Cholesterol & Hypercholesterolemia Treatment Thesis

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Those with abnormal levels (total cholesterol more than 200 mg/dL or HDL less than 40 mg/dL), will go on to have a test called fasting lipid profile (in which the person being tested refrains from eating for 8 to 12 hours, usually overnight, prior to the test) (Anderson et al., 2001). The fasting test will indicate whether or not total cholesterol levels fall within the normal range (between 140 and 200 mg/dL), are moderately high (between 200 and 240 mg/dL), or if they are in the very high range (240 mg/dL or greater) (Anderson et al., 2001). This blood test also reveals the levels of LDL, HDL, and triglycerides; according to guidelines released by the National Cholesterol Education Program (NCEP), the optimal level for LDL cholesterol depends on whether you have heart disease or not and whether there are other risk factors present for heart disease (such as diabetes and high blood pressure) (Anderson et al., 2001). The optimal level for HDL for all people (healthy or otherwise) is a measurement higher than 60 mg/dL; low levels are 40 mg/dL and below (Anderson et al., 2001).

Adults with normal total and HDL cholesterol levels should have their cholesterol checked every 5 years (Anderson et al., 2001). Those being treated for hypercholesterolemia should have their cholesterol levels measured every 2 to 6 months and have liver function tests as well if they are on cholesterol-lowering medication (Anderson et al., 2001).

Preventive Care (Anderson et al., 2001)

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Changing eating habits is key in preventing high cholesterol; other lifestyle changes that can reduce the risk of developing high cholesterol and cardiovascular disease include maintaining a normal weight and increasing physical activity (Anderson et al., 2001).

Diet (Anderson et al., 2001)

TOPIC: Thesis on Cholesterol & Hypercholesterolemia Treatment Assignment

The best ways to lower cholesterol through diet include the following: Reducing the amounts of saturated fat and cholesterol consumed each day; Increasing daily consumption of fruits, vegetables, fish, and whole grains; Supplementing the diet with other protective components such as fiber (Anderson et al., 2001).

There are a number of diets designed to keep cholesterol levels in check including the American Heart Association (AHA) diet, the Mediterranean diet, and the Ornish diet. While these three diets vary in some ways, they all emphasize whole grains and include fiber, fresh fruits and vegetables, lean protein, particularly soy and fish, and avoidance of saturated fats and trans fatty acids (Anderson et al., 2001). These diets are outlined below (Anderson et al., 2001):

The AHA Step I Diet is considered appropriate for the general population, including those who have normal cholesterol levels and want to prevent the development of high cholesterol (Anderson et al., 2001). This diet calls for up to 55% of daily calories from carbohydrates, 15% from protein, and no more than 30% from fat (Anderson et al., 2001). The diet also outlines quite specific of types of fat and the proportions to include:

Between 8% and 10% of fat from saturated fatty acids (saturated fats are found mainly in foods that come from animals such as butter, cheese, milk, cream, and ice cream); Up to 10% from polyunsaturated fatty acids (polyunsaturated fat is highly unsaturated fat that is found in large amounts in foods from plants, including safflower, sunflower, corn, and soybean oils); Up to 15% from monounsaturated fatty acids (monounsaturated fat is a slightly unsaturated fat found in large amounts in foods from plants, including peanut, avocado, canola, and olive oils); Less than 300 mg per day of dietary cholesterol (Anderson et al., 2001).

This diet also specifies the level of calories that helps people achieve and maintain a healthy weight, and it is ideal for those who currently include a lot of fat in their diets and have not previously attempted to lower their cholesterol levels through dietary changes (Anderson et al., 2001).

The AHA Step II Diet is designed for patients who require greater LDL lowering, and includes the Step I guidelines (above) with two modifications: Less than 7% of calories from saturated fat (instead of 8% to 10%); Less than 200 mg per day of dietary cholesterol (instead of less than 300 mg per day) (Anderson et al., 2001).

