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Why & How You Should Manage Your Cholesterol

Written by: Michele Seifert, Pharm.D., R.Ph., Rite Aid Drug Information Specialist

Diabetes is often associated with multiple risk factors for cardiovascular disease, such as high blood pressure and high cholesterol. Cardiovascular disease can lead to heart attacks and strokes. Heart disease and stroke account for roughly 65% of deaths in people with diabetes.¹ That means that an adult with diabetes will have a death rate from heart disease that is 2 to 4 times higher than an adult who does not have diabetes.¹ The risk of having a stroke is also 2 to 4 times higher and the death rate is 2.8 times higher than people without diabetes.¹ Controlling your cholesterol can help lower your risk of cardiovascular disease.

Cholesterol is a fat-like substance that is important to the body for the production of hormones, vitamins, cell membranes and tissues. It also helps with digestion. Your body will produce a sufficient amount of cholesterol in your liver to meet these needs. Cholesterol is also found in various foods from animal sources such as meat, fish, poultry, egg yolks, and whole-milk dairy products. Too much cholesterol can lead to problems such as a condition called diabetic dyslipidemia. This increases your risk for a heart attack or stroke.

Types of Blood Lipids

Low-density lipoproteins (LDL) – often called "bad" cholesterol, can cause narrowing and blocking of the blood vessels.
High-density lipoproteins (HDL) – often called "good" cholesterol, can remove deposits from the blood vessels and prevent blockages.
Triglycerides – a blood lipid that is the main form of fat that exists in the body and can increase the risk of a heart attack or stroke.

People with diabetes often have low HDL, high triglycerides and high LDL that is unusually dense and small which can harm blood vessels. These factors increase the risk of a heart attack or stroke. Therefore, it is important to have your blood lipids checked regularly. Studies have shown that lowering the LDL in a person with diabetes can decrease the risk of a heart attack by up to 42% and reduce cardiovascular complications by 20-50%.^1,2 The American Diabetes Association (ADA) recommends that blood lipids are checked at least once a year.

Target Levels

Blood lipid recommendations may vary for each person. In general, the ADA recommends:

LDL – below 100mg/dl (if you have other cardiovascular risk factors the recommendation may be below 70mg/dl)
HDL – above 40mg/dl for men and above 50mg/dl for women
Triglycerides – below 150mg/dl
Total Cholesterol – below 200mg/dl

Treatments

Unfortunately, there is no quick and easy solution to treat diabetic dyslipidemia. In order to manage blood lipid levels, a combination approach is used consisting of lifestyle changes and medication therapy.

Lifestyle Changes

1. Follow a diet low in cholesterol, and saturated and trans fats
   • Limit saturated fats, which are found in fatty meats, butter, ice cream, 2% or whole milk, poultry skin, palm oil, hydrogenated oils, coconut oil, shortening, or lard to less than 7% of your total calories
   • Minimize trans fats
   • Eat low-fat or fat-free dairy products
   • Eat lean meats/meat substitutes such as lean beef, chicken without skin, boiled ham or pork tenderloin
2. Increase fiber and healthy fats in the diet
   • Eat two or more servings of fish per week, which contain healthy fats
   • Eat healthy fats found in olive, canola, corn, sunflower or safflower oils
   • Add soluble fiber such as oats, fruits, vegetables, dried beans and peas to your diet
3. Utilize low-fat cooking techniques
   • Bake, roast or grill foods using cooking sprays and nonstick pans
4. Maintain a healthy weight
   • Lose weight (if necessary) by decreasing calories and fat in the diet
5. Quit smoking
6. Be physically active
   • Start exercise programs gradually and always check with your physician before starting a new program
   • Set a goal of 30 minutes of aerobic exercise most days of the week
7. Limit alcohol intake
   • When drinking, women should limit alcohol to 1 serving and men to 2 servings per day
   • One serving is equal to 12 oz. of beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits
   • Remember alcohol can not only effect your lipid levels, but also your blood glucose levels; monitor levels closely

Medication Therapy

1. HMG-CoA reductase inhibitors ("Statins") – increases HDL, and decreases LDL and triglycerides
2. Fibric acid derivatives ("Fibrates") – increase HDL, decrease triglycerides, and may increase, decrease, or have no effect on LDL
3. Cholesterol absorption inhibitors – increases HDL, and decreases LDL and triglycerides
4. Nicotinic acid (Niacin) – increases HDL, and decreases LDL and triglycerides
5. Bile acid sequestrants – increases HDL, decreases LDL, and may increase or have no effect on triglycerides

This treatment strategy may seem overwhelming at first, but remember your diabetes healthcare team is available to help you manage your cholesterol levels and reduce your cardiovascular risk. Your doctor can help you determine an appropriate level of physical activity and if you require medication therapy. A dietician is a good resource for suggesting dietary changes. Your Rite Aid Pharmacist can also help provide you with information on cholesterol medications and answer any questions that you might have. With so many great resources available, you can take control of your cholesterol levels and improve your overall health!

¹ American Diabetes Association website. Accessed 2/23/07 [9 screens]. Available from: http://www.diabetes.org/diabetes- statistics/
complications.jsp.

American Heart Association website. Accessed 2/23/07 [4 screens]. Available from: http://www.s2mw.com/heartofdiabetes/cholesterol.html.

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