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Controlling your cholesterol (Part 2)

Last Modified: November 20, 2019

Heart Health

In this second installment of a two-part video series, Charles Presti, MD, PPG – Cardiology and Patrick Daley, MD, PPG – Cardiology, discuss the importance of managing your lipids or cholesterol, key lifestyle modifications you can make and the essential role they both play in preventing cardiovascular disease.

What’s the connection?

The connection between cholesterol and blood vessel disease is no secret, but over the past 20-30 years, there have been multiple trials showing that lowering your LDL cholesterol now, can actually lower your risk for heart disease and cardiovascular events later in life. The lower the LDL cholesterol, the better!

Lipid mgmt 2


Being proactive is the foundation for prevention along with healthy lifestyle modifications, which include:

  1. Diet – The best choice is a heart healthy diet high in fruits, vegetables, and whole grains accompanying high-quality vegetable or animal protein, and fish. It’s also best to minimize the consumption of red meat, food and beverages high in sugar and simple, refined carbohydrates.
  2. Exercise – Physical activity has been proven to lower your LDL and raise your HDL. It’s recommended that you complete 150 minutes a week of moderate intensity exercise or 75 minutes a week of heavy intensity exercise. A little goes a long way – use the stairs instead of the elevator, park a little further away from the building – it all adds up by the end of the day.
  3. Stop smoking – If you smoke, it is imperative that you quit. Just by stopping you can lower your risk of heart disease by about 50% within one year.
  4. Lose weight – Shedding a few pounds not only lowers your cholesterol, but also your risk for diabetes, high blood pressure and more! The goal is to get into a lifestyle program that helps you achieve a 3-5-pound weight loss each month, by way of diet and exercise.

Unfortunately, diet and exercise may not be enough for everyone. If your cholesterol levels are not in a healthy range, your doctor may suggest the use of medication. There are several, very effective medicines that aid in the lowering of your LDL cholesterol. A few examples include:

  • Statins
  • Bile acid sequestrants
  • Cholesterol absorption inhibitors
  • Niacin (a B vitamin)
  • PCSK9 inhibitors

Generally, when utilizing medication, statins are the first choice. There has been enormous data over the past 30-40 years in their efficacy in lowering cholesterol by 30-50% as well as their effectiveness in lowering your risk of heart disease, heart attack, and cardiac death. Statins are also used because they have an anti-inflammatory effect which is highly beneficial for anyone who has had bypass, a heart attack, or stroke.

On the other hand, there are patients who do not respond to one medication and may need to be switched to another in which medications like PCSK9 inhibitors could be employed. While PCSK9 inhibitors are relatively new, they have shown to be very powerful and effective in lowering LDL cholesterol based on short-term observations, information and data collected.

Key takeaways
  1. Foundation - The most important and effective way to prevent cardiovascular disease is to promote a healthy lifestyle, beginning early and continuing throughout life.
  2. Evaluation – This should include an atherosclerotic risk assessment and discussion with a clinician about whether to proceed with further testing or medical therapy in addition to lifestyle modifications.
  3. Medication – When needed, statin therapy is considered the first line of defense in medical therapy for both primary and secondary prevention because they are well tolerated, inexpensive, and have been proven to be very effective.
  4. Team approach – Always very helpful when striving to achieve adequate lipid goals through support of a primary care physician, lipid clinic and patient efforts.

Dr. Presti shared one final thought, “Remember, when it comes to heart disease we have a lot of good treatments out there, but prevention is better than treatment.”

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