Top 3 Ways to Manage Your Cholesterol Levels

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 lipid (a fat like substance) 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 lead to plaque build-up, increasing the risk of heart complications and strokes. Triglycerides are molecules that serve as a source of energy as well as fat storage. They are 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 lipoprotein (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 remember how to balance these 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, heart disease, high cholesterol, and much, much more. 

The Problem: What is Dyslipidemia? 

Dyslipidemia 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. It is recommended to screen for dyslipidemia through a standard lab test. 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

The Solution: Management of Dyslipidemia

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. On top of managing your diet, regular physical activity should also be a part of a healthy lifestyle. 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 significantly better 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

Niacin, also known as vitamin B3, is used to improve cholesterol profiles by altering how the body handles fats. On a cellular level, niacin works by inhibiting a specific hormone-sensitive enzyme in adipose (fat) tissue, which reduces the breakdown of stored fats into free fatty acids. Because fewer fatty acids are delivered to the liver, the liver produces less very-low-density lipoprotein (VLDL), subsequently leading to a decrease in low-density lipoprotein (LDL, or "bad" cholesterol) and triglycerides. Additionally, niacin blocks the clearance of apolipoprotein in the liver, effectively boosting the levels and lifespan of high-density lipoprotein (HDL, or "good" cholesterol) circulating in the bloodstream.

3. Fish Oil

Another highly beneficial non-statin therapy for dyslipidemia is fish oil, which is derived from the long-chain omega-3 fatty acids extracted from the tissues of oily fish.

To effectively treat dyslipidemia, a daily therapeutic dose of 2 to 4 grams of pure EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) is typically required. Because standard supplements contain fillers, patients must add up the specific EPA and DHA milligrams listed on the back label to ensure accuracy. For example, if a high-concentration fish oil capsule contains 880 mg of combined EPA/DHA, a patient would need to take 4 to 5 capsules per day. For this reason, prescription-strength or high-concentration fish oils are generally preferred to minimize the pill burden.

Fish oil is frequently used in conjunction with statins. In many patients undergoing statin therapy, LDL levels successfully decrease and HDL levels improve, yet their triglycerides remain dangerously elevated. This is a significant clinical concern, as high triglycerides are independently linked to severe cardiovascular complications like heart attacks and strokes. By adding high-concentration fish oil to a statin regimen, patients can safely normalize their triglyceride levels and significantly reduce their overall cardiovascular risk. Purified EPA is particularly effective at targeting these fats and serves as the primary active ingredient in the prescription medication Vascepa.

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 patients 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!

References

Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., ... & Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(24), e285-e350.

Hall, J. E. (2016). Guyton and Hall textbook of medical physiology (13th ed.). Elsevier.

Martínez-Sánchez, P., Fuentes, B., & Diez-Tejedor, E. (2010). High doses of statins and stroke outcome. Stroke, 41(3), e157–e158.

Rosenson, R. S. (2019). Statins: Actions, side effects, and administration. UpToDate. Waltham, MA.

Tavackoli, S., Ashitkov, T., Hu, Z. Y., Motamedi, M., Uretsky, B. F., & Birnbaum, Y. (2004). Simvastatin-induced myocardial protection against ischemia–reperfusion injury is mediated by activation of ATP-sensitive K+ channels. Coronary Artery Disease, 15(1), 53–58.