High Cholesterol (Hyperlipidemia)

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1 High Cholesterol (Hyperlipidemia) My cholesterol medication is: The directions are: In recent years, powerful new drugs have been developed to reduce cholesterol in your blood, thereby reducing your risk of heart attacks and strokes. Your doctor has prescribed one of these drugs for you. This information sheet is provided to help you understand how these new drugs work to help keep you healthy. A chart at the end of this document lists the different kinds of drugs and potential side effects. Please take a few minutes to read this information. If you have further questions or concerns, please call your pharmacist or doctor. UCSF doctors and pharmacists may be located by calling What is cholesterol? 2 High cholesterol, also called hyperlipidemia, is an increased level of lipids in the blood associated with atherosclerosis, a condition in which fatty deposits in your arteries block or slow movement of blood to and from your heart. Atherosclerosis is a major cause of coronary heart disease (CHD), a condition believed to cause 20 percent of American deaths and to be the single largest killer of Americans today. Cholesterol is one kind of lipid. Another kind is called triglycerides. Both kinds are transported in the blood as part of large particles called lipoproteins. Hypercholesterolemia is a high level of cholesterol. Hypertriglyceridemia is a high level of triglyceride in the blood. There are five major families of lipoproteins and the most important ones are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Although a desirable level of cholesterol is less than 200 mg/dl, the balance between LDL and HDL cholesterol also plays an important role in evaluating your heart and artery health. It s important to know about these different kinds of blood fat because different medications are used to control them. Good cholesterol/bad cholesterol 2 LDL is the major cholesterol carrier in the blood. Too much LDL can contribute over time to the build up of atherosclerotic plaques in the walls of the blood vessels feeding the brain, heart, gut and legs. This plaque, a thick, hard deposit, can clog the arteries. This is known as atherosclerosis. A blood clot that forms in the area of atherosclerosis also can block blood flow. If the clot blocks the arteries feeding the heart muscles, it can cause a heart attack. If the

2 clot blocks blood flow to the brain, it may result in a stroke. A high level of LDL (160 mg/dl and above) increases the risk of heart disease, so LDL also is known as "bad" cholesterol. HDL is thought to carry cholesterol away from the arteries and back to the liver, where it is involved in making other essential substances. HDL is believed to remove excess cholesterol from atherosclerotic plaques and slow their growth and accumulation in arteries. HDL also is called "good" cholesterol because a high level of HDL may help protect against heart attack. A low level of HDL (less than 40 mg/dl) means an increase in the risk of heart attack and stroke. Why do some people have complications from high cholesterol? We know that factors including heredity, which we can t change, and life-style habits, which we can change, determine who will get heart attacks and strokes and who won t. Lifestyle risk factors we can control include: Smoking Poor diet High alcohol consumption Not taking prescribed medication as directed Avoiding exercise However, we also know that the following risk factors may not be under your control but increase your risk for heart or artery disease. High blood pressure (blood pressure over 140/90) Low HDL cholesterol (less than 40 mg/dl) Family history of early heart disease (male relatives under 55 years old, females under 65 years old) Age (men older than 45 years old, women older than 55 years old) Risk categories and goals for LDL reduction 1,3 The following chart suggests at which point your doctor is likely to suggest that you change your diet, or that you change your diet and take medication. means "more than or equal to"; < means "less than"

3 Initiate Lifestyle changes 3 Diet: (1) Saturated fat should amount to less than 7 percent of your total calorie intake, cholesterol should amount to less than 200mg/day. (2) Increase fiber intake Weight reduction Increase daily physical activities Diet and Cholesterol (from the American Heart Association) Your liver usually makes about 1,000mg (1 gram) of cholesterol a day, while your diet can provide another 400 to 500mg of cholesterol. Foods from animal sources (especially poultry, meat, seafood, egg yolks, and wholemilk dairy products) contain cholesterol. Foods from plants (fruits, vegetables, grains, nuts, and seeds) do not contain cholesterol. Saturated fatty acids can raise blood cholesterol. The American Heart Association recommends limiting your daily cholesterol intake to less than 300mg. If you have heart disease, limit to less than 200mg. People with severe hypercholesterolemia should eat no more than 6 oz. of lean meat, fish, and poultry daily and use fat-free or low-fat dairy products. High-quality proteins from vegetable sources, such as beans, can substitute for animal source protein. Exercise and Cholesterol 2 Physical inactivity is a major risk factor for heart disease. Exercise may increase HDL. Exercise can help control weight, blood sugar, and high blood pressure. Aerobic exercise (activities that increase your heart and breathing rates), such as brisk walking, jogging, and swimming, can help condition your heart and lungs. Moderate intensity daily activities, such as walking, gardening, yard work, housework, and dancing can also help reduce your risk. If you have heart disease, it is important to consult with your physician prior to beginning an exercise program

4 Cigarette/tobacco smoking/alcohol consumption and cholesterol 2 Quit smoking. Talk with your doctor about a smoking cessation program if necessary. Smoking is a major risk factor of heart disease. Smoking has been shown to reduce HDL levels. The American Heart Association recommends talking to your doctor first for advice on alcohol consumption. Moderate alcohol consumption may reduce the incidence of heart disease. However this must be individualized for each patient since it also may increase the incidence. Medications to help optimize your cholesterol levels 3 There are four major classes of drugs that can help optimize your lipid profile. The chart below lists the major classes, their commercial names, how they affect lipids and potential side effects. If you experience any of these side effects or any other unusual conditions while you are taking your medication, contact your doctor.

5 For Your Health and Your Heart Maintain a healthy lifestyle and a low-fat, low-cholesterol diet. Maintain daily physical activity. Quit smoking or excessive alcohol consumption. Talk to your doctor, pharmacist or nurse to see how you can optimize your lipid profile. References: 1. Close To The Heart Educational Program provided by Pfizer, Inc. March (the American Heart Association Website) 3. ATP III Guidelines At-A-Glance Quick Desk Reference by NIH, National Heart, Lung, and Blood Institute. Courtesy of the UCSF Division of Cardiology and UCSF Department of Clinical Pharmacy SDCAR0085 Rev. 08/02

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