The Mediterranean Diet is comprised of whole grains, fresh fruits and vegetables, fish, olive oil, garlic, and moderate, daily consumption of red wine (Anderson et al., 2001). Although this diet is not low in fat, it is high in monounsaturated fatty acids and has been shown to increase HDL cholesterol levels and to inhibit the process whereby LDL cholesterol adheres to artery walls (Anderson et al., 2001). One large, well-designed study found that people who had had at least one heart attack were between 50% and 70% less likely to suffer another heart attack if they followed the Mediterranean diet (Anderson et al., 2001). This diet puts a great emphasis on bread, root and green vegetables, and the daily consumption of fruit, fish, and poultry; only olive and rapeseed (canola) oils are used in this eating plan and margarine (with alpha-linolenic acid) is used instead of butter (Anderson et al., 2001). Eating beef and lamb is discouraged (Anderson et al., 2001). This diet is naturally rich in fiber, antioxidants, and omega-3 fatty acids; it contains the same amount of protein as the AHA diet, but the source of protein is primarily fish (Anderson et al., 2001). The Mediterranean diet has less carbohydrates than the AHA or Ornish diets, but places the same emphasis on consuming fruits, vegetables, nuts, legumes, and beans (Anderson et al., 2001).

The Ornish Diet is a completely vegetarian diet that has been shown to dramatically reduce cholesterol levels and to actually reverse the risk of heart disease (Anderson et al., 2001). No oils or animal products are allowed in the Ornish diet, except non-fat dairy products and egg whites (Anderson et al., 2001). In this diet, total fat is limited to 10% of daily calories, saturated fats are significantly limited, and carbohydrates generally make up 75% of calories (Anderson et al., 2001). Complex carbohydrates from whole grains and other high-fiber foods and from fresh fruits and vegetables are emphasized (Anderson et al., 2001).

Weight Reduction (Anderson et al., 2001)

Being overweight increases risk of high cholesterol and heart disease; even small degrees of weight loss can make nutritional changes more effective in lowering LDL -- a 5 to 10 pound weight loss can double the LDL reduction achieved by dietary adjustment alone (Anderson et al., 2001). Weight loss is often accompanied by lowered triglycerides and increased HDL levels (Anderson et al., 2001). The goal for weight loss should be a realistic one, rather than a rapid or dramatic loss (Anderson et al., 2001). Very low calorie diets (500 to 800 calories) can be dangerous and are not recommended (Anderson et al., 2001). A reasonable caloric restriction is considered a reduction of 250 to 500 calories per day in the usual diet aimed at achieving a gradual, weekly weight loss of one-half to one pound (Anderson et al., 2001).

Physical Activity (Anderson et al., 2001)

Regular physical activity by itself both reduces the risk of death from heart disease and enhances the effects of diet on LDL cholesterol levels (Anderson et al., 2001). In a study of 377 people who were divided into four groups (aerobic exercise, the AHA Step II diet, the Step II diet plus exercise, or no intervention), those who only made dietary changes did not show reduced LDL while the group on the Step II diet plus exercise had a significant reduction in LDL cholesterol (Anderson et al., 2001). Moderate exercise three to five times per week (the equivalent of walking 7 to 14 miles per week) can help promote weight loss in overweight individuals, reduce LDL and triglyceride levels, and produce favorable levels of HDL (Anderson et al., 2001). Exercise may also lower blood pressure; for these reasons, everyone with risk factors for heart disease should consider starting a program of regular, aerobic physical activity, individualized to suit physical fitness level, heart health, and exercise preferences (Anderson et al., 2001).

Treatment Approach (Anderson et al., 2001)

The main goal of treatment is to reduce the risk of cardiovascular diseases, such as heart disease and stroke, by lowering blood cholesterol levels (Anderson et al., 2001). Studies have shown that for every 1% reduction in cholesterol levels there is a 2% reduction in the rate of heart disease (Anderson et al., 2001). People who benefit most from lowering their cholesterol are those who already have heart disease or who have multiple risk factors for the disease (Anderson et al., 2001). In addition to lifestyle changes, specific cholesterol-lowering medications are often prescribed (Anderson et al., 2001).

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