Simeon Margolis, MD, PhD

Size: px
Start display at page:

Download "Simeon Margolis, MD, PhD"

Transcription

1 Simeon Margolis, MD, PhD Decisions on when to lower LDL cholesterol are based on a combination of risk status and the LDL cholesterol Cigarette smoking Hypertension HDL cholesterol <40 mg/ml Age (men > 45, women >55) Family history of premature coronary artery disease Male 1 st degree relative <55 Female 1 st degree relative <65 HDL cholesterol >60 is a negative risk factor Coronary heart disease Peripheral arterial disease Abdominal aortic aneurysm Symptomatic carotid artery disease Diabetes mellitus Multiple risk factors that confer > 20% risk of a coronary event in the next 10 years Risk category LDL-ch goal Zero to one risk factor <160 Two or more risk factors <130 High risk <100 (CHD or CHD equivalents) Very high risk (CHD+) <70 1

2 Lipoprotein Major component CHD risk VLDL Triglycerides Increased LDL Cholesterol Increased Lower total and LDL cholesterol Lower triglycerides Raise HDL cholesterol HDL Protein Decreased Proper diet Weight loss Exercise <10% of energy intake from saturated fat <7% of energy intake if LDL needs to be lowered Dietary cholesterol intake <300 mg/day <200 mg/d if LDL needs to be lowered Increase soluble fiber and plant stanol/sterol esters Unsaturated fat: unsaturated ~10% of energy intake monounsaturated preferred eat fish at least 2 times a week if coronary disease known, take fish oil supplements Minimize intake of trans fatty acids WEIGHT LOSS Supplements of omega-3 fatty acids Patients with triglycerides > 500 mg/dl need fat restriction and medications. 2

3 Weight loss Exercise Moderate alcohol intake Patients fail to comply with diet. Diet doesn t lower lipids enough. Drug Statins Bile acid sequestrants Ezetimibe Niacin Fibrates Mechanism Inhibit cholesterol synthesis Inhibit bile acid reabsorption Inhibits cholesterol absorption Inhibits VLDL synthesis Speed conversion of VLDL to LDL Statins - first choice Add-on drugs to achieve LDL-Ch, TG, or HDL-Ch goals Major use: Lower LDL cholesterol Lipid/lipoprotein effects: Lower LDL-Ch up to 60% Raise HDL-Ch 8 to 10% Lower triglycerides 10 to 30% Contraindications: Active liver disease Rosuvastatin Pitavastatin Atorvastatin Simvastatin* Pravastatin* = lovastatin* Fluvastatin * Indicates off-patent 3

4 Muscle pain Ask about muscle pain and weakness Myositis : symptoms + elevated CK Rhabdomyolysis and renal failure Permanent liver damage never reported Stop statin and measure CK If CK < 1000, restart same stain when muscle pain is no longer present If muscle pain recurs, Try different statins Low dose or less frequent dose Baseline LFT s only Follow-up LFTs not needed CP if muscle pain or weakness Fibrates especially gemfibrozil Macrolide antibiotics Erythromycin Clarithromycin Rifampin Azole antifungals Calcium channel blockers Amiodarone Cyclosporin Failure to start drug at hospital discharge Poor patient compliance Failure of physicians to monitor compliance Inadequate dose of medication Blocks absorption of dietary and biliary cholesterol Lowers LDL cholesterol by about 15% Useful in combination with statin (Vytorin) Few side effects 4

5 Major use: Lower LDL-ch Lipid/lipoprotein effects: Lower LDL-ch 10 to 25% Raise HDL-ch 1 to 3% Triglycerides: increase or no change Contraindications: Elevated triglycerides Major adverse effects: Gastrointestinal symptoms, decreased absorption of some drugs, elevated liver transaminases Cholestyramine (Questran) Colestipol (Colestid) Colesevelam (WelChol) Increase triglycerides Absolute contraindication TGs > 400 mg/dl Relative contraindication TG mg/dl Decreased absorption of anionic drugs and vitamins Not a problem with colesevelam Bloating, constipation, even bowel obstruction Taurine 500 mg may decrease constipation Classification Normal Borderline high High Very high Serum Level <150 mg/dl mg/dl mg/dl >500 mg/dl Goal: Prevent pancreatitis Very low fat diet (<15% of calories) TG-lowering drug usually required Reduce TG before lowering LDL-Ch 5

