Wednesday, March 4, 2015

High Cholesterol (Dyslipidemia)





                                  Source: Retrieved from healthmeup.com

This condition relates to an increased amount of fat circulating in your blood that causes plaque to build in your arteries over time causing heart disease that could lead to a heart attack or stroke.

Diagnosis and Monitoring

Your health care provider will monitor your cholesterol with four numbers called a lipid panel/profile. The American Heart Association (AHA, 2014) recommends anyone 20 or older without a diagnosis of heart disease have a lipid panel every four to six years. If there is a familial cause of high cholesterol or premature heart disease, Gotto and Moon (2012) recommend cholesterol screening start at age 2. Cassoobhoy (2014) describes the four cholesterol numbers as follows:

  1.  LDL (low-density lipoprotein or “bad” cholesterol)-LDL builds in the walls of your arteries and increases the chance of heart disease. Normal level is 130 or less; if you have high blood pressure or diabetes, the goal should be less than 100 or less than 70. The lower the number, the better.
  2. HDL (high-density lipoprotein or “good” cholesterol)-HDL protects against heart disease by taking “bad” cholesterol out of your blood. Normal level is greater than 40. The higher number, the better.
  3. Triglycerides-the form of most of the fat in the food we eat. The higher the number, the higher the risk of clogged arteries (coronary artery disease). Normal level is less than 150.
  4. Total cholesterol-a measure of LDL, HDL, and other lipid components. Normal level is less than 200. 
Recommended Lifestyle Changes:

  • Increase fiber in your diet (i.e. apples with the peeling, broccoli, egg whites instead of eggs with the yolk, oatmeal, wheat bread, and sweet potatoes).
  • Exercise as tolerated for weight loss.
  • Decrease junk food, fried food, greasy food, and fast food.
  • Take all prescribed medications.

                                          Source: Retrieved from healthyblush.com


Types of Cholesterol Medications (Cassoobhoy, 2014):

  • Statins-lower the LDL and triglycerides and can slightly raise HDL. Statins block the liver from making cholesterol and are the first choice for most patients. Statins are also associated with lower risk of heart disease.
  • Niacin-lowers LDL and raises HDL. Niacin is a B-complex vitamin found in food and at higher doses with a prescription. Research shows it will improve cholesterol, but does not lower your risk of heart disease.
  • Bile-acid resins-lowers total cholesterol and LDL. Bile-acid resin works inside the intestines and binds to bile to prevent the bile from being reabsorbed in the blood.
  • Fibrates-lower triglycerides and LDL and can increase HDL. Fibrates help breakdown triglyceride-rich particles and decrease the secretion of certain fats in the blood.
    •  
                                           Source: King, J. (2014). Retrieved from onlinecomicguide.com


Reference
American Heart Association. (2014). How to get your cholesterol tested. Retrieved from www.heart.org/HEARTORG/Conditions/Cholesterol/SymptomsDiagnosisMonitoring/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp

Cassoobhoy, A. (2014). Understanding cholesterol numbers. WebMD. Retrieved from  www.m.webmd.com/a-to-z-guides/understanding-numbers

Gotto, J. M., & Moon, J. E. (2012). Management of cardiovascular risk: The importance of meeting lipid targets. The American Journal of Cardiology, 110(Supplement), 3A-14A. http://dx.doi.org/10.1016 /j.amjcard.2012.04.002
Posted by at

8 comments:

  1. The Kidney NurseMarch 5, 2015 at 4:58 PM

    I didn't know they started screening at the age of 2! Nice information.

    ReplyDelete
    Replies
    1. UnknownMarch 5, 2015 at 6:51 PM

      Hi Nikeyia,

      It is recommended to start screening at age 2 if high cholesterol is inherited to family members (it is called familial hypercholesterolemia). The U. S. National Library of Medicine indicates that the condition starts at birth and can cause heart attacks and heart disease in childhood. The American Academy of Pediatrics Pediatrics now recommend lipid screening once between age 9 and 11 and again between ages 17 to 21.

      References:
      Howard, T., & Grosel, J. (2015). Updated guidelines for lipid screening in children and adolescents. Journal of the American Academy of Physician Assistants, 28(3), 30-36. http://dx.doi.org/10.1097/01.JAA.0000460916.60015.88

      U. S. National Library of Medicine. (2015). Familial hypercholesterolemia. Retrieved from www.nlm.nih.gov/medlineplus/ency/article/000392.htm

      Delete
  2. Sean ChickeryMarch 9, 2015 at 5:58 PM

    Kiesha

    Excellent blog! I am a lab manager so I review many lipid panels over the course of a day. It is normal for me to see total cholesterols above 200 more than below 200 every day. Bass (2015) states the average cholesterol is 200 mg/dL. I just don't see that in my population. Do you see that as the average in your practice for patients that are not on a statin? Also, Bass indicates an acceptable cholesterol is less than 170 mg/dL. In the pediatric/adolescent patient population you are familiar with, is that a reasonable goal without the use of statins?

