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DOING THE LDL LIMBO

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  1. DOING THE LDL LIMBO How Low Do YOU Need to Go Dr. Richard Sargent

  2. 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

  3. You’re not gonna live forever • AARP • Independently • In your own home • without being a burden to others • as long as you can

  4. 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

  5. LEADING CAUSES OF DEATH

  6. RISK FACTORS • Family History • Tobacco • Blood Pressure • Obesity • Diabetes • Cholesterol • Physical Activity • Diet

  7. CHOLESTEROL GOALSIt is not just one number

  8. “Lifestyle Modifications” • Swallow Pills • You Don’t get a Pass • Diet • Exercise • Stress reduction • Inflammation reduction

  9. DIET It’s Fat TuesdayDietary Fat Sources • Choose your fats • decrease your intake • mostly plants • Slow Food

  10. Diet: Choose your ‘butter’

  11. DIET • All Things in Moderation • Mostly Plants- Fruits and Vegetables • Starch or Carbohydrate- Reduce • Red Meat has high saturated fat content

  12. EXERCISEHit the Road, Jack!

  13. 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

  14. INFLAMMATION • Tobacco • Air Pollution • Second Hand Smoke • Infections • Endothelial Cell Death • Oxidized LDL Chol • Vasospasm • Blood Pressure • Clotting

  15. 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.

  16. 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

  17. CHOLESTEROL DEFINITIONS • Total Cholesterol <200 • Triglycerides <160 • LDL (Lethal cholesterol) • moving target • HDL (Healthy Cholesterol) • >40 men > 50 women

  18. 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

  19. 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

  20. 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

  21. Statin Side Effects • Impaired thinking • Co-enzyme Q10 100 mg/d • Muscle pain, breakdown • Joint Pain • Liver toxicity • Cough

  22. 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

  23. Heart Disease and/or Stroke • What we are trying to avoid • Inflammation • High Blood Pressure • Plaque Rupture • Clot

  24. Heart Attacks and Cholesterol • Most do not have severe stenosis • one third do not have warning signs • Symptoms are the tip of the iceberg

  25. Heart Attack Mechanism • Vasospasm • LDL Oxidation • Platelet Activation • Plaque Rupture • Clot Propagation

  26. 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

  27. The LDL LimboHow Low is Too Low? • Newborns have a level of 30-40 • If LDL < 40 in adults increased suicide

  28. 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%

  29. QUESTIONS ?

  30. THANK YOU • MOST PEOPLE WANT TO: • Live Independently • In Your Own Home • Without Being a Burden to Others • As Long as You Can