6 Primary target: lower LDL cholesterol Secondary target: Non-HDL cholesterol Achieve LDL goal with statins before treating non-hdl cholesterol Non-HDL-Ch = Total Ch HDL-Ch Non-HDL-Ch includes atherogenic VLDL and chylomicron remnants Non HDL-Ch goal = LDL-Ch goal + 30 mg/dl May predict CHD risk better than LDL-Ch By 20 to 50% Fibrates: gemfibrozil, fenofibrate Niacin Omega-3 fish oil Over-the counter Prescription By 7 to 25% Statins Lower triglycerides 20 to 50% Lower non-hdl-ch 12 to 18% Raise HDL-Ch 8 to 10% Lower total Ch 8 to 12 % But May raise LDL-Ch Use with caution: Gemfibrozil with statin, renal insufficiency Major adverse effects: GI symptoms, elevated liver transaminases, myositis with statins Dyspepsia Gallstones Elevated LFTs Venous thrombosis and pulmonary emboli Prothrombin time raised with warfarin Rx Reduce warfarin dose Lower dose in patients with impaired renal function Avoid gemfibrozil with statins Epidemiologic studies have shown that elevated triglycerides and low HDL-Ch are independent risk factors for coronary heart disease. BUT little proof that lowering triglycerides or raising HDL-Ch reduces CHD events 6

7 Two studies have shown a significant reduction in coronary events with gemfibrozil treatment. Helsinki Heart Study VA/HIT Study Niacin is most effective Fibrates and statins raise HDL cholesterol by about 8% to 10% Estrogens after the menopause Lower LDL-Ch 10 to 25% Raise HDL-Ch 15 to 35% Lower triglycerides 20 to 50% Flushing, itching, redness Liver toxicity Dyspepsia, nausea, vomiting Increased uric acid levels and gout Slight rise in fasting glucose and HbA1c Liver disease History of peptic ulcer or GI bleed Gout Start with low niacin dose Less flushing with extended-release niacin Flushing worsened with hot beverages, spicy foods, alcohol, hot showers Aspirin or other NSAIDs 30 to 60 min before niacin dose Flushing diminishes over time with consistent dosing 7

8 Immediate release - crystalline niacin Sustained (Slow) release Extended release (Niaspan) Immediate release no cases with < 3 g Extended release 2 g 0/223 subjects Sustained releases 1.5 to 3g 12/223 Reports of severe liver toxicity DON T use sustained release Drug Cholesterol Triglycerides HDL-CH Bile acid sequestrants -or - Niacin Statins Fibrates Ezetimibe - - 8

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour

More information

Primary Care Management of Women with Hyperlipidemia. Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing

Primary Care Management of Women with Hyperlipidemia. Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing Primary Care Management of Women with Hyperlipidemia Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing Objectives: Define dyslipidemia in women Discuss the investigation process leading

More information

Cholesterol and Triglycerides What You Should Know

Cholesterol and Triglycerides What You Should Know Cholesterol and Triglycerides What You Should Know Michael T. McDermott MD Professor of Medicine Endocrinology Practice Director Division of Endocrinology, Metabolism and Diabetes University of Colorado

More information

THE THIRD REPORT OF THE EXpert

THE THIRD REPORT OF THE EXpert SPECIAL COMMUNICATION 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

More information

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2 Diabetes Mellitus Type 2 What is it? Diabetes is a common health problem in the U.S. and the world. In diabetes, the body does not use the food it digests well. It is hard for the body to use carbohydrates

More information

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION Hull & East Riding Prescribing Committee PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION For guidance on Primary Prevention please see NICE guidance http://www.nice.org.uk/guidance/cg181

More information

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

CHOLESTEROL 101: WHAT YOU NEED TO KNOW TO KEEP YOUR HEART HEALTHY. By: Camille Quiles, PharmD., RPh. CHOLESTEROL 101: WHAT YOU NEED TO KNOW TO KEEP YOUR HEART HEALTHY By: Camille Quiles, PharmD., RPh. WHAT IS CHOLESTEROL? CHOLESTEROL Waxy, fat-like substance found in all cells of the body Your body uses

More information

Managing Dyslipidemias in Patients With Chronic Kidney Disease

Managing Dyslipidemias in Patients With Chronic Kidney Disease Managing Dyslipidemias in Patients With Chronic Kidney Disease Causes of Death Among Period Prevalent Patients, 1997-1999, Treated with Hemodialysis, Peritoneal Dialysis or Kidney Transplantation Abbreviations:

More information

An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia

An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates

More information

Education. Panel. Triglycerides & HDL-C

Education. Panel. Triglycerides & HDL-C Triglycerides & HDL-C Thomas Dayspring, MD, ACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph s s Hospital, Paterson, NJ Certified

More information

Omega-3 Fatty Acid Products

Omega-3 Fatty Acid Products Omega-3 Fatty Acid Products Policy Number: 5.01.563 Last Review: 7/2016 Origination: 6/2014 Next Review: 7/2017 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for the

More information

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING

More information

Statins for Hyperlipidemia (High Cholesterol)

Statins for Hyperlipidemia (High Cholesterol) Statins for Hyperlipidemia (High Cholesterol) Examples of statin drugs Brand Name Mevacor Pravachol Zocor Lescol, Lescol XL Lipitor Crestor Chemical Name lovastatin pravastatin sodium simvastatin fluvastatin

More information

What is high cholesterol?

What is high cholesterol? Statin medicines This brochure gives you information on high cholesterol and the medicines most commonly used to manage it. You ll learn how these medicines compare and get important information about

More information

High Blood Cholesterol What you need to know

High Blood Cholesterol What you need to know National Cholesterol Education Program High Blood Cholesterol What you need to know Why Is Cholesterol Important? Your blood cholesterol level has a lot to do with your chances of getting heart disease.

More information

Cardiovascular Risk and Dyslipidemia Management Clinician Guide MAY 2015

Cardiovascular Risk and Dyslipidemia Management Clinician Guide MAY 2015 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Cardiovascular Risk and Dyslipidemia Management Clinician Guide MAY 2015 Introduction This Clinician Guide was developed to assist Primary Care physicians

More information

Anti-Atheroscrerotic Drugs

Anti-Atheroscrerotic Drugs Anti-Atheroscrerotic Drugs Masuko Ushio-Fukai, PhD, FAHA Dept. of Pharmacology University of Illinois at Chicago Anti-Atherogenic Drugs: Treatment of Hyperlipidemias Knowledge Objectives: 1) Know the mechanism

More information

NEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? LAUREN HYNICKA, PHARMD, BCPS MOHAMED SARG, PHARMD, BCPS

NEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? LAUREN HYNICKA, PHARMD, BCPS MOHAMED SARG, PHARMD, BCPS NEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? LAUREN HYNICKA, PHARMD, BCPS MOHAMED SARG, PHARMD, BCPS NEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? ACTIVITY DESCRIPTION Cholesterol

More information

Cholesterol and Human Health

Cholesterol and Human Health Cholesterol and Human Health Hongbao Ma Department of Medicine, Michigan State University, East Lansing, Michigan 48824, USA hongbao@msu.edu, (517) 432-0623 Abstract: Cholesterol plays a major role in

More information

High Cholesterol and Heart Disease

High Cholesterol and Heart Disease Evaluating statin drugs to treat: High Cholesterol and Heart Disease Comparing Effectiveness, Safety, and Price Contents Our Recommendations........................................... 3 Welcome....................................................

More information

Welchol (colesevelam HCl) Receives FDA Approval to Reduce Blood Glucose in Adults with Type 2 Diabetes

Welchol (colesevelam HCl) Receives FDA Approval to Reduce Blood Glucose in Adults with Type 2 Diabetes For Immediate Release Company name: DAIICHI SANKYO COMPANY, LIMITED Representative: Takashi Shoda, President and Representative Director (Code no.: 4568, First Section, Tokyo, Osaka and Nagoya Stock Exchanges)

More information

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program High Blood Cholesterol Detection Evaluation Treatment Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and

More information

Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes

Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes Obesity Approximately 1 in 3 adults are overweight in the U.S. Arizona According to CDC, Arizona has highest reported percentage of adults who

More information

Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).

Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Complete Summary GUIDELINE TITLE (1)Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment

More information

JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014

JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014 JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates January 30, 2014 GOALS Review key recommendations from recently published guidelines on blood pressure and cholesterol management Discuss

More information

High Cholesterol (Dyslipidemia)

High Cholesterol (Dyslipidemia) High Cholesterol (Dyslipidemia) What is high cholesterol? Cholesterol is a type of fat that is found in every cell in the body. It is used to build healthy cells and some vital hormones. High levels of

More information

Cholesterol made simple!

