Hyper Cholesterolemia

1. Hyper Cholesterolemia Neel Ganguly Mr. Schnieder’s science class Period 5 October 22, 2001

2. What is Hyper Cholesterolemia Hypercholesterolemia is a high level of cholesterol in the blood that can cause plaque to form and build up leading to blockages in the arteries (arteriosclerosis), increasing the risk for heart attack, stroke, circulation problems, and death.

3. History • Hypercholestrolemia is an inherited condition and for several years scientists have studied the effects of high cholesterol on the circulatory system. In one study of young men without known heart disease, cholesterol levels were measured and participants were observed for 6 years. Researchers found that the deaths of those participants who had high cholesterol levels were typically linked to heart disease. It was concluded that the risk for a fatal heart attack is about 5 times higher in those with a cholesterol level of 300 mg/dL or more, than in those with a cholesterol level below 200 mg/dL. The Framingham Heart Study is probably the most famous ongoing heart study in the world. Cholesterol levels, smoking habits, heart attack rates, and deaths in the population of an entire town have been recorded for over 40 years. After 30 years, over 85% of people with cholesterol levels of 180 mg/dL or less were still alive; almost 33% of those with cholesterol levels greater than 260 mg/dL had died.

4. Symptoms of Hyper Cholesterolemia • High cholesterol rarely causes symptoms. It is usually detected during a regular blood test that measures cholesterol levels. Being diagnosed with conditions that may be caused in part by high cholesterol (such as arteriosclerosis, coronary artery block, and stroke) may be the first clue that a person has high cholesterol. For example: •          The first symptom of coronary artery disease (CAD) is often chest pain (angina). Chest pain may occur during activities that increase the heart rate. However, many people have CAD for several years without symptoms. • Unless the person has a transient ischemic attack (TIA), it is rare to have any warning signs of an oncoming stroke. • Some people with lipid disorders or familiall hypercholesterolemia may have other distinct symptoms such as deposits of excess cholesterol that collect in the skin or eye tissue. These cholesterol deposits can also cause nodules in tendons in the hands or feet or rarely yellow streaks in the hands.

5. Types of Cholesterol Levels • There are many different types of cholesterol levels. • Some of the types are LDL, HDL, & Triglycerides. • LDL Cholesterol circulates in the bloodstream. It clogs up the arteries and causes atherosclerosis. • HDL Cholesterol helps your body remove cholesterol from arteries while circulating in the bloodstream. • High Triglycerides levels can cause pancreatitis(irritation of the pancreas). Most commonly found in people with genetic predisposition for it.

6. Tests A history or physical exam and other tests to check certain medical conditions (such as diabetes, thyroid or kidney problems) that may raise cholesterol levels are usually the first steps in evaluating whether a person has risk factors for heart disease. To measure cholesterol, HDL, and triglyceride levels, a fasting blood test is used. This means you do not eat or drink anything except water for 12 hours before the test.

7. How it affects your body • High Cholesterol Causes Arteriosclerosis The development of plaque and blockages in the arteries, arteriosclerosis, involves several steps. (1) The innermost lining of the arteries (the endothelium) is damaged or becomes dysfunctional and cholesterol particles deposit into the damaged wall. (2) The cholesterol becomes incorporated into a mixture called plaque, which is composed of cholesterol, other fatty substances, fibrous tissue, and calcium. (3) As more cholesterol and other substances incorporate, the plaque grows, narrowing the artery (Figure 1). (4) (5)Plaque build-up can grow large enough to impede blood flow through the artery (called a "blockage"). When the arteries supplying the heart with blood are blocked, chest pain (angina) may occur; when arteries in the legs are blocked, leg pain or cramping may occur; when arteries supplying the brain with blood are blocked, stroke may occur. If the plaque ruptures, a blood clot may develop on top of it. If the blood clot completely blocks blood flow through a coronary artery, it may result in a heart attack (myocardial infarction); if it occurs in an artery supplying blood to the brain, it may result in a stroke.

