Medications
A few months after making these lifestyle changes, you should have another blood test to see how you're doing. If your cholesterol is still too high, your doctor will probably prescribe medications to lower it.
The statin drugs are the safest, most effective and most widely used cholesterol-lowering medications now available. Formally known as HMG-CoA reductase inhibitors, statins interfere with the liver's ability to synthesise cholesterol. Popular statins include pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol) and atorvastatin (Lipitor). Although these drugs have a very low incidence of side effects, careful monitoring by your doctor is essential because (rarely) statins can cause liver damage or serious muscle pain and weakness. Some evidence also suggests that statins may help reduce your risk of osteoporosis and Alzheimer's disease.
Not everyone responds well to statin drugs, however. If you don't, your doctor may prescribe nicotinic acid, which lowers LDL and raises HDL. To be eligible for government-subsidised, lipid-lowering statins you need to fulfil certain crtiteria. These criteria include an assessment based on risk factors that include your lipid levels and also your medical history. Consequently, people who have had a heart attack are eligible ffor this medication, even with a normal cholesterol level, but those people with no risk factors may not qualify.
Is it really okay for me to eat an egg every day?
Even though egg contain significant quantities of cholesterol, contrary to earlier widespread belief it is now accepted by most nutritionists that eating four to five eggs a week is unlikely to be harmful to your heart's health. However, the Heart Foundation still recommends you limit your egg intake if you have high cholesterol. A single egg contains about 213 mg of dietary cholesterol; current guidelines suggest consuming non more than about 200 mg of cholesterol a day. So, if you have an egg, aim to steer clear of other dietary sources of cholesterol that day, including meat, poultry and high-fat dairy products.
>ANGER MAY AFFECT YOUR CHOLESTEROL LEVELS, according to a University of Maryland study of 103 healthy middle-aged women. Those prone to frequent angry out-bursts had significantly poorer cholesterol profiles than their more even tempered counterparts. Researchers speculate that poor anger control may be linked to the release of excess adrenaline and other hormones, which have been shown to affect blood lipid levels. On the positive side, the health risks associated with an angry temperament were offset in those women who exercised regularly and were otherwise physically fit.
ASSESSING YOUR CHOLESTEROL NUMBERS
TOTAL CHOLESTEROL
------------------------------------------------------------------------------------------------------------------------------
Optimal Less than 4.0 mmol/L
Normal Less than 5.5 mmol/L
Borderline-high 5.5-6.5 mmol/L
High More than 6.5 mmol/L
LDL CHOLESTEROL
------------------------------------------------------------------------------------------------------------------------------
Optimal Less than 2.5 mmol/L
Normal 2.5-3.5 mmol/L
High More than 3.5 mmol/L
HDL CHOLESTEROL
-----------------------------------------------------------------------------------------------------------------------------
Optimal More than 1.0 mmol/L
Low (CHD risk factor) Less than 1.0 mmol/L
TRIGLYCERIDES
------------------------------------------------------------------------------------------------------------------------------
Optimal Less than 2.0 mmol/L
Borderline-high 2-4 mmol/L
High More than 4mmol/L
------------------------------------------------------------------------------------------------------------------------------
About triglycerides
--------------------------------------------------------------------------------------------------------------------------------
Cholesterol is only a part of the lipid story. Produced by the liver, tiglycerides (also lipids) are also an abundant fat in food (90 percent of dietary fat), and the body's main source of stored energy. They're measured in a blood test a 12-hour fast.
A triglyceride reading of less than 2.0 to 4.0 mmol/L is borderline-high and greater than 4.0 mmol/L is high. If your triglyceride level is 8.0 mmol/L or more you should be treated with medication even if you have no other risk factors. Repeated testing may be needed to get an accurate picture because triglycerides fluctuate so much. High levels are common in people with diabetes and are associated with obesity, a high-fat diet, excessive alcohol or carbohydrate consumption, hypothyroidism, kidney disorders and use of certain medications.
