What is Cholesterol?

The term “cholesterol” has earned a bad reputation among the general public. It is commonly associated with issues like heart disease and high blood pressure. But what most people may not realize is that like all things in life, cholesterol can be both good and bad. Cholesterol is a fat that exists in abundance in the human body. Besides being an essential structural component for our cells, it is also required in the synthesis of hormones and other substances. Without it, we would not be able to effectively absorb the vitamins and nutrients from our food.Medical complications can arise when there is too much cholesterol. Lipids (fats), such as cholesterol and triglycerides are not soluble in our bloodstream. As a result, excessive amounts of lipids can actually clog the bloodstream and increase the risk of heart complications.Triglycerides are molecules that serve as a source of energy as well as fat storage. It is made up of two main components: fatty acids and glycerol. Fatty acids become a source of energy when our body lacks glucose from carbohydrates. Additionally, when triglycerides are not being used as fuel for energy, they are stored as fat in adipose tissues for later use. (Hall, 2016).Low-density lipoproteins (LDL) are made up of cholesterol ester, triglycerides, and a type of protein called apo B-100. LDL is also known as “bad cholesterol”, which we don’t want to increase. As mentioned earlier, excessive amounts of LDL can build up in our arteries and create plaques. These plaques can increase the risk of coronary arterial diseases like heart attacks and strokes.On the other hand, high-density lipoproteins (HDL) transports excess cholesterol to the liver, where it is metabolized and excreted. HDL is better known as “good cholesterol”, which cleans up bad fat.Ideally, the total amount of triglycerides and LDL in your body should be low to lessen your risk for cardiovascular complications. In turn, your HDL should be high. An easy way to differentiate the two is to focus on the following phrase: Low-density lipoproteins (LDL) should be low, and high-density lipoproteins should be high.

Chronic Disease Management

One of the services of Direct Primary Care is that we take care of your chronic diseases. This includes diabetes, high blood pressure, asthma, eart disease, high cholesterol, and much, much more. 

The Problem: What is Dyslipidemia? 

Dyslipedemia refers to an abnormal level of LDL, HDL and triglycerides. The normal values for each of these lipid components are as follows.

• Triglycerides: <150mg/dL
• Total cholesterol: <200mg/dL
• LDL: <100mg/dL
• HDL: >40-50mg/dL

In the early stages of Dyslipidemia, there are no specific signs or symptoms. As a result, people who suffer from it are often unaware it’s even an issue. Those that suffer from dyslipidemia often discover it’s existence from blood tests conducted by their primary care provider.Left untreated, Dyslipidemia can lead to severe conditions such as peripheral artery disease and coronary artery disease. These outcomes can be debilitating and possibly even fatal. While dyslipidemia itself is asymptomatic, signs and symptoms associated with its complications include the following:

• Chest pain 
• Vomiting and nausea
• Pain around the shoulders and arms
• Shortness of breath
• Cold sweats
• Fatigue and dizziness
• Sudden weakness of one side of the body
• Sudden difficulty in speaking
• Facial asymmetry

Heart attacks and strokes are considered as emergencies. If you think you may be having a heart attack or stroke, call 911 or go to the emergency room as soon as possible so that appropriate treatment can be administered.

The Solution: Management of Dyslipedemia

Dyslipidemia is a common disorder; hence, there are many specialists that can provide treatment for it. Care can be given by a general practitioner, a family medicine physician, an internist or cardiologist. The 2018 Clinical Practice Guidelines for Dyslipidemia states that the best way to manage dyslipidemia is with a combination of lifestyle changes and maintenance medication. 

3 Best Cholesterol Management Interventions

The best thing about lifestyle changes is that you can start at any point in your life. As with most things, the younger you start, the better off you’ll be later on. If you immediately commit to lifestyle changes after becoming aware of slightly impaired lipid levels, you will see much quicker results and may not even require medication.Some of these lifestyle changes include making vegetables, fruits, legumes and whole grains a priority. Sources of protein should come from lean meats, fish and nuts. Also artificially sweetened drinks and sugary foods. Your total caloric intake depends on your daily needs. As long as it promotes healthy weight and lessens the risk of becoming obese, it can help to reduce the risk of dyslipidemia.On top of managing your diet, regular physical activity should also be a part of these lifestyle changes. Make sure you get at least 40 minutes of moderate-to-vigorous aerobic exercise at least 3-4 times a week.

