Greater Harrisburg's Community Newspaper January 2010 - theBurg

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Your Health The Cholesterol Crisis Diet, lifestyle make us prone to elevated levels. Dr. John Goldman High cholesterol affects approximately one out of every two Americans and is one of the major risk factors for coronary artery disease, peripheral vascular disease and strokes. Consequently, all adults should be screened for high cholesterol, and those with hypercholesterolemia should be treated with either diet and exercise or pharmacologic agents. Screening for increased cholesterol should begin at age 20, preferably with a fasting lipid panel that will include measurement of low density lipids (bad cholesterol), indirect measurement of high density lipids (good cholesterol) and triglycerides. Total cholesterol of less than 200 is considered desirable, 200- 240 is considered borderline and greater than 240 is considered high risk. Low density cholesterol (LDL) is considered the most accurate 26 TheBurg predictor of cardiovascular risk. An LDL of less than 100 is considered optimal, 100–130 is considered borderline and anything over 130 is considered high. People with normal or low cholesterol should have their lipid profile re-checked every five years. Patients with borderline cholesterol should be checked every year. Patients with high cholesterol should be treated. The degree with which cholesterol should be lowered will depend on the number of cardiac risk factors. Cardiac risk factors include hypertension, tobacco use, diabetes and a family history of heart disease. A patient without risk factors or only one risk factor should have an LDL less than 160; with two or more risk factors, an LDL less than 130; and patients with established heart disease, diabetes or who are at high risk for heart disease should have an LDL less than 100. All patients with high or borderline cholesterol should attempt to lower their lipids through a combination of diet, exercise and lifestyle changes. Lifestyle changes would consist of keeping a normal weight, a diet low in fat (25–35 percent of calories from fat), exercising aerobically for at least 30 minutes on most, if not all, days of the week, avoiding all forms of tobacco (cigarettes, cigars, and smokeless tobacco) and avoidance of heavy alcohol use (more than one to two drinks per day). Diet, exercise and lifestyle modification can usually only lower cholesterol levels 5–15 percent. Consequently, many patients will require pharmacologic intervention. The mainstay of lowering cholesterol are “statin” drugs. These drugs work by inhibiting the chief enzyme in cholesterol production. They are very effective and will generally lower cholesterol 30–50 percent and have been associated with reducing the risk of heart attacks by as much as 25 percent. Unfortunately, many patients with very high cholesterol or those whose goal is an LDL of less than 100 secondary to pre-existing heart disease will need more than one agent. There are two main agents that are used in addition to the statins: zetia, which inhibits absorption of cholesterol, and niacin, which is a vitamin that works by an unknown mechanism. Zetia is effective at lowering cholesterol, but it is less clear if it prevents secondary outcomes Street Snap (heart attacks, strokes, peripheral artery disease). There is better evidence that niacin works at preventing secondary outcomes but is associated with unacceptable side effects, particularly flushing. Currently, it is not clear what, if any, agent should be added to patients who do not reach their goals despite treatment with the maximal doses of a statin. All Americans are at risk of heart disease due to our diet and lifestyle. Many Americans have cholesterol that is too high, and it is rare to have a cholesterol level that is low enough to be considered optimal. Therefore, everyone should get their cholesterol checked by their physician, and most will require some form of treatment. Dr. John Goldman is the Program Director of Internal Medicine at PinnacleHealth. The Susquehanna River, shrouded in fog, looking west
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Page 1 and 2: TheBurg Greater Harrisburg’s Comm
Page 3 and 4: Contents In the Burg 4 The First Wo
Page 5 and 6: City Hall Thompson Sworn In; Events
Page 7 and 8: Corner Office Local Realtors Get As
Page 9 and 10: Street Corners Intersections Crossr
Page 11 and 12: Around Town Citizens, over Crime Ac
Page 13 and 14: Past Tense A Century of Production
Page 15 and 16: Home Cooking Ring in 2010 with—Oi
Page 17 and 18: Let ’s Dance Music & Passion, Aga
Page 19 and 20: Happenings “3rd in The Burg” De
Page 21 and 22: Home & Family On Faith A Different
Page 23 and 24: Wags & Whiskers Furry First Aid Bad
Page 25: Sports & Bodies The Great Outdoors

Greater Harrisburg's Community Newspaper January 2010 - theBurg

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