8. How a person’s life is affected by it • How the Person’s Daily Life is Affected by the Disease • People with high cholesterol levels not only have to take medication but they have to change their lifestyles dramatically. (My interview with my grandfather will provide good examples of both methods of controlling this dangerous disease). Most importantly, diet, weight loss and exercise. • Diet. Minimize excess cholesterol and fat intake, especially saturated fat. These fats raise cholesterol levels more than any other substances. Cholesterol and saturated fats are found primarily in foods derived from animals, such as meats and dairy products. Unwanted cholesterol and fats lurk in many foods that might never be suspected of having high amounts of these substances. Here are some dietary guidelines for reducing cholesterol and fat consumption: • 1.     Eat lean fish, poultry, and meat. Remove the skin from chicken and trim the fat from beef before cooking. • 2.     Avoid eating commercially prepared and processed food (cakes, cookies, etc.) • 3.     Increase the relative amount of fruits, vegetables, breads, cereals, rice, legumes, and pasta. • 4.     Use skim or 1% milk. • 5.     Avoid breaded fried foods. • 6.     Eat no more than 2 egg yolks (or whole eggs) per week. • 7.     Use cooking oils that are high in unsaturated fat (e.g., corn, olive, canola, safflower oils) • 8.     Use soft margarines. They contain less saturated fat. • Weight loss. Losing modest amounts of weight (even only 5-10 lbs.) can double the reduction in LDL levels achieved through an improved diet. Weight loss should be achieved gradually by modestly decreasing calorie intake and increasing exercise. • Exercise. Exercise can decrease LDL levels and increase HDL levels to some extent. For example, taking a brisk 30-minute walk or a low-level jaunt on a treadmill 3-4 times a week is likely to positively impact the cholesterol profile. Patients with chest pain and/or known or suspected heart disease should talk to their doctors before beginning any exercise program.

9. There are many different ways to treat high cholesterol like Nonpharmacological Therapy, Diet, Weight loss, Exercise, Statins &Pharmacological(Drug) therapy Standard nonpharmacological therapy mostly consists of adjusting to eating and exercise habits. lowers the LDL cholesterol level by about 30 mg/dL. Diet minimizes extra cholesterol and fat intake, especially saturated fat. Weight Loss, even if losing 5-10lbs. of weight can double the reduction in LDL levels achieved through a diet. Weight loss can be achieved by decreasing your calorie intake and increasing exercise. Statins lower LDL cholesterol levels by 20%-40%. If someone takes maximum doses, they lower LDL levels by 40%-50%. They get a benefit of increasing the amount of HDL ("good") cholesterol level in the body by about 5%-10%. There are two rare but possible side effects connected with these statin medications. The first, mild irritation of the liver, can be detected by simple blood tests (liver function tests, or LFTs)The second very rare side effect is muscle irritation, soreness, pain, and weakness. Treatment for Hyper Cholesterolemia

10. Ongoing Research • Researchers are working on whether patients already taking one of the older types of cholesterol-lowering medications should switch to a statin. They have to consider several things. First, some people are possibly being treated with a different type of medication because the primary lipid problem may not be a high LDL level but some other abnormality, such as a markedly high triglyceride level. Second, if treatment with an older type of medication is working well and the patient is satisfied, there's no reason to change. However, if the person doesn't take the medication regularly because it's hard to remember to take several doses every day, because it has unpleasant side effects, or because it has failed to lower the LDL to an acceptable level, it may be worthwhile to switch to one of the statins. There are two potential side effects associated with these medications, mild inflammation of the liver and muscle inflammation, soreness, pain, and weakness. Research is ongoing on how to reduce these effects. • Occasionally, even with high-dose statin therapy, the LDL level may not decrease sufficiently. Researchers are working on othermedications. These medications, when combined with a statin, may help lower cholesterol to an acceptable level. These drugs include: cholestyramine (LoCHOLEST®, Questran®), colestipol (Colestid®), fenofibrate (Tricor®), fluvastatin (Lescol®), gemfibrozzil (Lopid®), and niacin (Niacinol®, Niacor®, Nicolar®, Slo-Niacin®). Researchers are working on how to dispense these medications without causing adverse side effects like liver malfunction or muscle inflammation.

11. Interview with my Grandfather • October 2, 2001   • 1.      What caused you to have high cholesterol? Hereditary, intake of high cholesterol and fatty food during early part of life till the age of 40. • 2.      When did you find out that you had high cholesterol? Accidentally at the age of 40. Cholesterol was not known let alone the ill effects of it. I had a blackout and during a routine check up the cholesterol and triglyceride were found. • 3.      What were the symptoms? No symptoms, a few yellow marks below the eye. I have never had any symptoms like angina. Only blockage in my coronary arteries for which I needed a bypass surgery. Right artery 95% and 70%, central 100% and left 95% blockage. Extreme left was clear. • 4.      How are you treating this disease? Simvastatin 10 and walking for an hour everyday. Strictly fat free diet with cholesterol intake of 100 mg/day. • 5.      How serious is this disease? Fairly serious since I have completed 10 years after coronary artery bypass surgery. • 6.      Is there any research being done to find a better cure for this disease? Yes in the U.S. • 7.      At what age do people normally get this disease? How many people get this disease? In their 40’s. Stress and strain from the age of 30 managing an industrial workshop, working long hours caused the exacerbation of this disease. Many people get this disease. • 8.      How has this disease changed your life? This has restricted my normal activities to a great extent. I could only reduce the stress and strain of work after my retirement to a great extent and I have to lead a very regulated life.