Cholesterol Measurement All adults should have their blood cholesterol measured every 5 years May be in non-fasting state Fasting preferred

I have some bad news for you. While your cholesterol has remained the same, the research findings have changed.

ATP III Classification of Total Cholesterol Total Cholesterol (TC) < 200Desirable Borderline High > 240High All levels are measured fasting

ATP III Classification of LDL LDL Cholesterol (LDL-C) < 100Optimal Near optimal/above optimal Borderline high High > 190Very high

ATP III Classification of HDL and Triglyceride HDL Cholesterol (HDL-C) < 40Low (undesirable) > 60High (protective) Triglyceride (TG) < 150Desirable Borderline High High > 500Very High

Ratio Total Chol/HDL RiskMenWomen Very low (1/2 average)<3.4<3.3 Low risk Average risk Moderate risk (2x average) High risk (3x risk)>23>11 Total/HDL – Over 5.0 = elevated risk

Cholesterol Screening: Recommendations

Risk Factors That Influence LDL Diabetes (a CHD risk equivalent – as much risk as MI) Cigarette smoking Hypertension BP >140/90 mmHg or on antihypertensive meds Low HDL cholesterol <40 mg/dL Family history of premature CHD CHD in male first degree relative < 55 years old CHD in female first degree relative <65 yrs old Age men > 45 years; women > 55 years HDL > 60 is a “negative” risk factor (remove one risk factor from count)

Recommend a Lipoprotein Analysis (Breakdown) When person has history of MI, angina, TIA’s Within 1 year if TC is with < two CHD risk factors Within 2 months if TC is with > two risk factors If HDL is below 40 mg/dL

Therapeutic Lifestyle Changes (TLC) Total fat < 30% Saturated fat < 7% Cholesterol < 200 mg/dL Fiber20-30 gms/day Sodium1500 mg/day Caloriesenough to achieve ideal weight Alcoholmoderation

What are the medications for elevated cholesterol? Lipid-lowering meds lower LDL, raise HDL, and lower triglycerides (with side effects) –HMG-CoA reductase inhibitors (statins) –Bile acid sequestrants –Niacin – nicotinic acid – Raises HDL but no greater protection than statins –Fibrates Antihypertensive Med

CHD/Cholesterol Medications (cont) Anticoagulant –Coumadin –Aspirin – (considered primary prevention) Estrogen Replacement Therapy Antianginal –Nitrates –Beta Blockers –Calcium Channel Blockers