High Cholesterol (Hyperlipidemia)My cholesterol medication is:_________________________________

The directions are:___________________________________________

In recent years, powerful new drugs have been developed to reduce cholesterol in yourblood, thereby reducing your risk of heart attacks and strokes. Your doctor has prescribed oneof these drugs for you. This information sheet is provided to help you understand how thesenew drugs work to help keep you healthy. A chart at the end of this document lists the differ-ent kinds of drugs and potential side effects. Please take a few minutes to read this informa-tion. If you have further questions or concerns, please call your pharmacist or doctor. UCSFdoctors and pharmacists may be located by calling 415-476-9000.

What is cholesterol? 2

High cholesterol, also called hyperlipidemia, is an increased level of lipids in the blood asso-ciated with atherosclerosis, a condition in which fatty deposits in your arteries block or slowmovement of blood to and from your heart. Atherosclerosis is a major cause of coronary heartdisease (CHD), a condition believed to cause 20 percent of American deaths and to be the sin-gle largest killer of Americans today.

Cholesterol is one kind of lipid. Another kind is called triglycerides. Both kinds are transport-ed in the blood as part of large particles called lipoproteins. Hypercholesterolemia is a highlevel of cholesterol. Hypertriglyceridemia is a high level of triglyceride in the blood.

There are five major families of lipoproteins and the most important ones are low-densitylipoproteins (LDL) and high-density lipoproteins (HDL). Although a desirable level of choles-terol is less than 200 mg/dL, the balance between LDL and HDL cholesterol also plays animportant role in evaluating your heart and artery health.

It’s important to know about these different kinds of blood fat because different medicationsare used to control them.

Good cholesterol/Bad cholesterol 2

LDL is the major cholesterol carrier in the blood. Too much LDL can contribute over time tothe build up of atherosclerotic plaques in the walls of the blood vessels feeding the brain,heart, gut and legs. This plaque, a thick, hard deposit, can clog the arteries. This is known asatherosclerosis. A blood clot that forms in the area of atherosclerosis also can block bloodflow. If the clot blocks the arteries feeding the heart muscles, it can cause a heart attack. If the

clot blocks blood flow to the brain, it may result in a stroke. A high level of LDL (160 mg/dLand above) increases the risk of heart disease, so LDL also is known as "bad" cholesterol.

HDL is thought to carry cholesterol away from the arteries and back to the liver, where it isinvolved in making other essential substances. HDL is believed to remove excess cholesterolfrom atherosclerotic plaques and slow their growth and accumulation in arteries. HDL alsois called "good" cholesterol because a high level of HDL may help protect against heartattack. A low level of HDL (less than 40 mg/dL) means an increase in the risk of heartattack and stroke.

Why do some people have complications from high cholesterol?

We know that factors including heredity, which we can’t change, and life-style habits, whichwe can change, determine who will get heart attacks and strokes and who won’t. Lifestylerisk factors we can control include:

• Smoking

• Poor diet

• High alcohol consumption

• Not taking prescribed medication as directed

• Avoiding exercise

However, we also know that the following risk factors may not be under your control butincrease your risk for heart or artery disease.

• High blood pressure (blood pressure over 140/90)

• Low HDL cholesterol (less than 40 mg/dL)

• Family history of early heart disease (male relatives under 55 years old, females under65 years old)

• Age (men older than 45 years old, women older than 55 years old)

Risk categories and goals for LDL reduction1,3

The following chart suggests at which point your doctor is likely to suggest that you changeyour diet, or that you change your diet and take medication.

≥ means "more than or equal to"; < means "less than"

Initiate Lifestyle changes3

• Diet: (1) Saturated fat should amount to less than 7 percent of your total calorieintake, cholesterol should amount to less than 200mg/day. (2) Increase fiber intake

• Weight reduction

• Increase daily physical activities

Diet and Cholesterol (from the American Heart Association)

• Your liver usually makes about 1,000mg (1 gram) of cholesterol a day, while your dietcan provide another 400 to 500mg of cholesterol.

• Foods from animal sources (especially poultry, meat, seafood, egg yolks, and whole-milk dairy products) contain cholesterol.

• Foods from plants (fruits, vegetables, grains, nuts, and seeds) do not contain cholesterol.

• Saturated fatty acids can raise blood cholesterol.

• The American Heart Association recommends limiting your daily cholesterol intake toless than 300mg. If you have heart disease, limit to less than 200mg.

• People with severe hypercholesterolemia should eat no more than 6 oz. of lean meat,fish, and poultry daily and use fat-free or low-fat dairy products.

• High-quality proteins from vegetable sources, such as beans, can substitute for animalsource protein.

Exercise and Cholesterol2

• Physical inactivity is a major risk factor for heart disease.

• Exercise may increase HDL.

• Exercise can help control weight, blood sugar, and high blood pressure.

• Aerobic exercise (activities that increase your heart and breathing rates), such as briskwalking, jogging, and swimming, can help condition your heart and lungs.

• Moderate intensity daily activities, such as walking, gardening, yard work, housework,and dancing can also help reduce your risk.

• If you have heart disease, it is important to consult with your physician prior to begin-ning an exercise program

Cigarette/tobacco smoking/alcohol consumption and cholesterol2

• Quit smoking. Talk with your doctor about a smoking cessation program if necessary.

• Smoking is a major risk factor of heart disease.

• Smoking has been shown to reduce HDL levels.

• The American Heart Association recommends talking to your doctor first for advice onalcohol consumption. Moderate alcohol consumption may reduce the incidence ofheart disease. However this must be individualized for each patient since it also mayincrease the incidence.

Medications to help optimize your cholesterol levels3

There are four major classes of drugs that can help optimize your lipid profile. The chartbelow lists the major classes, their commercial names, how they affect lipids and potentialside effects. If you experience any of these side effects or any other unusual conditions whileyou are taking your medication, contact your doctor.

For Your Health and Your Heart

• Maintain a healthy lifestyle and a low-fat, low-cholesterol diet.

• Maintain daily physical activity.

• Quit smoking or excessive alcohol consumption.

Talk to your doctor, pharmacist or nurse to see how you can optimize your lipid profile.

References:

1. Close To The Heart Educational Program provided by Pfizer, Inc. March 2001.

2. www.americanheart.org (the American Heart Association Website)

3. ATP III Guidelines At-A-Glance Quick Desk Reference by NIH, National Heart, Lung,and Blood Institute.

Courtesy of the UCSF Division of Cardiology and UCSF Department of Clinical Pharmacy • SDCAR0085 • Rev. 08/02