Cholesterol made simple! Cholesterol made simple! Cholesterol is the biggest risk factor for heart disease and also increases your risk of stroke and circulatory disease - Heart UK The Cholesterol Charity What is Cholesterol and

More information

High Cholesterol and Heart Disease

High Cholesterol and Heart Disease Evaluating statin drugs to treat: High Cholesterol and Heart Disease Comparing Effectiveness, Safety, and Price Contents 2: Our recommendations 4: Welcome 7: Who should take a statin drug? 10: Choosing

More information

Cardiovascular Disease Risk Factors

Cardiovascular Disease Risk Factors Cardiovascular Disease Risk Factors Risk factors are traits and life-style habits that increase a person's chances of having coronary artery and vascular disease. Some risk factors cannot be changed or

More information

Individual Study Table Referring to Part of Dossier: Volume: Page:

Individual Study Table Referring to Part of Dossier: Volume: Page: 2.0 Synopsis AbbVie Inc. Name of Study Drug: Trilipix (ABT-335) Name of Active Ingredient: choline salt of fenofibric acid Individual Study Table Referring to Part of Dossier: Volume: Page: (For National

More information

Shared Decision Making

Shared Decision Making Deciding what to do about high cholesterol This short decision aid is to help you decide what to do about your high cholesterol. You can use it on your own, or with your doctor, to help you make a decision

More information

Nutrition and Health Info-Sheet F o r H e a l t h P r o f e s s i o n a l s

Nutrition and Health Info-Sheet F o r H e a l t h P r o f e s s i o n a l s Nutrition and Health Info-Sheet F o r H e a l t h P r o f e s s i o n a l s Produced by Erin Digitale, PhD Cristy Hathaway, BS Sheri Zidenberg-Cherr, PhD Karrie Heneman, PhD UC Cooperative Extension Center

More information

PRESCRIBING INFORMATION Refer to Summary of Product Characteristics (SmPC) before Prescribing

PRESCRIBING INFORMATION Refer to Summary of Product Characteristics (SmPC) before Prescribing EZETROL (ezetimibe) PRESCRIBING INFORMATION Refer to Summary of Product Characteristics (SmPC) before Prescribing Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.

More information

Statin Template Guidance Use of statins in primary and secondary prevention of vascular disease Endorsed by ABHB MTC for use in Gwent (October 2012)

Statin Template Guidance Use of statins in primary and secondary prevention of vascular disease Endorsed by ABHB MTC for use in Gwent (October 2012) Statin Template Guidance Use of statins in primary and secondary prevention of vascular disease Endorsed by ABHB MTC for use in Gwent (October 2012) Notes relating to this guidance This guidance serves

More information

ABOUT HIGH CHOLESTEROL AND HIGH TRIGLYCERIDES

ABOUT HIGH CHOLESTEROL AND HIGH TRIGLYCERIDES ABOUT HIGH CHOLESTEROL AND HIGH TRIGLYCERIDES Because the more you know, the healthier you can be. This booklet is designed to help you understand high cholesterol and high triglycerides (called lipids

More information

Hyperlipidemia and Atherosclerosis 2005 Robert S. Lees, M.D.

Hyperlipidemia and Atherosclerosis 2005 Robert S. Lees, M.D. Harvard-MIT Division of Health Sciences and Technology HST.151: Principles of Pharmocology Instructor: Dr. Robert Lees 1 BACKGROUND Hyperlipidemia and Atherosclerosis 2005 Robert S. Lees, M.D. I. Atherosclerosis:

More information

Lipid-lowering: Can ezetimibe help close the treatment gap?

Lipid-lowering: Can ezetimibe help close the treatment gap? REVIEW CME CREDIT RYAN C. NEAL, MD* Assistant Professor of Medicine, Baylor College of Medicine, Houston, Texas PETER H. JONES, MD Associate Professor of Medicine, Baylor College of Medicine, Houston,

More information

Article. Heart health and cholesterol levels of Canadians, 2007 to 2009. Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets

Article. Heart health and cholesterol levels of Canadians, 2007 to 2009. Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets Article Heart health and cholesterol levels of Canadians, 2007 to 2009 March How to obtain more information For information about

More information

Patient Information VYTORIN (VI-tor-in) (ezetimibe and simvastatin) Tablets

Patient Information VYTORIN (VI-tor-in) (ezetimibe and simvastatin) Tablets Patient Information VYTORIN (VI-tor-in) (ezetimibe and simvastatin) Tablets Read this Patient Information carefully before you start taking VYTORIN and each time you get a refill. There may be new information.

