Hyperlipidemia

Cholesterol is a major component of plaque in arteries.

Lowering cholesterol decreases its accumulation in arteries and will decrease the amount of plaque and frequency of heart attacks.

Most plaques are asymptomatic before a heart attack – even when the vessel is > 50% occluded.

Cholesterol is divided into types: the “bad” cholesterol (LDL, VLDL or triglyceride, IDL) and the “good” cholesterol (HDL). Having a high LDL is bad, but it is much worse if you also have low HDL and high VLDL (triglyceride). Lowest mortality is associated with total cholesterol that is 100 plus your age.

Treatment

Dietary changes, exercise, niacin, and red wine increase HDL. Diet and exercise decrease the occlusion of vessels in < 2 years and stabilize the plaques sooner.

1.)  Diet

  • To lower cholesterol substantially often requires great dietary modification: 30% or less calories from total fat, less than 7% of calories from saturated fat, and less than 200 mg cholesterol.  This often requires counseling by a dietician or nutritionist.
  • Dietary therapy is more effective in patients with high cholesterol, or in those whose diet is high in cholesterol and saturated fats.
  • The failure to reach a defined target value for the reduction of cholesterol does not mean that a diet should be abandoned; any measurable reduction can be expected to lower the risk of CAD (coronary artery disease) appreciably, and the adoption of a healthier lifestyle, which often accompanies dietary modification, can have added health benefits that go beyond the reduction of cardiovascular risk.
  • Choose monounsaturated oils as the major source of dietary fat (e.g., olive oil).
  • Avoid hydrogenated vegetable oils (margarine and vegetable shortening).
  • Avoid deep-frying and minimize heating of fats. When fats are heated, free radicals (unstable molecules) are produced, and they turn rancid.  This is concentrated when oil is reused for frying.
  • Choose vegetables as a source of protein rather than animal products.
  • Avoid caffeine.
  • Choose complex carbohydrates (vegetables, beans, etc.) as opposed to refined sugars.
  • Also of benefit is increasing daily intake of soluble fiber; an intake of 30 grams of soluble fiber is recommended. Insoluble fiber has little effect on serum cholesterol. Some examples of soluble fiber include oat bran, beans, fruit, psyllium and vegetables.
  • Fiber supplements can be used as an adjunct to a high fiber diet; e.g., psyllium and pectin.
  • As fiber intake is increased, gas production may increase; this may improve over time. Also, severe constipation may result if water intake is inadequate. It is best to gradually increase fiber intake by 5 grams per week.

2.) Exercise

  • A minimum of 30-60 minutes of moderate-intensity activity three to four times weekly (e.g., walking, jogging, cycling, or other aerobic activity), supplemented by an increase in daily lifestyle activities (e.g., walking breaks at work, using stairs, gardening, household work).  Maximum benefit is achieved with 5-6 hours’ activity per week.

3.) Antioxidants

  • Vitamin E. When the plaque becomes oxidated it becomes inflamed, attracting more macrophages (large white blood cells that ingest foreign particles) which deposit cholesterol.

4.) Drug therapy

  • Niacin decreases VLDL synthesis and secretion from the liver.  As a result, triglyceride and LDL concentrations decrease.  Niacin also stimulates the secretion of HDL.  Doses of 1.2 grams/day or greater (up to 12 in some studies) are usually effective.  Niacinol has fewer adverse effects.
    • Adverse Effects: flushing (reduce with aspirin), itching, dry skin, nausea, vomiting, diarrhea.  Start low and work up.  For example, begin with 25-100 mg three times a day with or after meals, and increase gradually over 6-8 weeks to 1.5-3 grams per day divided into 3-4 doses with or after meals.
    • Other reactions: activation of peptic ulcer disease, impaired glucose intolerance, increased uric acid, liver dysfunction (all usually reversible).
    • Liver function tests should be performed periodically.
  • Folic acid, B6, B12, vitamin C, vitamin E, vitamin A, chromium, magnesium, selenium, zinc, CoQ10, and pantothenic acid may also help to lower cholesterol.
  • Statin prescription drugs. Always take CoQ10 in the form of ubiquinol if you are going to take statins.

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