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Senior Life: High Cholesterol

Senior Life: Tips for Healthy Living, Pharmacy

What is High Cholesterol and How is it Treated? 

High cholesterol affects approximately 38% of adults in the United States and has sometimes been referred to as the “silent killer” because there are no symptoms. High cholesterol can lead to heart disease, which is the number one cause of death in the US.

So, what is cholesterol, and why does it matter?

Cholesterol is a waxy substance produced by the liver and used in the body to build cell membranes and make things like vitamin D and hormones. Our bodies can also get cholesterol from foods such as meat, poultry, and dairy. These foods are also high in trans and saturated fats, which cause the liver to make even more cholesterol, leading to elevated levels. 

There are two main types of cholesterol: 

Low-density lipoprotein (LDL) – the “bad” cholesterol – LDL makes up much of the cholesterol in your body. When too much LDL is in the body, it forms “plaque” on the walls of the blood vessels and increases your risk of heart disease and stroke. This plaque narrows the insides of the blood vessels, which can reduce or even block the blood flow to and from the heart and other organs. When blood flow to the heart is blocked, it can cause chest pain or a heart attack. Ideally, you want your LDL to be less than 100, but if you have certain conditions, are at a high risk of having a heart attack or stroke, or have already had a heart attack or stroke, your doctor might want your LDL to be less than 70. 

High-density lipoprotein (HDL) – the “good” cholesterol – helps bring cholesterol to the liver so the body can remove it. High HDL levels can help lower your risk for heart disease and stroke. An HDL level greater than 50 in women and 40 in men is considered normal. 

Triglycerides – a type of fat found in the blood and used by the body for energy. Too much LDL and too many triglycerides can increase the heart attack or stroke risk. 

Prevention and Treatment:

Lifestyle modifications such as diet, exercise, weight loss, and quitting smoking are excellent ways to jumpstart your journey to lower cholesterol. These changes alone may not be enough to get your cholesterol to where it needs to be, and many patients will still need a cholesterol-lowering medication. If you have any questions or concerns about your cholesterol, talk to your doctor or pharmacist to find out what is best for you. 

Diet

- Eat heart-healthy foods that are low in saturated fat, trans fat, sodium, and added sugar

- Good choices include:

  • Fruits and vegetables
  • Whole grains and legumes
  • Low-fat dairy
  • Poultry
  • Fish/Seafood
  • Nuts
  • Oatmeal

- Limit sweets, sugar-sweetened beverages, and red meats

Maintain a healthy weight

- Talk to your doctor about calculating your body mass index (BMI) and discuss what a healthy weight is for you. 

- Find a diet and exercise program that works for you. Physical activity is a great way to help maintain a healthy weight and lower cholesterol levels.

- The CDC recommends 150 minutes of moderate to intense physical activity per week. 

  • “Moderate to intense exercise” can mean different things to different people but is generally classified as an activity that raises your heart rate by 50 to 60%. For some, this can include walking, biking, and swimming, while for others, it may be raking the yard, mopping the floors, gardening, or washing your car. 

Quit smoking – it’s never too late!

- Smoking can cause damage to blood vessels and can make the arteries harden faster. Quitting smoking will lower your risk for heart disease

- Talk to your doctor or pharmacist about different ways to help you quit

Limit your alcohol intake

- Consuming too much alcohol can increase your cholesterol levels

- Men should consume no more than two drinks per day

- Women should consume no more than one drink per day

Medications:

Many prescription medications can help lower your cholesterol, including HMG-CoA Reductase Inhibitors, or “statins". Statins are by far the most widely used cholesterol-lowering medications and include drugs like atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor). These medications work to lower cholesterol by reducing the amount of cholesterol the liver is making and helping the liver remove cholesterol that is already in the blood. The most common side effects of statins are headache and muscle pain. Muscle pain caused by statins can range from mild discomfort to pain severe enough to interfere with your daily activities. Talk to your doctor if you are experiencing muscle pain, tiredness, or weakness while taking a statin. They can help rule out if it might be medication related or caused by something else. Sometimes changing to another statin can help relieve these issues.  

Other commonly used medications to help lower cholesterol include Cholesterol Absorption Inhibitors, like Ezetimibe (Zetia); PCSK-9 Inhibitors such as Praluent (alirocumab) and Repatha (evolocumab); Bile Acid Sequestrants like cholestyramine (Questran), colesevelam (WelChol), and colestipol (Colestid); Fibrates/Fibric Acid such as gemfibrozil (Lopid) and fenofibrate (Tricor); and prescription Omega-3 Fatty Acids like Lovaza and Vascepa. 

Over-the-counter supplements, such as fish oil, are often a popular choice for patients who want to get control of their cholesterol; however, studies regarding certain medications often show that they may do more harm than good. Fish oil has good evidence supporting its ability to lower triglycerides; however, some forms can actually increase your bad cholesterol or LDL. There are other over-the-counter products that patients sometimes take, however, there is little data available to show if these drugs are effective.  With minimal FDA regulation they can be unsafe for patients and may also interact with many other medications. Talking to your pharmacist or doctor before starting any over-the-counter medications is always essential. 

-Kim Dykstra, Pharmacy Student

-Courtney Feist, PharmD

References

  1. American Heart Association. Control Your Cholesterol. www.heart.org. Published 2017. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol
  2. CDC. Preventing High Cholesterol. Centers for Disease Control and Prevention. Published April 5, 2018. https://www.cdc.gov/cholesterol/prevention.htm
  3. CDC. Types of cholesterol-lowering medicine. Centers for Disease Control and Prevention. Published April 5, 2018. 
  4. Fish Oil. In: Natural Medicines [database on the Internet]. Somerville (MA): Therapeutic Research Center; publication year [cited date]. Available from: https://naturalmedicines.therapeuticresearch.com. Subscription required to view.
  5. https://www.cdc.gov/cholesterol/treating_cholesterol.htm
  6. Lipid - Saturated fatty acids | Britannica. In: Encyclopædia Britannica. ; 2020. https://www.britannica.com/science/lipid/Saturated-fatty-acids
  7. Red Yeast Rice. In: Natural Medicines [database on the Internet]. Somerville (MA): Therapeutic Research Center; publication year [cited date]. Available from: https://naturalmedicines.therapeuticresearch.com. Subscription required to view.

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