High Cholesterol

You have been diagnosed with high cholesterol. High cholesterol, also known as hyperlipidemia, contributes in a large way to heart attack and stroke. If you smoke, have high blood pressure, diabetes, heart disease, or previous stroke, you are at increased risk for even more problems if you do not treat your high cholesterol.

Many people wonder where they “get” cholesterol. CAGE is the answer:

C-cheese and other sources of dairy fats such as milk, ice cream, cream and yogurt.
A-animal fats; hamburgers, hotdogs, sausage, fried foods, bologna, fatty cuts of meat
G-get it away from home; high fat meals purchased from or eaten in restaurants
E-eat extra high fat commercial products (candy, pastries, pies, doughnuts, cookies)
**Notice; if it comes from an animal, it has cholesterol**

If this doesn’t describe you, it may also be that your body simply makes cholesterol because your genetic make-up is designed to do so. Often if this is the case, your cholesterol will be extremely high- even in the thousands (1,000-2,000).

Listed below are the values which we will use to set goals for your treatment. Depending on your current medical risk; we will use either lifestyle changes (diet, exercise, smoking cessation) or medical management (medicines) to lower your cholesterol.

Risk Category Cholesterol Target Goal LDL Goal Lifestyle Changes Needed if… Drug Therapy Indicated/Medicines Needed if…

Diabetes, Peripheral Artery disease, Coronary Artery disease, Abdominal Aneurysm <200 <100 LDL: 100-130
Cholesterol: >200 >130 LDL – will use a “Statin” Drug(Lipitor, Simvastatin)

If abnormal Triglycerides or low HDL:
Nicotinic acid /Fibrates will be added

2+ risk factors (smoker, Hypertension, low HDL, Family history heart disease, >55 years old) <200 <130 >130 LDL
>200 Cholesterol
After 3 months, Drug therapy Framingham risk 10-20% >130 ***
Framingham risk <10% >160 ***
***See your risk score on the back of this sheet.

0-1 risk factor <200 <160 >160 LDL
>200 Cholesterol 160-189 LDL medicine optional
>190 LDL treat with medicine

Summary of Drugs used to treat High Cholesterol

Drug Name Dosage Effects Contraindications Considerations

Lipitor (Atorvastatin) 10-80 mg /day Decreases LDL Liver Disease Take at Evening Meal

Zocor (Simvastatin) 20-80 mg /day Increases HDL Liver Disease Take at Evening Meal

Pravachol (Pravastatin) 10-40 mg/day Decrease Trig Liver Disease Take at bedtime

Cholesterol medicines should be re-evaluated every 6 weeks for effectiveness on the LDL, as well as the effect on the liver of the patient. Blood will be drawn every 6 weeks for the first 3 visits. Stop taking the medicine if you develop extremely sore muscles, or if your urine turns brown; If this happens, be seen for a medical visit in the office; tell the provider that you experienced these symptoms while taking cholesterol medicines. Grapefruit juice may alter how the drug works; avoid taking the medicine with grapefruit juice.

Nutritional Recommendations for People with High Cholesterol

CHOOSE MORE CHOOSE LESS For Weight Reduction

BREADS AND CEREALS
6 or more servings daily
Whole Grains, Whole Cereals
Brown Rice, Dry Beans, Dry Peas

VEGETABLES
3-5 servings daily
Fresh, canned, without fat, sauce or fat

FRUITS
2-4 Servings Daily
Fresh, Frozen, Canned, Dry

DAIRY
2-3 Servings Daily
Fat free, skim, 1%, Yogurt, cottage cheese, Fat-free and low fat cheese

EGGS
<2 yolks per WEEK
Egg white or substitutes OK

FISH, MEAT, POULTRY
<5 oz per day
Fist, lean cuts loin, extra lean hamburger,
Cold cuts made with lean meat or soy,
Skinless poultry.

FATS AND OILS
Unsaturated fats, olive oil, canola, peanut,
Vegetable oil, nuts, fish

DIET OPTIONS
Sterol containing margarines (Benecol),
Fiber food sources: barley, oats, apples,
banana, berries, citrus, nectarines,
peaches, pears, plums, prunes,
broccoli, brussel sprouts, carrots,
dry beans, peas, soy (tofu). Breads/Cereal: Bakery products
Doughnuts, Biscuits, Butter Rolls, Muffins,
Croissants, Sweet Rolls, Danish, Cakes, Pies,
Coffee Cake, Cookies, Chips, Puffs, Snack Mixes,
Crackers, Buttered Popcorn

Vegetables:
Fried, buttered, Cheesy, creamy or saucy

Fruits:
served with butter or Cream

Dairy:
whole milk, 2%, whole yogurt,
ice cream, cream, whole fat cheese

Eggs:
Egg yolks, whole eggs

Meat Poultry, Fish: Higher fat

Meat cuts:
ribs, t-bone, Steak, regular hamburger, Bacon, sausage, cold cuts, salami, Bologna, hot dogs,
organ meats, Liver, brains, sweetbreads, Poultry with skin,
fried meat, fried Poultry, fried fish.