If your triglycerides are high, the lifestyle measures recommended for high cholesterol apply here too. Medications usually start with a statin drug and a second drug may be added as well--possibly niacin or one of the fibrates such as gemfibrozil (Lopid). Although combination drug therapy helps successfully control both LDL and triglycerides, side effects--particularly severe muscle inflammation--can be troublesome.
Not very effective, studies show, are garlic and lecithin supplements and antioxidants suh as vitamins C and E, which don't naturally reduce heart disease risk as has been theorised, but may actually interfere with statin drugs.
Another possibility is the class of drugs known as bile-acid sequestrants. These drugs--including cholestyramine (Questran) and colestipol (Colestid)--bind with bile acids in your intestine and are then excreted in your stool. Because the liver manufacturers bile acids from LDL Cholesterol, it is now stimulated to make more, lowering your cholesterol level in the process. Lastly, fibric acid derivatives, such as gemfibrozil (Lopid), are typically prescribed for people with unacceptably high triglyceride levels. These drugs may also modestly reduce LDL and total cholesterol levels but are generally not used alone to lower cholesterol.
>HEART PATIENTS WHO HAD STOPPED TAKING STATIN DRUGS after being hospitalised for chest pain were more than three times more likely to suffer a heart attack or die as those who had kept taking their drugs, according to a study published in the medical journal Circulation.
>NATURAL SUBSTANCES CALLED plant stanols and sterols, now incorporated into margarines (Logicol, Pro-Activ) and other food products, have been shown to reduce total cholesterol by 10-15%, if used regularly.
Natural methods
Studies show that stress can boost lipid levels in the bloodstream. Therefore, find an activity or technique--yoga, meditation, tai chi or biofeedback--to help you relax and manage your stress better.
Several nutritional supplements may have cholesterol-lowering effects but evidence varies on their efficacy. Among the most effective are plant sterols and stanols and the Indian herb gugulipid, which block the absorption of cholesterol in the intestine. Another supplement, inositol hexaniacinate, is a safe form of niacin that is less likely to cause skin flushing than standard niacin.
A few months after making these lifestyle changes, you should have another blood test to see how you're doing. If your cholesterol is still too high, your doctor will probably prescribe medications to lower it.
The statin drugs are the safest, most effective and most widely used cholesterol-lowering medications now available. Formally known as HMG-CoA reductase inhibitors, statins interfere with the liver's ability to synthesise cholesterol. Popular statins include pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol) and atorvastatin (Lipitor). Although these drugs have a very low incidence of side effects, careful monitoring by your doctor is essential because (rarely) statins can cause liver damage or serious muscle pain and weakness. Some evidence also suggests that statins may help reduce your risk of osteoporosis and Alzheimer's disease.
Not everyone responds well to statin drugs, however. If you don't, your doctor may prescribe nicotinic acid, which lowers LDL and raises HDL. To be eligible for government-subsidised, lipid-lowering statins you need to fulfil certain crtiteria. These criteria include an assessment based on risk factors that include your lipid levels and also your medical history. Consequently, people who have had a heart attack are eligible ffor this medication, even with a normal cholesterol level, but those people with no risk factors may not qualify.
Is it really okay for me to eat an egg every day?
Even though egg contain significant quantities of cholesterol, contrary to earlier widespread belief it is now accepted by most nutritionists that eating four to five eggs a week is unlikely to be harmful to your heart's health. However, the Heart Foundation still recommends you limit your egg intake if you have high cholesterol. A single egg contains about 213 mg of dietary cholesterol; current guidelines suggest consuming non more than about 200 mg of cholesterol a day. So, if you have an egg, aim to steer clear of other dietary sources of cholesterol that day, including meat, poultry and high-fat dairy products.
>ANGER MAY AFFECT YOUR CHOLESTEROL LEVELS, according to a University of Maryland study of 103 healthy middle-aged women. Those prone to frequent angry out-bursts had significantly poorer cholesterol profiles than their more even tempered counterparts. Researchers speculate that poor anger control may be linked to the release of excess adrenaline and other hormones, which have been shown to affect blood lipid levels. On the positive side, the health risks associated with an angry temperament were offset in those women who exercised regularly and were otherwise physically fit.
