What You Need to Know About Cholesterol

At UIC Pharmacy we want to keep you informed, being knowledgeable about cholesterol and it’s impact on our body is critical in order to promote optimum health outcomes. It is interesting to note that in 2005, 50% of Americans had total cholesterol levels that exceeded 200 mg/dL. With such an astonishingly high number, Americans need to be aware of the dangers of elevated cholesterol levels. For a normal, healthy adult, total cholesterol levels should be less than 200 mg/dL. Elevated levels of cholesterol are known to cause problems like stroke, myocardial infarction (heart attack), and can increase the risk of death.

Here are some facts about cholesterol:

•Cholesterol is one of the major lipids in the body.

•Cholesterol is essential for cell membrane composition and serves as a starting point for hormone synthesis.

•Keeping cholesterol under control may help to reduce the risk of heart attack or stroke that can result from hardening and narrowing of the blood vessels.

•The two major forms of cholesterol are LDL (Low Density Lipoprotein) and HDL (High Density Lipoprotein).  

•The main target for cholesterol management is focused on lowering LDL.  Other goals include reducing total cholesterol as well as increasing HDL.

How often should I get my cholesterol checked?

According to the National Cholesterol Education Program (NCEP), individuals that are 20 years or older should get their cholesterol levels checked at least once every 5 years. Generally, the target goals for cholesterol levels are:

• Total Cholesterol < 200 mg/dL

• LDL < 160 mg/dL*

• HDL > 60 mg/dL

• Triglycerides < 150 mg/dL

*Additionally, if there are other risk factors such as diabetes or heart disease, the LDL goal can be as low as 100 mg/dL and for some, less than 70 mg/dL.

Can I test my cholesterol from home?

While it is advisable to see a licensed health practitioner, home cholesterol test kits are available to patients. CholesTrak and Cardiochek ST are two products that can assist in home cholesterol monitoring. Be sure to follow-up with your doctor to review these results.  

What about Lifestyle Modifications?

Lifestyle modifications are a great way to help improve cholesterol levels. Some examples of lifestyle modifications include:

 • Smoking cessation

•  Weight loss

•  Dietary improvements

 • Exercising with moderate intensity at least 30 minutes per day

For smokers, many products are available to help kick the habit. Over the counter products that contain nicotine are available in a variety of forms such as gums, patches, and lozenges. These products work by releasing nicotine into the body to assist with withdrawal symptoms associated with quitting smoking. Additionally, the prescription products Chantix and Zyban may be beneficial for some patients.

Diet and exercise can be very important steps in taking control of cholesterol. The American Heart Association recommends dietary interventions to help lower cholesterol levels such as increasing your daily intake of fruits and vegetables, drinking skim milk or 1% dairy products, and eating lean meat and poultry. In addition, the therapeutic lifestyle change diet has even more specific recommendations, which include:

Total fat being 25-35% of total calories

Saturated fat being less than 7% of total calories

Carbohydrates being 50-60% of total calories

Cholesterol intake of less than 200 mg per day

Dietary fiber intake of 20-30 grams per day

 What Treatments are Available?

While the first step in managing elevated cholesterol is to promote changing diet and exercise habits, drug options are also available for when cholesterol is still not controlled. These drugs may work to lower LDL, raise HDL, or a combination of the two. For instance, a drug class referred to as the statins work to decrease LDL; examples include atorvastatin (Lipitor) and simvastatin (Zocor).

An additional drug that focuses solely on decreasing LDL is ezetimibe (Zetia). Ezetimibe prevents the absorption of cholesterol in the gut. Other classes of drugs include the bile acid sequestrants (e.g., cholestyramine, colestipol, colesevelam); niacin; and fibric acid derivatives (e.g., fenofibrate, gemfibrozil).

Summary

First line therapy is to promote lifestyle changes to patients. If after lifestyle changes have been promoted and cholesterol levels are still not under control, pharmacologic therapy is recommended with statins usually being the drug of choice to help in decreasing LDL levels. Ultimately, it is up to the patient to combine a healthy lifestyle with drug therapy in order to reach optimum cholesterol levels.

Written by:

Naeil Elhaj, Pharm.D. candidate, Class of 2013

UIC College of Pharmacy