Past Feature Article

Cholesterol Basics.

Written by: Melissa Szymczak, R.Ph., Pharm.D.
Rite Aid Pharmacist and Clinical Program Manager

Managing diabetes certainly is not easy. In addition to keeping your blood glucose at target levels, it is just as important to know each of your cholesterol numbers and meet the goals you and your health care team establish. Diabetes itself increases your risk for heart disease and having high cholesterol significantly adds to that risk.

What is cholesterol?

Cholesterol is a fatty substance that is made in the liver and released into the blood stream in response to numerous factors, including the foods you ingest. Low-density lipoprotein (LDL) or the “bad cholesterol” can deposit and build up in your blood stream leading to plaque formation and an inflammatory response that directly contributes to cardiovascular disease. Keeping your LDL cholesterol as low as possible, is therefore very important. High-density lipoprotein (HDL) is the “good cholesterol”, as it clears LDL cholesterol out of your tissues and blood, to help prevent heart disease. A third type of cholesterol or lipid you should know about is called triglyceride. High triglycerides can also contribute to heart disease.

What are your goals?

The national recommendations for cholesterol goals are established from large clinical trials that demonstrate that lower cholesterol numbers reduce a person’s risk for having a heart attack, being hospitalized, or even dying from heart disease. Since people with diabetes are considered at “high risk” for heart disease, and people with diabetes and heart disease are considered “very high risk” for future cardiovascular events, the following recommendations have been established:
LDL cholesterol goals: At least less than 100 mg/dL! Less than 70 mg/dL if you already have heart disease & diabetes or for greater protection against heart disease.
HDL cholesterol goals: Greater than 40 mg/dL for men
Greater than 50 mg/dL for women
Triglyceride goals: Less than 150 mg/dL
Total cholesterol goal: Less than 200 mg/dL, but knowing each of your cholesterol numbers is much more important!

How often should you have your cholesterol tested?

Adults with diabetes should have their cholesterol tested with a full lipid panel at least annually. Children with diabetes should be tested after diagnosis and again once they reach their blood glucose goals. Children with cholesterol levels below goal and no family history of cardiovascular disease should be retested every five years. If you are on cholesterol-lowering medications, you should have your cholesterol tested more frequently, to make sure you are on the right medication(s) and the right dose(s).

How is high cholesterol treated?

TLC! Therapeutic lifestyle changes are most important for reducing total and LDL cholesterol levels. TLC includes the following components:

Reducing your intake of saturated fats to less than 7% of your total calories
Consuming less than 200 mg/dL a day of cholesterol from food
Weight reduction to your ideal body weight
Physical activity- try to build up to 30 minutes every day!

If TLC does not get you to your cholesterol goals within a few months or if your LDL cholesterol is higher than TLC alone can help (usually about greater than 135 mg/dL), cholesterol-lowering medication is necessary.

Cholesterol Medications

HMG Co-A Reductase Inhibitors or “Statins” are most commonly used to lower cholesterol levels and are the best at reducing LDL or “bad” cholesterol. They also increase your HDL or “good” cholesterol and reduce your triglycerides. Statins have been shown to significantly reduce your risk for heart disease even if your cholesterol levels are low before starting therapy. Drugs in this class include:

atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor).

For people who cannot take Statins, or those needing a second cholesterol-lowering medication to reach their goals, bile-acid resins can be used to lower LDL levels. They increase HDL levels just slightly, but have no effect or may actually increase triglyceride levels. Drugs in this class include cholestyramine (Prevalite, Questran Light), cholesevelam (Welcol), and colestipol (Colestid). These drugs can interfere with other drugs absorption, so be sure to ask your Rite Aid Pharmacist about possible drug interactions before filling your prescription.

If you have very high triglyceride levels, you may need to take a fibrate, such as gemfibrozil (Lopid), clofibrate (Atromid-S), or fenofibrate (Tricor). Niacin also lowers triglycerides, and increases HDL cholesterol and lowers LDL cholesterol. Since there are a number of side effects associated with the various formulations of niacin, it is very important to consult with your physician or Rite Aid Pharmacist before starting niacin therapy.

There is also a new cholesterol-lowering medication available called ezetimibe (Zetia), which works by reducing the amount of cholesterol absorbed from your digestive track. Because it works differently from all of the other cholesterol-lowering medications, Zetia is a good second therapy when you are unable to reach your LDL cholesterol goal with one medication alone.

Just remember- no medication is a magic-bullet for preventing heart disease all by itself!! Preventing heart disease requires a lot of TLC. You must continue to eat healthy, engage in regular physical activity, maintain your ideal body weight, keep your blood glucose levels at your target levels, and keep your blood pressure under control. That’s a lot to remember and you may not be able to do it alone! Use your health care team, including your Rite Aid Pharmacist to assist you along with way!