More information

I The THREE types of LIPIDS

I The THREE types of LIPIDS LECTURE OUTLINE Chapter 5 The Lipids: Fats, Oils, Phospholipids and Sterols I The THREE types of LIPIDS A. Triglycerides (fats & oils)- the MAJOR type of lipid in food and humans. 1. 2 parts of triglyceridesa)

More information

Management of Lipids in 2015: Just Give them a Statin?

Management of Lipids in 2015: Just Give them a Statin? Management of Lipids in 2015: Just Give them a Statin? James H. Stein, M.D. Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Stone NJ, et al. Circulation

More information

10/11/2014. Laura C. Halder, Pharm.D. Postgraduate Year Two Pharmacy Resident Cardiology Abbott Northwestern Hospital Allina Health October 30, 2014

10/11/2014. Laura C. Halder, Pharm.D. Postgraduate Year Two Pharmacy Resident Cardiology Abbott Northwestern Hospital Allina Health October 30, 2014 Laura C. Halder, Pharm.D. Postgraduate Year Two Pharmacy Resident Cardiology Abbott Northwestern Hospital Allina Health October 30, 2014 1 1. List two major changes to the 2013 cholesterol treatment guidelines.

More information

Rx Updates New Guidelines, New Medications What You Need to Know

Rx Updates New Guidelines, New Medications What You Need to Know Rx Updates New Guidelines, New Medications What You Need to Know Maria Pruchnicki, PharmD, BCPS, BCACP, CLS Associate Professor of Clinical Pharmacy OSU College of Pharmacy Background scope and impact

More information

Cholesterol. Objectives. Case #1. Case #2 8/6/2012 CHOLESTEROL BASICS: A REVIEW. Cholesterol Basics ATP 3 guidelines

Cholesterol. Objectives. Case #1. Case #2 8/6/2012 CHOLESTEROL BASICS: A REVIEW. Cholesterol Basics ATP 3 guidelines Objectives Cholesterol Ben Brown MD July 2012 With thanks to Fasih Hameed MD & Wendy Kohatsu MD Cholesterol Basics ATP 3 guidelines Two tools how to use with your patients. Lifestyle Management Meds: Basics

More information

National Lipid Association 2014 Scientific Sessions, Orlando, FL

National Lipid Association 2014 Scientific Sessions, Orlando, FL National Lipid Association 2014 Scientific Sessions, Orlando, FL Lori Alexander, MSHS, RD, CCRC, CLS, FNLA Site Director St Johns Center for Clinical Research Ponte Vedra, FL Financial Disclosures None

More information

Overview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status?

Overview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status? Overview Nutritional Aspects of Primary Biliary Cirrhosis Tracy Burch, RD, CNSD Kovler Organ Transplant Center Northwestern Memorial Hospital Importance of nutrition therapy in PBC Incidence and pertinence

More information

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process

More information

Triglycerides: Frequently Asked Questions

Triglycerides: Frequently Asked Questions Triglycerides: Frequently Asked Questions Why are triglycerides important? The amount of triglycerides (or blood fats) in blood are one important barometer of metabolic health; high levels are associated

More information

Prescribing Information

Prescribing Information The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it. Omacor Prescribing Information 1 NAME OF THE MEDICINAL PRODUCT OMACOR, 1000 mg, soft

More information

Blood clot in atheroma. help make vitamin D and hormones, like oestrogen and testosterone, in your body.

Blood clot in atheroma. help make vitamin D and hormones, like oestrogen and testosterone, in your body. CHOLESTEROL This factsheet explains what cholesterol is and why too much cholesterol in your blood is harmful. It also provides information regarding cholesterol testing and tips to help reduce your blood

More information

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

If you have any concerns about taking this medicine, ask your doctor or pharmacist. EZETROL ezetimibe 10 mg tablet What is in this leaflet This leaflet answers some common questions about EZETROL. It does not contain all the available information. It does not take the place of talking

More information

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.