    Sean

    Reference
    Bass, P. (2015). Cholesterol, LDL, HDL, and triglycerides in children and adolescents. Retrieved from http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01593

    ReplyDelete
    Replies
    1. UnknownMarch 9, 2015 at 9:40 PM

      Hi Sean,

      Thank you for the compliment and taking the time to contribute to my blog. I cannot accurately gage an average total cholesterol value because my patient population is extremely diverse (infants to those over 80 years old). Regarding pediatric patients, the recommendation to screen patients starting between 9 and 11 and again between 17 and 20 by the American Academy of Pediatrics were just released (Howard and Grosel, 2015) and have not been widely implemented. Therefore, lipid panels are rarely done in pediatric/adolescent patients so I cannot intelligently answer your question of whether <170 mg/dL is reasonable or not. Treatment for adolescents is also limited. The article by Eiland and Luttrell (2010) indicates statins have only been FDA approved for children diagnosed with familial hypercholesterolemia and lifestyle changes with weight loss is the focus of treatment plans in pediatrics.

      Thank you,
      Kiesha

      Reference:
      Eiland, L. S., & Luttrell, P. K. (2010). Use of statins for dyslipidemia in the pediatric population. The Journal of Pediatric Pharmacology and Therapeutics: JPPT, 15(3), 160-172

      Howard, T., & Grosel, J. (2015). Updated guidelines for lipid screening in children and adolescents. Journal of the American Academy of Physician Assistants, 28(3), 30-36. http://dx.doi.org/10.1097/01.JAA.0000460916.60015.88

      Delete
  3. UnknownMarch 10, 2015 at 4:53 PM

    Good information, particularly because people are usually always concerned with having HBP. It is true that these two kind of go hand and hand, right? Glad to know that I already have foods that reduce cholesterol in my diet!

    ReplyDelete
    Replies
    1. UnknownMarch 10, 2015 at 10:42 PM

      Alishia,

      Thanks for your post. High blood pressure and cholesterol are definitely connected. The American Heart Association (AHA, 2014) recommends cholesterol medicine for adults with high LDL (bad cholesterol), diabetes, people with a higher risk of having a stroke or heart attack within 10 years, or someone with a history of a cardiovascular event, which includes heart attack, stroke, chest pains, or any heart procedures. AHA always suggests talking to your health care provider to determine your risk and necessity of cholesterol-lowering medication.

      Kiesha
      Reference:
      American Heart Association. (2014). Drug therapy for cholesterol. Retrieved from www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp

      Delete
  4. reprohealthMarch 13, 2015 at 10:34 PM

    Obesity, heart disease, and diabetes have grown to alarming numbers over the years. The increase in these conditions has been attributed to industrialization and technology. People now can go through a drive thru and get a prepared meal where years before people did not have cars and had to prepare meals at home. Many jobs are sedentary and therefore Americans get very little exercise. The food that Americans buy is processed and high in fat and calories, which, leads to chronic diseases and cause many health challenges. A study by Rahmati-Najarkolaei, Ghaffarpasand, Fesharaki, and Jonaidi-Jafari (2015) illustrated the pros and cons of nutrition and physical educational intervention in decreasing cardiovascular risk factors. The study showed a positive correlation on cardiovascular risk factors- blood cholesterol, systolic and diastolic blood pressure, as well as smoking cigarette in high when there was an intervention. This seems to be right in line with the suggested lifestyle changes in your blog: increase fiber, exercise, decrease junk food, and to take all prescribed medications.
    References
    Rahmati-Najarkolaei, F., Ghaffarpasand, E., Gholami Fesharaki, M., & Jonaidi-Jafari, N. (2015). Nutrition and Physical Activity Educational Intervention on CHD Risk Factors: A Systematic Review Study. Archives Of Iranian Medicine (AIM), 18(1), 51-57.

    ReplyDelete
    Replies
    1. UnknownMarch 14, 2015 at 8:46 PM

      Thank you for contributing to the discussion, all the reasons you listed above is why I was so eager to create this health blog. Kiesha

      Delete

Subscribe to: Post Comments (Atom)