1. Cholesterol Measurement All adults should have their blood cholesterol measured every 5 years May be in non-fasting state Fasting preferred http://www.nhlbi.nih.gov/guidelines/cholesterol/

2. I have some bad news for you. While your cholesterol has remained the same, the research findings have changed.

3. ATP III Classification of Total Cholesterol Total Cholesterol (TC) < 200Desirable 200-239Borderline High > 240High All levels are measured fasting http://www.nhlbi.nih.gov/guidelines/cholesterol/

4. ATP III Classification of LDL LDL Cholesterol (LDL-C) < 100Optimal 100-129Near optimal/above optimal 130-159Borderline high 160-189High > 190Very high

5. ATP III Classification of HDL and Triglyceride HDL Cholesterol (HDL-C) < 40Low (undesirable) > 60High (protective) Triglyceride (TG) < 150Desirable 150-199Borderline High 200-499High > 500Very High

6. Ratio Total Chol/HDL RiskMenWomen Very low (1/2 average)<3.4<3.3 Low risk4.03.8 Average risk5.04.5 Moderate risk (2x average)9.57.0 High risk (3x risk)>23>11 http://www.nhlbi.nih.gov/about/ncep/index.htm Total/HDL – Over 5.0 = elevated risk

7. Cholesterol Screening: Recommendations

8. Risk Factors That Influence LDL Diabetes (a CHD risk equivalent – as much risk as MI) Cigarette smoking Hypertension BP >140/90 mmHg or on antihypertensive meds Low HDL cholesterol <40 mg/dL Family history of premature CHD CHD in male first degree relative < 55 years old CHD in female first degree relative <65 yrs old Age men > 45 years; women > 55 years HDL > 60 is a “negative” risk factor (remove one risk factor from count) http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf

9. Recommend a Lipoprotein Analysis (Breakdown) When person has history of MI, angina, TIA’s Within 1 year if TC is 200-239 with < two CHD risk factors Within 2 months if TC is 200-239 with > two risk factors If HDL is below 40 mg/dL

10. Therapeutic Lifestyle Changes (TLC) Total fat < 30% Saturated fat < 7% Cholesterol < 200 mg/dL Fiber20-30 gms/day Sodium1500 mg/day Caloriesenough to achieve ideal weight Alcoholmoderation

11. What are the medications for elevated cholesterol? Lipid-lowering meds lower LDL, raise HDL, and lower triglycerides (with side effects) –HMG-CoA reductase inhibitors (statins) –Bile acid sequestrants –Niacin – nicotinic acid – Raises HDL but no greater protection than statins –Fibrates Antihypertensive Med

12. CHD/Cholesterol Medications (cont) Anticoagulant –Coumadin –Aspirin – (considered primary prevention) Estrogen Replacement Therapy Antianginal –Nitrates –Beta Blockers –Calcium Channel Blockers