More information

Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075

Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075 Title: Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075 Investigator: Institution: Gail Gates, PhD, RD/LD Oklahoma State University Date

More information

Diabetes and Stroke. Understanding the connection between diabetes and the increased risk of stroke

Diabetes and Stroke. Understanding the connection between diabetes and the increased risk of stroke Diabetes and Stroke Understanding the connection between diabetes and the increased risk of stroke Make the Connection Almost 26 million people in the U.S. roughly 8 percent of the population have diabetes.

More information

Cardiovascular Risk in Diabetes

Cardiovascular Risk in Diabetes Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,

More information

MEDICATION GUIDE JUXTAPID (JUKS-tuh-pid) (lomitapide) capsules

MEDICATION GUIDE JUXTAPID (JUKS-tuh-pid) (lomitapide) capsules MEDICATION GUIDE JUXTAPID (JUKS-tuh-pid) (lomitapide) capsules Read this Medication Guide before your treatment. What is the most important information I should know about JUXTAPID? JUXTAPID is available

More information

Margarines and Heart Disease. Do they protect?

Margarines and Heart Disease. Do they protect? Margarines and Heart Disease Do they protect? Heart disease Several studies, including our own link margarine consumption with heart disease. Probably related to trans fatty acids elevate LDL cholesterol

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

The menopausal transition usually has three parts:

The menopausal transition usually has three parts: The menopausal transition usually has three parts: Perimenopause begins several years before a woman s last menstrual period, when the ovaries gradually produce less estrogen. In the last 1-2 years of

More information

Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires

Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires Prof. J. Philippe Effect of estrogens on glucose metabolism : Fasting Glucose, HbA1c and C-Peptide

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

Health Maintenance: Controlling Cholesterol

Health Maintenance: Controlling Cholesterol Sacramento Heart & Vascular Medical Associates February 18, 2012 500 University Ave. Sacramento, CA 95825 Page 1 What is cholesterol? Cholesterol is a fatty substance. It has both good and bad effects

More information

Pharmacy Coverage Guidelines are subject to change as new information becomes available.

Pharmacy Coverage Guidelines are subject to change as new information becomes available. capsule, VASCEPA (icosapent ethyl) oral capsule Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This

More information

Acquired Heart Disease: Prevention and Treatment

Acquired Heart Disease: Prevention and Treatment Acquired Heart Disease: Prevention and Treatment Prevention and Treatment Sharon L. Roble, MD Assistant Professor Adult Congenital Heart Program The Ohio State University/Nationwide Children s Hospital

More information

Atherosclerotic Cardiovascular Disease (ASCVD) Secondary Prevention Guideline 1

Atherosclerotic Cardiovascular Disease (ASCVD) Secondary Prevention Guideline 1 Atherosclerotic Cardiovascular Disease (ASCVD) Secondary Prevention Guideline Major Changes as of January 2016... 2 Preface... 2 Definitions... 3 Target Population... 3 Goals of ASCVD Secondary Prevention...

More information

Health Passport. Your Journey to Wellness. Health Fair ID#

Health Passport. Your Journey to Wellness. Health Fair ID# Health Passport Your Journey to Wellness Health Fair ID# Body Mass Index What is BMI? Your body mass index, or BMI, shows the amount of fat in your body. BMI is calculated using height, weight, and waist

More information

Lipid-Lowering Drugs and Atherosclerosis

Lipid-Lowering Drugs and Atherosclerosis 25 Lipid-Lowering Drugs and Atherosclerosis HMG-CoA reductase inhibitors (statins) Fibric acid derivatives MAJR DRUG CLASSES Therapeutic verview Bile acid sequestrants Cholesterol absorption inhibitors

More information

Lipid Management in Diabetic Patients (June 2014 version)

Lipid Management in Diabetic Patients (June 2014 version) (June 2014 version) Background Accelerated atherosclerosis is multifactorial and begins years/decades prior to the diagnosis of type 2 diabetes: Risk for atherosclerotic events is two to four-fold greater

More information

ROLE OF PLANT STEROLS AND STANOLS IN A CHOLESTEROL LOWERING DIET

ROLE OF PLANT STEROLS AND STANOLS IN A CHOLESTEROL LOWERING DIET ROLE OF PLANT STEROLS AND STANOLS IN A CHOLESTEROL LOWERING DIET OUTLINE What are plant sterols/stanols? Mechanism of action What is the evidence for plant sterols/stanols in cholesterol lowering? An additive

More information

AACE Guidelines. Copyright 2012 AACE

AACE Guidelines. Copyright 2012 AACE AACE Guidelines Paul S. Jellinger, MD, MACE; Donald A. Smith, MD, FACE; Adi E. Mehta, MD, FRCP(C), FACE; Om Ganda, MD, FACE; Yehuda Handelsman, MD, FACP, FACE; Helena W. Rodbard, MD, FACP, MACE; Mark D.

