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Cholesterol Care

Posted on June 1, 2022 | No Comments on Cholesterol Care

What comes to your mind when you hear the word cholesterol? For most of us, almost intuitively, we think of something bad for the health. But did you know that cholesterol per se is an essential part of the human body? It is very important especially in the immune system, where it serves to protect us from foreign bodies, such as viruses and bacteria, by means of substances that are derived from it. So, if the levels are within normal limits, cholesterol is not bad.

Cholesterol becomes dangerous to health when its composition and levels become abnormal. In medical terms, this is called dyslipidemia. But there are several kinds of dyslipidemia, depending on which is high or low. The most common form is elevated levels of the bad cholesterol or low-density lipoprotein cholesterol (LDL-C).

Among Filipinos, the latest National and Nutrition and Health Survey showed that another common abnormality is low levels of the good cholesterol or high-density lipoprotein cholesterol (HDL-C).

The way to treat abnormal cholesterol levels in men and women are the same. What differs is the assessment of the risk of developing coronary heart disease (CHD) using several parameters. This is also called the global CHD risk. This calculated risk, in turn, dictates the level of blood cholesterol that should be targeted.

Women are assessed quite differently from men when looking at the identified risk factors. Age is the first factor considered. The cut-off age for men is 45 years and older while it is 55 years and older for women. CHD rates are higher in the elderly than in the young and in men than in women of the same age. Another significant risk factor is the presence of heart disease in first-degree relatives. Family history of premature CHD or heart attack is a risk factor if seen in male primary relatives before age 55 years or in female primary relatives before age 65 years.

Other risk factors that are included in computing for the global risk include smoking status, presence of hypertension or high blood pressure, and low levels of the good cholesterol. Patients with diabetes are at high-risk for CHD; hence, diabetes is considered to be a CHD equivalent.

After computing for the risk and before starting any form of treatment, secondary causes of abnormal lipid levels should be considered and treated when appropriate. For patients with diabetes, this means that blood sugar must also be controlled as part of the treatment of dyslipidemia.

Diet and exercise are the cornerstone of treatment for patients with dyslipidemia. Patients with an elevated LDL-C level should begin a diet low in fat, especially saturated fat, and high in soluble fiber and an individualized program of regular aerobic exercise. Patients who are overweight should be advised to reduce their calorie intake to achieve weight loss. Patients should follow the diet and exercise program for a reasonable amount of time to determine whether their LDL-C level is lowered to the target range.

Other components of lifestyle modification include intake of aspirin, evaluation of alcohol consumption, intake of fish oil (EPA-DHA), and smoking cessation. Vitamin E supplements should not be used because studies have shown no benefit in preventing clinical outcomes and smaller studies even suggest a blunting of the benefit of cholesterol-lowering medications with its use.

The target cholesterol levels for patients who are at high risk, like those with diabetes, are stricter than in the general population. Bad cholesterol should be brought down to less than 100 mg/dL, while the good cholesterol should be brought up to greater than 40 mg/dL in men and greater than 50 mg/dL in women. If lifestyle modification does not lower cholesterol levels to target, drugs need to be given. Statins are the drugs of choice for lowering LDL-C and aggressive treatment with statins should be pursued.

If patients are unable to take statins, then bile acid sequestrants, niacin, fibric acids, and ezetimibe can be used. It is important to remember, however, that drugs should only be started upon the advice of the doctor because not all drugs work the same way and need to be individualized.

Being a woman sure has its intricacies and cholesterol levels are not exempted. But much like the men, women, especially those with diabetes, need to attain target levels in order to reduce their risks. In this sense, women are not necessarily the stronger sex.

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