Saturated Fats: Coconut Oil, butter, Stick margarine.
*In general, if the food is solid when it is cold but liquid when it is hot, avoid it.
Example: (Butter is solid in the fridge but liquid when melted) Keep track of Weight:
Record Weight and BMI Weekly

BMI >30 is OBESE
GOAL: BMI of <25

Lose Weight:
10% Body weight in 6 months
½ to 1 pound per week

Develop Healthy Eating Patters:
Choose healthy foods (column 1)
Reduce unhealthy foods (column 2)
Limit large meals
Increase small meals to 5-6/day
Select portion sizes smaller than your fist
Avoid second helpings
Drink a glass of water before each meal
Skip dessert
Identify and reduce hidden fat by reading food labels.
Choose products low in saturated Fats and calories.
Identify and reduce sources of Excess carbohydrates such as
Fat free and regular crackers,
Cookies and desserts,
Snacks and sugar containing Drinks.

Limit Alcohol
Move more often:
Park far away in the lot and walk!
Move your body while watching TV (lift water jugs or small weights)
Take the stairs
Walk every night with your family after dinner.
Take a bike ride.
Garden.
Next day off, go to the park instead of the movies.

Risk Category Cholesterol	Target Goal	LDL Goal	Lifestyle Changes Needed if…	Drug Therapy Indicated/Medicines Needed if…
Diabetes, Peripheral Artery disease, Coronary Artery disease, Abdominal Aneurysm	<200	<100	LDL: 100-130 Cholesterol: >200	>130 LDL – will use a “Statin” Drug(Lipitor, Simvastatin) If abnormal Triglycerides or low HDL: Nicotinic acid /Fibrates will be added
2+ risk factors (smoker, Hypertension, low HDL, Family history heart disease, >55 years old)	<200	<130	>130 LDL >200 Cholesterol After 3 months, Drug therapy	Framingham risk 10-20% >130 * Framingham risk <10% >160 * ***See your risk score on the back of this sheet.
0-1 risk factor	<200	<160	>160 LDL >200 Cholesterol	160-189 LDL medicine optional >190 LDL treat with medicine

Drug Name	Dosage	Effects	Contraindications	Considerations
Lipitor (Atorvastatin)	10-80 mg /day	Decreases LDL	Liver Disease	Take at Evening Meal
Zocor (Simvastatin)	20-80 mg /day	Increases HDL	Liver Disease	Take at Evening Meal
Pravachol (Pravastatin)	10-40 mg/day	Decrease Trig	Liver Disease	Take at bedtime

CHOOSE MORE	CHOOSE LESS	For Weight Reduction
BREADS AND CEREALS 6 or more servings daily Whole Grains, Whole Cereals Brown Rice, Dry Beans, Dry Peas VEGETABLES 3-5 servings daily Fresh, canned, without fat, sauce or fat FRUITS 2-4 Servings Daily Fresh, Frozen, Canned, Dry DAIRY 2-3 Servings Daily Fat free, skim, 1%, Yogurt, cottage cheese, Fat-free and low fat cheese EGGS <2 yolks per WEEK Egg white or substitutes OK FISH, MEAT, POULTRY <5 oz per day Fist, lean cuts loin, extra lean hamburger, Cold cuts made with lean meat or soy, Skinless poultry. FATS AND OILS Unsaturated fats, olive oil, canola, peanut, Vegetable oil, nuts, fish DIET OPTIONS Sterol containing margarines (Benecol), Fiber food sources: barley, oats, apples, banana, berries, citrus, nectarines, peaches, pears, plums, prunes, broccoli, brussel sprouts, carrots, dry beans, peas, soy (tofu).	Breads/Cereal: Bakery products Doughnuts, Biscuits, Butter Rolls, Muffins, Croissants, Sweet Rolls, Danish, Cakes, Pies, Coffee Cake, Cookies, Chips, Puffs, Snack Mixes, Crackers, Buttered Popcorn Vegetables: Fried, buttered, Cheesy, creamy or saucy Fruits: served with butter or Cream Dairy: whole milk, 2%, whole yogurt, ice cream, cream, whole fat cheese Eggs: Egg yolks, whole eggs Meat Poultry, Fish: Higher fat Meat cuts: ribs, t-bone, Steak, regular hamburger, Bacon, sausage, cold cuts, salami, Bologna, hot dogs, organ meats, Liver, brains, sweetbreads, Poultry with skin, fried meat, fried Poultry, fried fish. Saturated Fats: Coconut Oil, butter, Stick margarine. *In general, if the food is solid when it is cold but liquid when it is hot, avoid it. Example: (Butter is solid in the fridge but liquid when melted)	Keep track of Weight: Record Weight and BMI Weekly BMI >30 is OBESE GOAL: BMI of <25 Lose Weight: 10% Body weight in 6 months ½ to 1 pound per week Develop Healthy Eating Patters: Choose healthy foods (column 1) Reduce unhealthy foods (column 2) Limit large meals Increase small meals to 5-6/day Select portion sizes smaller than your fist Avoid second helpings Drink a glass of water before each meal Skip dessert Identify and reduce hidden fat by reading food labels. Choose products low in saturated Fats and calories. Identify and reduce sources of Excess carbohydrates such as Fat free and regular crackers, Cookies and desserts, Snacks and sugar containing Drinks. Limit Alcohol Move more often: Park far away in the lot and walk! Move your body while watching TV (lift water jugs or small weights) Take the stairs Walk every night with your family after dinner. Take a bike ride. Garden. Next day off, go to the park instead of the movies.