More information

Screening and Management of Lipids

Screening and Management of Lipids Guidelines for Clinical Care Ambulatory Lipid Therapy Guideline Team Team Leader Audrey L Fan, MD General Medicine Team Members Jill N Fenske, MD Family Medicine R Van Harrison, PhD Medical Education Elizabeth

More information

MEDICATIONS COMMONLY USED IN CHRONIC KIDNEY DISEASE. HealthPartners Kidney Health Clinic 2011

MEDICATIONS COMMONLY USED IN CHRONIC KIDNEY DISEASE. HealthPartners Kidney Health Clinic 2011 MEDICATIONS COMMONLY USED IN CHRONIC KIDNEY DISEASE HealthPartners Kidney Health Clinic 2011 People with chronic kidney disease (CKD) require multiple medications. This handout will help explain the reason

More information

An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance

An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance Gerald Reaven, M.D., is Professor Emeritus (Active) of Medicine at Stanford University. He has served as director of the Division

More information

YOUR GUIDE TO. A Healthy Heart. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute

YOUR GUIDE TO. A Healthy Heart. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute YOUR GUIDE TO A Healthy Heart U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute YOUR GUIDE TO A Healthy Heart U.S. DEPARTMENT OF HEALTH

More information

Type 2 Diabetes Fact Sheet

Type 2 Diabetes Fact Sheet Type 2 Diabetes Fact Sheet Diabetes Overview Diabetes is a chronic disease characterized by high blood glucose levels (hyperglycemia) that results from the inability of the body to properly use and/or

More information

YOUR GUIDE TO. Managing and Understanding Your Cholesterol Levels

YOUR GUIDE TO. Managing and Understanding Your Cholesterol Levels YOUR GUIDE TO Managing and Understanding Your Cholesterol Levels Our goal at the Mercy Health Heart Institute is to help you be well. Our experienced team includes cardiologists, cardiovascular surgeons,

More information

Dyslipidemia. Management Strategies for Patients/Clients. Why is it Important to Monitor Your Cholesterol Level?

Dyslipidemia. Management Strategies for Patients/Clients. Why is it Important to Monitor Your Cholesterol Level? Management Strategies for Patients/Clients What is cholesterol? Cholesterol is a type of lipid or fat that is essential to the body. It plays a role in the manufacture of cells as well as hormone production.

More information

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Steroid as a structure Best known for its association with atherosclerosis Biochemically is a precursor of important other steroids: Bile acids

Steroid as a structure Best known for its association with atherosclerosis Biochemically is a precursor of important other steroids: Bile acids Necrotizing statins, beta blockers, propofol, ETOH heroin, cocaine, amphetamines, opioids Autophagocytic chloroquine, amiodarone Antimicrotubular colchicine, vincristine Mitochondrial HIV medications Inflammatory

More information

HYPERTENSION ASSOCIATED WITH RENAL DISEASES

HYPERTENSION ASSOCIATED WITH RENAL DISEASES RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein

More information

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent

More information

Cardiac Rehabilitation

Cardiac Rehabilitation Cardiac Rehabilitation Introduction Experiencing heart disease should be the beginning of a new, healthier lifestyle. Cardiac rehabilitation helps you in two ways. First, it helps your heart recover through

More information

KDIGO CLINICAL PRACTICE GUIDELINE FOR LIPID MANAGEMENT IN CHRONIC KIDNEY DISEASE. Supplemental Tables November 2013

KDIGO CLINICAL PRACTICE GUIDELINE FOR LIPID MANAGEMENT IN CHRONIC KIDNEY DISEASE. Supplemental Tables November 2013 KDIGO CLINICAL PRACTICE GUIDELINE FOR LIPID MANAGEMENT IN CHRONIC KIDNEY DISEASE Supplemental Tables November 2013 Suppl Table 1: Summary table of RCT examining the effect of exercise in CKD 5HD patients

