Cholesterol Guidelines

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Rubber duckies are evil. Erectile dysfunction is bad in more ways than you would think. All this and much more were released in the new 2009 Dyslipidemia guidelines! These are what your doctor reads to see how the experts in the field recommend that he or she treats your high cholesterol. The Guidelines are a big document, so I’m going to focus on two parts. Who should get their cholesterol tested and something called Apo-B.

Who should get their cholesterol levels tested? The first group includes any male over 40 (I’m getting close), and any female over 50 or who is in menopause. It is nice the guideslines were more specific about exactly who should get tested, but these recommendations weren’t surprising. Us guys probably start getting fatty streaks in our arteries in our teens or twenties due to poor diets and lack of exercise. By the time we hit 40, our doctors should start testing our cholesterol because those fatty streaks in our arteries may have started to partially block them. You women have estrogen in you to protect the lining of your blood vessels for a decade longer than us guys.

The next group of people that should be screened might be a little more surprising. This is not the complete list, but cholesterol testing is recommended in any adult who: has diabetes, is a current smoker, has high blood pressure, has obesity, or has erectile dysfunction. All of these conditions, yes even erectile dysfunction, can be signs of damage to the lining of your arteries or to the very small blood vessels in your body. Any of the above conditions increases your risk of a heart attack or stroke. This is why your doctor should keep an eye on your cholesterol.

This year the Guidelines talked a lot about Apo-B. Now I don’t want to confuse you. The Guidelines still says the number one indicator we should follow is LDL. LDL is the famous “bad cholesterol”. HDL is the famous “good cholesterol”. These are still the most important markers. But they are still markers. Remember we don’t really care about your cholesterol. What we want to do is reduce your chance of heart attack and stroke. Cholesterol is just a surrogate marker of your cardiovascular risk.

Another marker you will probably hear more about soon is called Apo-B. Apo-B’s full name is Apolipoprotein B. Remember LDL or bad cholesterol and HDL or good cholesterol? Well LDL’s full name is low density lipoprotein and HDL’s is high density lipoprotein. Although we talk about cholesterol floating around in your blood, that isn’t really how it works. Just like oil doesn’t mix with water, cholesterol alone doesn’t mix with blood. Cholesterol (a lipid) must be attached to a protein to form a lipoprotein for it to stay in your blood. There are a lot of different lipoproteins like chylomicrons, very-low density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low density lipoprotein (LDL), or high-density lipoprotein (HDL). All lipoproteins except HDL (remember the good cholesterol) have a particle of Apolipoprotein B in them. So counting the number of particles of Apo-B in someone’s blood sample is another way to access cardiovascular risk.

Traditional measurements of LDL actually weighs the amount of LDL cholesterol in a blood sample. This is still the gold standard for assessing risk in someone who isn’t on any cholesterol medications. LDL levels of less than 2.0 mmol/L is still the goal the doctors are trying to reach when they put you on a cholesterol medication. But, the guidelines say doctors could look at your Apo-B levels too when they are trying to figure out if they have you on the right dose of your cholesterol medication. The Apo-B level to shoot for is less than 0.8 g/L.

In some cases, Apo-B may be more useful to see how someone on a cholesterol treatment is doing than LDL. First remember that rubber duckies are evil. So, LDL is measured by weight. Let’s pretend low density lipoproteins are evil rubber duckies filled to bursting with oil. The doctor orders an LDL test and we weigh the evil oil filled rubber duckies and we get a number. Then, the doctor puts you on a cholesterol pill and in 6 months measures your LDL again. The number is lower. That is good, right? Well, since we just weighed the evil rubber duckies, we don’t know if we have less evil rubber duckies, or if each evil rubber ducky just dumped some oil out. To keep track of the evil rubber duckies, it would be better to count them. So in our world, Apo-B is the bill on the rubber ducky. To do an Apo-B test we draw out some blood, put all the evil rubber duckies in a blender and count the number of duck bills that come out. This way we can count how many evil rubber duckies we have.

So count your evil rubber duckies. Remember erectile dysfunction puts you at higher risk for heart attacks and stroke. And have a Merry Christmas.

For more info on Cholesterol Guideline visit:
www.ccs.ca/download/consensus_conference/consensus_conference_archives/2009_Dyslipidemia-Guidelines.pdf

As always if you have any questions or concerns about these products, ask your pharmacist.