol circulating in the blood Most effective at lowering LDL (bad) cholesterol Modest effects on lowering triglycerides and raising HDL (good) cholesterol Most level of evidence for benefit Works best when taken before bedtime. Side effects are generally mild and go away as your body adjusts. Muscle problems and liver abnormalities are less common Call your doctor immediately if your urine turns a dark red or brown color as this can be a major side effect. Do not take if you are pregnant or have liver disease.

26 CHOLESTEROL ABSORPTION INHIBITORS: ZETIA How does it work? Prevents the absorption of cholesterol from the intestine. Moderately effective at lowering LDL (bad) cholesterol Modest effects on lowering triglycerides and raising HDL (good) cholesterol May be used as add-on therapy to a statin Available in a combination with simvastatin (Vytorin ) Expensive No generic available

27 BILE ACID RESINS: QUESTRAN, COLESTID, WELCHOL How do they work? Works in the intestines by promoting increased disposal of cholesterol in the feces resulting in less cholesterol circulating in the bloodstream Modest effects on LDL cholesterol lowering. May increase triglycerides Most common side effects are stomach upset, flatulence, constipation May affect the absorption of medications and vitamins. Available in different dosage forms Oral powder, tablet

28 How does it work? Works in the liver by affecting the production of blood fats. NIACIN: NIASPAN Effective at increasing HDL (good) cholesterol Modest effects on lowering LDL cholesterol & triglycerides Do NOT use over-the-counter Niacin dietary supplements for cholesterol treatment Side effects: Flushing, itching, and stomach upset Your liver functions needs to be closely monitored. Can raise blood sugar in diabetics

29 PCSK9 INHIBITORS: PRALUENT, REPATHA How do they work: First injectable biologics treatment for high LDL cholesterol They prevent the protein PCSK9 from binding and degrading liver LDL receptors This leads to more LDL receptors and more LDL cholesterol clearing from the blood, and thus leaving less LDL cholesterol to do damage on your vessels. Very effective at lowering LDL cholesterol Is not yet to be proven to improve cardiovascular outcomes and be safe with long-term use. Very expensive May cost about $10,000 per patient per year Expected to be used in patients with familial hypercholesterolemia as an add-on to statin therapy Will be out in the next few months

30 FIBRATES: LOPID, TRICOR, LOFIBRA, ANTARA, TRILIPIX How do they work? They activate a factor in tissues of the liver, kidney, heart, and muscle that degrades fatty acids. Very effective at lowering triglycerides May also have beneficial effects on HDL Not as effective for lowering LDL cholesterol. Main therapy for the treatment of very high triglycerides (levels above 500 mg/dl) Certain fibrates should not be used in combination with statins due to increased risk for muscle problems Should be used in combination with lifestyle management to lower triglycerides Meals with fish with high omega-3 content twice a week to daily Salmon, white albacore tuna, halibut, herring, trout Diet lower in simple carbohydrates Switch to whole grains

31 OMEGA-3 FISH OILS: LOVAZA Derived from fish oils that are chemically changed and purified. Used to lower triglycerides in people with very high triglyceride levels (over 500 mg/dl) Should not be used in individuals with fish and/or shellfish allergies or sensitivities May cause drug interactions with blood thinners. Should monitor for increased chance of bleeding Should be used in combination with lifestyle management to lower triglycerides Meals with fish with high omega-3 content twice a week to daily Salmon, white albacore tuna, halibut, herring, trout Diet lower in simple carbohydrates Switch to whole grains

32 INFORMATION RESOURCES

33 Ask your doctor or pharmacist on information for cholesterol lifestyle management and therapies Get your annual HealthWatch screening done American Heart Association: Centers for Disease Control (CDC): National Heart, Lung, & Blood Institute (NHLBI):

34 ANY QUESTIONS?

35 REFERENCES 1. National Institute of Health, & National Heart, Blood, and Lung Institute. (2012, September 19). What Is Cholesterol?. Retrieved August 6, 2015, from 2. American Heart Association. (n.d.). Cholesterol. Retrieved August 10, 2015, from esterol_ucm_001089_subhomepage.jsp 3. WebMD. (2014, March 23). Cholesterol Pictures: High Cholesterol, LDL, HDL, "Bad" Foods and More. Retrieved from

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