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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

DOING THE LDL LIMBO

How Low Do YOU Need to Go

Dr. Richard Sargent

mike copass
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
You’re not gonna live forever
  • AARP
  • Independently
  • In your own home
  • without being a burden to others
  • as long as you can
7 secrets to long life
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
risk factors
RISK FACTORS
  • Family History
  • Tobacco
  • Blood Pressure
  • Obesity
  • Diabetes
  • Cholesterol
  • Physical Activity
  • Diet
lifestyle modifications
“Lifestyle Modifications”
  • Swallow Pills
  • You Don’t get a Pass
  • Diet
  • Exercise
  • Stress reduction
  • Inflammation reduction
diet it s fat tuesday dietary fat sources
DIET It’s Fat TuesdayDietary Fat Sources
  • Choose your fats
  • decrease your intake
  • mostly plants
  • Slow Food
slide11
DIET
  • All Things in Moderation
  • Mostly Plants- Fruits and Vegetables
  • Starch or Carbohydrate- Reduce
  • Red Meat has high saturated fat content
physical activity another moving target
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
inflammation
INFLAMMATION
  • Tobacco
  • Air Pollution
  • Second Hand Smoke
  • Infections
  • Endothelial Cell Death
  • Oxidized LDL Chol
  • Vasospasm
  • Blood Pressure
  • Clotting
stress reduction
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.
heart attack prevention
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
cholesterol definitions
CHOLESTEROL DEFINITIONS
  • Total Cholesterol <200
  • Triglycerides <160
  • LDL (Lethal cholesterol)
    • moving target
  • HDL (Healthy Cholesterol)
    • >40 men > 50 women
vitamins
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
supplements
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
prescription drugs
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
statin side effects
Statin Side Effects
  • Impaired thinking
  • Co-enzyme Q10 100 mg/d
  • Muscle pain, breakdown
  • Joint Pain
  • Liver toxicity
  • Cough
others
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
heart disease and or stroke
Heart Disease and/or Stroke
  • What we are trying to avoid
  • Inflammation
  • High Blood Pressure
  • Plaque Rupture
  • Clot
heart attacks and cholesterol
Heart Attacks and Cholesterol
  • Most do not have severe stenosis
  • one third do not have warning signs
  • Symptoms are the tip of the iceberg
heart attack mechanism
Heart Attack Mechanism
  • Vasospasm
  • LDL Oxidation
  • Platelet Activation
  • Plaque Rupture
  • Clot Propagation
avoid a heart attack
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
the ldl limbo how low is too low
The LDL LimboHow Low is Too Low?
  • Newborns have a level of 30-40
  • If LDL < 40 in adults increased suicide
american heart assoc
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%
thank you
THANK YOU
  • MOST PEOPLE WANT TO:
  • Live Independently
  • In Your Own Home
  • Without Being a Burden to Others
  • As Long as You Can