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DOING THE LDL LIMBO

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

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  1. DOING THE LDL LIMBO How Low Do YOU Need to Go Dr. Richard Sargent

  2. 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

  3. You’re not gonna live forever • AARP • Independently • In your own home • without being a burden to others • as long as you can

  4. 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

  5. LEADING CAUSES OF DEATH

  6. RISK FACTORS • Family History • Tobacco • Blood Pressure • Obesity • Diabetes • Cholesterol • Physical Activity • Diet

  7. CHOLESTEROL GOALSIt is not just one number

  8. “Lifestyle Modifications” • Swallow Pills • You Don’t get a Pass • Diet • Exercise • Stress reduction • Inflammation reduction

  9. DIET It’s Fat TuesdayDietary Fat Sources • Choose your fats • decrease your intake • mostly plants • Slow Food

  10. Diet: Choose your ‘butter’

  11. DIET • All Things in Moderation • Mostly Plants- Fruits and Vegetables • Starch or Carbohydrate- Reduce • Red Meat has high saturated fat content

  12. EXERCISEHit the Road, Jack!

  13. 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

  14. INFLAMMATION • Tobacco • Air Pollution • Second Hand Smoke • Infections • Endothelial Cell Death • Oxidized LDL Chol • Vasospasm • Blood Pressure • Clotting

  15. 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.

  16. 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

  17. CHOLESTEROL DEFINITIONS • Total Cholesterol <200 • Triglycerides <160 • LDL (Lethal cholesterol) • moving target • HDL (Healthy Cholesterol) • >40 men > 50 women

  18. 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

  19. 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

  20. 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

  21. Statin Side Effects • Impaired thinking • Co-enzyme Q10 100 mg/d • Muscle pain, breakdown • Joint Pain • Liver toxicity • Cough

  22. 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

  23. Heart Disease and/or Stroke • What we are trying to avoid • Inflammation • High Blood Pressure • Plaque Rupture • Clot

  24. Heart Attacks and Cholesterol • Most do not have severe stenosis • one third do not have warning signs • Symptoms are the tip of the iceberg

  25. Heart Attack Mechanism • Vasospasm • LDL Oxidation • Platelet Activation • Plaque Rupture • Clot Propagation

  26. 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

  27. The LDL LimboHow Low is Too Low? • Newborns have a level of 30-40 • If LDL < 40 in adults increased suicide

  28. 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%

  29. QUESTIONS ?

  30. THANK YOU • MOST PEOPLE WANT TO: • Live Independently • In Your Own Home • Without Being a Burden to Others • As Long as You Can

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