If an individual has any two of the following risk factors, they’re going to be treated very seriously even if they don’t have any symptoms.
Risk Factors
- Male > 45 years old, female > 55 y/o
- Family history of CHD (coronary heart disease)
- Hypertension
- Low HDL-C (<40 mg/dl). There are no foods that could raise your HDL level. Exercise is the only way. That’s why you must raise your heart activity a minimum of three times a week to help raise that HDL.
- Smoking
Treatment Goals
The treatment involves lowering the LDL and the LDL target number depends on how many risk factors there are.
These are very aggressive targets, which is why drugs must usually be involved to get them there.
| Patient Category | LDL Target (mg/dl) |
|---|---|
| No CHD, <2 risk factors | <160mg/dl |
| No CHD, >2 risk factors | <130mg/dl |
| CHD | <100mg/dl |
Consequences
There are very serious consequences of not controlling this LDL level.
- Increased atherosclerosis
- Coronary Artery Disease
- Hypertension
- Stroke
- Peripheral vascular disease
Lipoproteins
For the scope of this series, we break down our lipoproteins into three categories.
1. Very Low Density Lipoproteins (VLDL)
VLDL’s are primarily associated with triglycerides. Medications can be used to lower triglycerides. Diet can also help: By lowering saturated fat intake. Palm Kernel oil and Coconut oil are very rich in these fats.
- Associated with triglycerides
- Decreases with lowering saturated fats in diet
2. Low Density Lipoproteins (LDL)
Diet by itself doesn’t do very much, the reason being that our body produces cholesterol. We need cholesterol because it’s the backbone for many other things our body needs such as the corticotropic hormones, the sex (male and female) hormones. Even some of our cell structure has cholesterol in it. For most of our bodies, our body produces much more cholesterol than we need. Lowering a persons cholesterol intake does not result in decreased LDL levels. Food labels are misleading because they may advertise that it has 0mg Cholesterol, but it may be rich in saturated fats, which is what you actually need to watch out for.
- Associated with cholesterol
- Does not decrease with lowering cholesterol
3. High Density Lipoprotein (HDL)
This is the protector. This is the good one. The only way to really raise the HDL level is by exercise. There are no other ways. Drugs barely do anything in regards to this.
- Protectant
- Increases with exercise
Drug Therapy
We’re going to split the drug therapy into two categories. Drugs are either going to increase elimination of lipoproteins or decrease production of lipoproteins.
Increase elimination
- Bile Sequestering Agents
- Colestipol
- Cholestyramine
Decrease production
- HMG CoA Reductase Inhibitors
- Fibric Acid Derivatives:
- Nicotinic Acid (Vitamin B3)