More information

Initiation and Adjustment of Insulin Regimens

Initiation and Adjustment of Insulin Regimens Start with bedtime intermediateacting insulin or bedtime or morning long-acting insulin (can initiate with 10 units or 0.2 units per kg) Initiation and Adjustment of Insulin Regimens Insulin regimens should

More information

Dietary Fiber and Alcohol. Nana Gletsu Miller, PhD Fall 2-13

Dietary Fiber and Alcohol. Nana Gletsu Miller, PhD Fall 2-13 Dietary Fiber and Alcohol Nana Gletsu Miller, PhD Fall 2-13 Dietary Fiber It is the complex carbohydrate in plants that can not be broken down by human digestive enzymes Sources Grains Fruits and Vegetables

More information

Body Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ

Body Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ Body Composition & Longevity Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ LONGEVITY Genetic 25% Environmental Lifestyle Stress 75% BMI >30 OBESE 25-30 OVERWEIGHT 18-25 NORMAL WEIGHT 18

More information

Fat Facts That Can Help Your Heart. Most Common Risk Factors for Heart Disease

Fat Facts That Can Help Your Heart. Most Common Risk Factors for Heart Disease Fat Facts That Can Help Your Heart Sally Barclay, MS RD LD Nutrition Clinic for Employee Wellness Most Common Risk Factors for Heart Disease High LDL (bad) cholesterol Smoking Low HDL (good) cholesterol

More information

Drug Excretion. Renal Drug Clearance. Drug Clearance and Half-Life. Glomerular Filtration II. Glomerular Filtration I. Drug Excretion and Clearance

Drug Excretion. Renal Drug Clearance. Drug Clearance and Half-Life. Glomerular Filtration II. Glomerular Filtration I. Drug Excretion and Clearance t/.drugexcretion AINTRAVENOUSDOSE 36848765430TIME(hours) t/ Drug Excretion Dr. Robert G. Lamb Professor Pharmacology & Toxicology Drug Excretion and Clearance Drug Excretion: is the movement of drug from

More information

ACUTE STROKE UNIT ORIENTATION

ACUTE STROKE UNIT ORIENTATION ACUTE STROKE UNIT ORIENTATION 2014 TEACHING YOUR STROKE PATIENTS ABOUT THEIR MEDICATION Please refer to Module 8: Secondary Stroke Prevention for additional information Blood Pressure Medication Angiotensin

More information

Beating insulin resistance through lifestyle changes

Beating insulin resistance through lifestyle changes Beating insulin resistance through lifestyle changes This information is relevant to people at risk for type 2 diabetes, those who already have type 2 diabetes, pre- diabetes, polycystic ovary syndrome

More information

1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME

1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME 1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME Izet Aganović, Tina Dušek Department of Internal Medicine, Division of Endocrinology, University Hospital Center Zagreb, Croatia 1 Introduction The metabolic syndrome

More information

Drug and Supplement Interactions

Drug and Supplement Interactions Drug and Supplement Interactions With the billion-dollar supplement industry today and the ever-changing world of prescription medications, it is essential to be up-to-date with potentially harmful interactions

More information

NCD for Lipids Testing

NCD for Lipids Testing Applicable CPT Code(s): NCD for Lipids Testing 80061 Lipid panel 82465 Cholesterol, serum or whole blood, total 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein blood;

More information

Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland

Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland 14:00-14:55 WS #45: New Therapies for Lipid Management 15:05-16:00 WS #57: New Therapies for

More information

Prevention Of Atheromatous Heart Disease

Prevention Of Atheromatous Heart Disease Prevention Of Atheromatous Heart Disease By O.P. Agarwal, M.D., F.I.C.A. Angiology, Vol 36, Number 8, August 1985 Presented at the 31st Annual Meeting, American College of Angiology and 26th Annual Meeting,International

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Diabetes Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014 PURPOSE:

More information

Vascular Risk Reduction: Addressing Vascular Risk

Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction (VRR) Welcome! Presentation & Activities Focus: Managing known risk factors for vascular disease. Engage, collaborate and have

More information

Living with Cholesterol Cholesterol and healthy living

Living with Cholesterol Cholesterol and healthy living Living with Cholesterol heartandstroke.ca Cholesterol and Healthy Living What is cholesterol? The word cholesterol can refer either to the cholesterol found in the body (blood cholesterol) OR the cholesterol

More information