ASSESSING YOUR CHOLESTEROL NUMBERS
TOTAL CHOLESTEROL
------------------------------------------------------------------------------------------------------------------------------
Optimal Less than 4.0 mmol/L
Normal Less than 5.5 mmol/L
Borderline-high 5.5-6.5 mmol/L
High More than 6.5 mmol/L
LDL CHOLESTEROL
------------------------------------------------------------------------------------------------------------------------------
Optimal Less than 2.5 mmol/L
Normal 2.5-3.5 mmol/L
High More than 3.5 mmol/L
HDL CHOLESTEROL
-----------------------------------------------------------------------------------------------------------------------------
Optimal More than 1.0 mmol/L
Low (CHD risk factor) Less than 1.0 mmol/L
TRIGLYCERIDES
------------------------------------------------------------------------------------------------------------------------------
Optimal Less than 2.0 mmol/L
Borderline-high 2-4 mmol/L
High More than 4mmol/L
------------------------------------------------------------------------------------------------------------------------------
About triglycerides
--------------------------------------------------------------------------------------------------------------------------------
Cholesterol is only a part of the lipid story. Produced by the liver, tiglycerides (also lipids) are also an abundant fat in food (90 percent of dietary fat), and the body's main source of stored energy. They're measured in a blood test a 12-hour fast.
A triglyceride reading of less than 2.0 to 4.0 mmol/L is borderline-high and greater than 4.0 mmol/L is high. If your triglyceride level is 8.0 mmol/L or more you should be treated with medication even if you have no other risk factors. Repeated testing may be needed to get an accurate picture because triglycerides fluctuate so much. High levels are common in people with diabetes and are associated with obesity, a high-fat diet, excessive alcohol or carbohydrate consumption, hypothyroidism, kidney disorders and use of certain medications.
If your triglycerides are high, the lifestyle measures recommended for high cholesterol apply here too. Medications usually start with a statin drug and a second drug may be added as well--possibly niacin or one of the fibrates such as gemfibrozil (Lopid). Although combination drug therapy helps successfully control both LDL and triglycerides, side effects--particularly severe muscle inflammation--can be troublesome.
Not very effective, studies show, are garlic and lecithin supplements and antioxidants suh as vitamins C and E, which don't naturally reduce heart disease risk as has been theorised, but may actually interfere with statin drugs.
Another possibility is the class of drugs known as bile-acid sequestrants. These drugs--including cholestyramine (Questran) and colestipol (Colestid)--bind with bile acids in your intestine and are then excreted in your stool. Because the liver manufacturers bile acids from LDL Cholesterol, it is now stimulated to make more, lowering your cholesterol level in the process. Lastly, fibric acid derivatives, such as gemfibrozil (Lopid), are typically prescribed for people with unacceptably high triglyceride levels. These drugs may also modestly reduce LDL and total cholesterol levels but are generally not used alone to lower cholesterol.
>HEART PATIENTS WHO HAD STOPPED TAKING STATIN DRUGS after being hospitalised for chest pain were more than three times more likely to suffer a heart attack or die as those who had kept taking their drugs, according to a study published in the medical journal Circulation.
>NATURAL SUBSTANCES CALLED plant stanols and sterols, now incorporated into margarines (Logicol, Pro-Activ) and other food products, have been shown to reduce total cholesterol by 10-15%, if used regularly.
Natural methods
Studies show that stress can boost lipid levels in the bloodstream. Therefore, find an activity or technique--yoga, meditation, tai chi or biofeedback--to help you relax and manage your stress better.
Several nutritional supplements may have cholesterol-lowering effects but evidence varies on their efficacy. Among the most effective are plant sterols and stanols and the Indian herb gugulipid, which block the absorption of cholesterol in the intestine. Another supplement, inositol hexaniacinate, is a safe form of niacin that is less likely to cause skin flushing than standard niacin.
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