1. Statins

Statins are a class of medication that inhibit the enzyme HMG-CoA reductase, which is required for cholesterol synthesis. As a result, statins indirectly lessen cholesterol formation, lowers LDL and modestly increases HDL. Triglycerides have also been shown to decrease by up to 40% after statin intake. You may be familiar with some of its generic names such as simvastatin, atorvastatin and rosuvastatin. Rosuvastatin in particular can increase HDL levels by a significant amount (Rosenson, 2019). Current guidelines indicate that people who are ≥ 21 years old and possess LDL levels ≥ 190 mg/dL should undergo high-intensity statin therapy. Comparatively, people between 40-75 years old with LDL levels between 70 to 189 mg/dL require moderate-to-high-intensity statin treatment (Grundy et al, 2019).Statin therapy can also protect people from the complications of dyslipidemia. Studies show that outcomes were greater in stroke patients that underwent statin therapy, as compared to those who did not (Martínez-Sánchez et. al., 2009). In one animal study, researchers concluded that simvastatin can act as a protective agent for myocardial infarction, by reducing the size of the injury (Tavackoli et. al., 2004).In small percentages of people that undergo statin therapy, side effects include diarrhea, nasopharyngitis and myalgia. It can also cause muscle spasms and musculoskeletal pain. Additionally, some statins like simvastatin carry contraindications – it should not be used on patients that are pregnant or have acute liver disease. 

2. Niacin

Statins are a class of medication that inhibit the enzyme HMG-CoA reductase, which is required for cholesterol synthesis. As a result, statins indirectly lessen cholesterol formation, lowers LDL and modestly increases HDL. Triglycerides have also been shown to decrease by up to 40% after statin intake. You may be familiar with some of its generic names such as simvastatin, atorvastatin and rosuvastatin. Rosuvastatin in particular can increase HDL levels by a significant amount (Rosenson, 2019). Current guidelines indicate that people who are ≥ 21 years old and possess LDL levels ≥ 190 mg/dL should undergo high-intensity statin therapy. Comparatively, people between 40-75 years old with LDL levels between 70 to 189 mg/dL require moderate-to-high-intensity statin treatment (Grundy et al, 2019).Statin therapy can also protect people from the complications of dyslipidemia. Studies show that outcomes were greater in stroke patients that underwent statin therapy, as compared to those who did not (Martínez-Sánchez et. al., 2009). In one animal study, researchers concluded that simvastatin can act as a protective agent for myocardial infarction, by reducing the size of the injury (Tavackoli et. al., 2004).In small percentages of people that undergo statin therapy, side effects include diarrhea, nasopharyngitis and myalgia. It can also cause muscle spasms and musculoskeletal pain. Additionally, some statins like simvastatin carry contraindications – it should not be used on patients that are pregnant or have acute liver disease. 

3. Fish Oil

Another non-statin therapy that is considered beneficial for dyslipidemia is fish oil. It is derived from long chain omega-3 fatty acids that are extracted from the tissues of oily fish. From a medical standpoint, this type of oil is considered “good” for the body.Fish oil has many clinical uses. It is used in psychiatry as an adjunct treatment for bipolar disorder, and in adjunct therapy for hypertension and arthritis. In treating dyslipidemia, 2-4g of fish oil should be ingested on a daily basis. The EPA+DHA amounts should be added up. For example, if the EPA+DHA in a capsule of fish oil adds up to 880mg. You would want to take 4-5capsules per day. High-concentration fish oil is often preferred in these circumstances.Fish oil is able to decrease triglyceride levels by up to 50% after only a month of treatment. This is possible by decreasing the production of very low density lipoproteins (LDL) in the liver. Triglycerides are often found in abundance if the liver contains a lot of fatty acids. Fish oil has a positive effect by reducing the delivery of these fatty acids to the liver, which in turn reduces triglyceride levels. On a cellular level, fish oil has also been shown to increase the activity of pathways responsible for reducing blood triglyceride levels (Shearer, Savinova & Harris, 2012). Fish oil is often used in conjunction with statins. In some patients, LDL levels decrease, HDL levels increase, but triglycerides remain elevated. This is a problem as elevated triglyceride levels are known to be associated with cardiovascular complications like heart attack and stroke. Thus, by adding fish oil on top of undergoing therapy, patient’s can improve their triglyceride levels and reduce these risks (Preston Mason, 2019). EPA is particularly known to lower triglycerides and is the primary ingredient in the pharmaceutical Vascepa.Cholesterol is a fat that is essential for bodily functions. The issue is that many people take in more bad than good cholesterol, leading to health complications such as dyslipidemia. Additionally, dyslipidemia does not display any symptoms or signs in its early stages, making it difficult to diagnose. By undergoing routine blood tests, you can discover the early stages of dyslipidemia and take immediate steps to improve the situation.

Well Life ABQ  provides Chronic Disease Management and more!

At Well Life ABQ, our team of clinicians offer screening, counseling and management to help with cholesterol related complications. We treat our patients like family, and unlike other medical clinics, we never rush an appointment. Our focus is on providing our patient’s with a quality medical experience, because we understand that’s the first step towards achieving a solution. If you’re looking for a clinic that will provide you with the care and time you need, get in touch with us today!