If you have had a stroke, heart attack, heart bypass surgery, a stent placed in one of your heart’s arteries or have diabetes, you are classified as Category I, and at the highest risk for cardiovascular disease. In this case, you should have your cholesterol level checked at least once yearly and your low density lipoprotein (LDL) goal is less than 100 mg/dL.
Even if your LDL is below 100, you should follow the Therapeutic Lifestyle Change (TLC) diet on your own to keep your LDL as low as possible. If your LDL is 100 or above, the recommendation is that you begin the TLC diet. If your LDL is 100 to 129, drug treatment may be considered for you in conjunction with the TLC diet. If your LDL is 130 or higher, drug treatment is commonly recommended with the TLC diet.
Your LDL level should be measured at least once a year to make sure it is in the range that will decrease your chances of having a heart attack or stroke.
Lowering Cholesterol with Therapeutic Lifestyle Changes (TLC)
TLC is a set of things you can do to help lower your LDL cholesterol. The main parts of TLC are:
The TLC Diet - This is a low saturated fat, low cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines and salad dressings) can also be added to the TLC diet to boost its LDL-lowering power.
Weight Management - If you are overweight, losing weight can help lower LDL and is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (40 inches or more for men and 35 or more inches for women).
Physical Activity - Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of drugs available for cholesterol lowering including statins, ezetimibes, bile acid resins, nicotinic acids and fibrates. The statin drugs are very effective in lowering LDL levels and are safe for most people. Ezetimibes and bile acid resins also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid (niacin) lowers LDL and triglycerides and raises HDL. Fibric acids (fibrates) lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Your doctor can help decide which type of drug is best for you.
Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking and possibly taking medication.
The key is to stick with the TLC program so you may reduce or reverse your risk for cardiovascular disease and diabetes.
For additional information:
Discuss with your physician.
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Adapted from: National Heart, Lung and Blood Institute