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DOING THE LDL LIMBO How Low Do YOU Need to Go Dr. Richard Sargent Mike Copass The person next to you Not everyone needs pills Pills are not a license to sit and eat Trying to find a moving target You’re not gonna live forever AARP Independently In your own home

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Doing the ldl limbo l.jpg

DOING THE LDL LIMBO

How Low Do YOU Need to Go

Dr. Richard Sargent


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Mike Copass

  • The person next to you

  • Not everyone needs pills

  • Pills are not a license to sit and eat

  • Trying to find a moving target


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You’re not gonna live forever

  • AARP

  • Independently

  • In your own home

  • without being a burden to others

  • as long as you can


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7 ‘SECRETS’ TO LONG LIFE

  • Avoid tobacco

  • Buckle Up

  • Exercise

  • Diet to lower cholesterol

  • Brush and Floss your teeth

  • Limit alcohol

  • 800-1000 IU Vitamin D daily



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RISK FACTORS

  • Family History

  • Tobacco

  • Blood Pressure

  • Obesity

  • Diabetes

  • Cholesterol

  • Physical Activity

  • Diet


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CHOLESTEROL GOALSIt is not just one number


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“Lifestyle Modifications”

  • Swallow Pills

  • You Don’t get a Pass

  • Diet

  • Exercise

  • Stress reduction

  • Inflammation reduction


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DIET It’s Fat TuesdayDietary Fat Sources

  • Choose your fats

  • decrease your intake

  • mostly plants

  • Slow Food



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DIET

  • All Things in Moderation

  • Mostly Plants- Fruits and Vegetables

  • Starch or Carbohydrate- Reduce

  • Red Meat has high saturated fat content


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EXERCISEHit the Road, Jack!


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PHYSICAL ACTIVITYAnother ‘Moving’ Target

  • Thirty Minutes 5 or 7 days a week

  • Increase daily lifestyle activity

    • breaks, parking away, active playing

    • turn off the TV

  • Resistance Training two days per week

  • Supervised Programs for High Risk Patients


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INFLAMMATION

  • Tobacco

  • Air Pollution

  • Second Hand Smoke

  • Infections

  • Endothelial Cell Death

  • Oxidized LDL Chol

  • Vasospasm

  • Blood Pressure

  • Clotting


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Stress Reduction

  • Serum Cortisol and blood sugar

  • Serum Cortisol and serum lipids.

  • Serum Cortisol and fat deposition

  • Having a confidante most important

    • spouse, friend, family member

    • Must be able to confide in them.

    • Tough guys hold it in and die.


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Heart Attack Prevention

  • Still depends on Risk Factors

  • Most information for Highest Risk Patients

  • Antiplatelet drugs

    • Aspirin, Plavix, Aggrenox

  • Blood Pressure meds

    • Beta Blockers, ACE Inhibitors (?ARBs)

  • Long Acting Nitrates

  • Cholesterol Lowering Drugs-----Later


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CHOLESTEROL DEFINITIONS

  • Total Cholesterol <200

  • Triglycerides <160

  • LDL (Lethal cholesterol)

    • moving target

  • HDL (Healthy Cholesterol)

    • >40 men > 50 women


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Vitamin E- Deleterious

Vitamin C- No effect

Garlic- No major Role

Soy Protein and Fiber

Both Replace High Fat foods

Plant Sterols / Stanols

lowers TC and LDL

Fish Oil Capsules

Triglycerides and DM 2

Vitamin D

Blood Pressure, Inflammation, CHF

VITAMINS


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SUPPLEMENTS

  • Niacin

    • Slow Release 500-2000 mg daily

    • Flushing Reactions

    • Aspirin

  • Co-Enzyme Q-10 100 mg daily

    • Reduces Statin Side Effects

  • Tart Cherry Pills and Flax Seed

    • Michigan State U.

    • Maybe Plant Sterols


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Prescription DRUGS

  • Statins

    • Pravastatin- more water soluble

    • when others aren’t tolerated

    • Lovastatin- Generic, cheap,

    • Simvastatin, Atorvastatin, Rosuvastatin

      • Simvastatin generic

      • Heavily advertised

      • Hard to tell if one is better


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Statin Side Effects

  • Impaired thinking

  • Co-enzyme Q10 100 mg/d

  • Muscle pain, breakdown

  • Joint Pain

  • Liver toxicity

  • Cough


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OTHERS

  • Fibrates-

    • Generally used for high triglycerides or second line

    • increased non-cardiovascular mortality

    • Similar side effects as Statins but not predictable

    • increased Homocysteine (inflammation, clotting)

  • Zetia

    • it is not a fibrate or a statin

    • anti-inflammatory


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Heart Disease and/or Stroke

  • What we are trying to avoid

  • Inflammation

  • High Blood Pressure

  • Plaque Rupture

  • Clot


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Heart Attacks and Cholesterol

  • Most do not have severe stenosis

  • one third do not have warning signs

  • Symptoms are the tip of the iceberg


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Heart Attack Mechanism

  • Vasospasm

  • LDL Oxidation

  • Platelet Activation

  • Plaque Rupture

  • Clot Propagation


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Diet

Exercise

Inflammation

Tobacco

Air Pollution/SHS

Aspirin

Antiplatelet Drugs

Statins

Blood Pressure

Diabetes

Aspirin

anti-inflammatory

Vitamin D

Niacin

Co-enzyme Q10

Plant sterols

Statins

fibrates?

Zetia.

AVOID A HEART ATTACK


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The LDL LimboHow Low is Too Low?

  • Newborns have a level of 30-40

  • If LDL < 40 in adults increased suicide


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AMERICAN HEART ASSOC.

  • Cholesterol or Heart Attack Risk Calculator

  • http://americanheart.org/presenter.jhtml?identifier=3003499

  • 50 yo male, Sedentary, BMI 29, bp 130/80, TC 254, LDL 180, HDL 43, TGs 167

  • Ten Year Risk 10%

  • Change any Factor and Risk drops to 6%

  • Change ALL and Risk Drops to <2%



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THANK YOU

  • MOST PEOPLE WANT TO:

  • Live Independently

  • In Your Own Home

  • Without Being a Burden to Others

  • As Long as You Can


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