Lipitor, a cholesterol-lowering statin, remains the number one best selling drug bringing in $7.2 billion for 2012 even though it has been replaced by Vicodin as the most commonly prescribed drug. Another statin medication, generic Zocor (simvastatin), takes the number two spot for the most prescribed drug in 2012 with 94.1 million prescriptions due to its lower cost than Lipitor. With the increasing number of patients being prescribed expensive statins that require additional patient monitoring with an extensive side effect profile (muscle pain, liver damage, digestive problems, rash) and numerous drug interactions, one wonders why so many Americans are being prescribed statins and is it always medically necessary?
High cholesterol is a major risk factor in the development of artherosclerosis, the hardening and narrowing of arteries. The arteries work to pump blood all throughout the body from the heart. High cholesterol, high blood pressure, and smoking can all damage the endothelium (lining of arterial wall) allowing LDL “bad” cholesterol to enter through the wall and form a plaque. Plaques decrease blood flow through the arteries, and can cause chest pain (angina). A ruptured plaque can cause a blood clot resulting in a heart attack, stroke, or peripheral vascular disease – collectively known as “cardiovascular disease” (the number one cause of death in America).
Statins work by inhibiting an enzyme, HMG-CoA reductase, in the liver that is responsible for the production of cholesterol. Statins can lower LDL (“bad”) cholesterol by more than 30%, and physicians must consider the patient’s baseline lipid panel and other risk factors for developing cardiovascular disease when deciding on how to treat hyperlipidemia, an excess of lipids found in the blood usually caused by a lipoprotein metabolism disorder from lipoprotein overproduction. Physicians may prescribe lifestyle changes over statin drug therapy depending on the goal LDL reduction – triglycerides are only targeted first in drug therapy when in the “very high” category or still “high” after LDL goal is reached (see table below). In order for patients to understand how to take control of their own therapy, one must understand the difference between good and bad cholesterol and what numbers to be looking for during health screenings.
Cholesterol tests are usually repeated once every five years for prevention. The lipid panel is more accurate when the patient is fasting for 9 to 12 hours beforehand.
- HDL (high-density lipoprotein), also known as the “good” cholesterol act as “scavengers” for excess LDL cholesterol in the body by picking LDL up and breaking it down in the liver. Elevated HDL levels are a negative risk factor for cardiovascular disease.
- Ways to increase HDL levels: aerobic exercise; smoking cessation; elimination of trans fats from the diet, increasing the intake of fruit, vegetables, and monounsaturated “healthy” fats; and only a moderate consumption of alcohol (maximum of 2 drinks per day for men and 1 for women).
- Falsely elevated HDL level results from birth control pills and alcohol; drugs that decrease HDL levels: beta blockers and anabolic steroids.
- LDL (low-density lipoprotein), also known as the “bad” cholesterol for contributing to plaque formation in the arteries. The higher the LDL level, the higher the risk of developing cardiovascular disease.
- Triglycerides are a chemical form of fat found in the blood where a higher level is associated with an increased risk of cardiovascular disease. They can be pretty “ugly” in patients with diabetes that have a characteristically higher triglyceride level with usually only a marginally elevated LDL level.
If cholesterol is minimally elevated, diet and exercise changes may be advised before starting drug therapy when the benefits of the medication do not outweigh the risks. Preventing high cholesterol through lifestyle changes and regular cholesterol testing along with knowing your family history for cardiovascular disease should be a national concern to decrease the costs of medical care and more importantly, decrease patient morbidity and mortality.
- Talbert RL. Hyperlipidemia. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM (eds) Pharmacotherapy: A pathophysiologic approach. 7th edition, 2008; 385-407.
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.
Changing up my usual green morning smoothie, I decided to try a different protein base using goji berries. The goji berry, also known as the “wolfberry”, is packed with antioxidants that may aid in slowing the aging process and in preventing cancer. One serving containing 1/4 cup of dried goji berries (roughly a large handful) has 104 calories, 4 g of protein, 1 g of fat, 4 g of fiber, and is rich in essential vitamins and minerals (mainly vitamin A, vitamin C, iron, and calcium). I also added 1 tbsp of hemp seeds for a healthy dose of omega-3 fatty acids and an additional protein boost.
Caution: Goji berries may interact with certain prescription medications such as blood thinners (i.e. warfarin) or some diabetes medications.
- 1 cup of unsweetened almond milk
- 1 banana
- 1/4 cup dried goji berries
- 1/4 – 1/2 cup strawberries
- large handful of spinach
- 1 slice of fresh pineapple
- 1 tbsp hemp seeds
- 4-5 ice cubes
- stevia as needed for sweetness
Sometimes explaining the many forms of vegetarianism is even more confusing to people than itemizing what you actually do consume or avoid. Limited lacto-vegetarian, but a lacto-ovo-vegetarian only when eating Mom’s baked goods and a pollo-vegetarian once Thanksgiving rolls around… anyone following? So, to try to classify myself has been a challenge as well as finding a diet that studies support and perhaps most importantly, that works for both my beliefs and my body. After being a vegetarian (lacto-vegetarian to be exact) for about six years, I have found that adding fish (pesce-) and eggs (ovo-) for other forms of protein and healthy fats, mainly omega 3 fatty acids, with limiting dairy has worked best for me. The once villainized egg for its cholesterol content is packed with other essential nutrients such as protein, iron and carotenoids; furthermore, eating one egg daily is still within the American Heart Association’s guidelines for daily consumption of cholesterol. I sometimes describe myself as a fegan, a vegan that eats fish or a faux vegan.
It has been fun to experiment with different recipes for seasoning fish or finding salsas or sauces for added flavor with a variety of fish. I find cod to not have a particularly “fishy” taste, and it contains a lower level of mercury compared to other commonly consumed fish. Here is a quick and easy baked cod recipe below along with balsamic roasted vegetables as a side.
Balsamic Roasted Vegetables
- 1 bag of brussel sprouts, halved and stems cut off, may also remove outer leaf
- 3 carrots, peeled and sliced into rounds
- 1/4 white onion, sliced
- 2 tbsp balsamic vinegar
- 1 tbsp extra virgin olive oil
- sea salt and fresh ground pepper to taste
Preheat oven to 400°F and line a baking pan with aluminum foil. Whisk together the dressing and drizzle onto vegetables in pan. Cook for 20-25 minutes, stirring occasionally to flip vegetables.
Baked Cod with Dijon Mustard
- 1 cod fillet
- 1/2 – 1 tbsp Dijon mustard
- drizzle of extra virgin olive oil
- 1/4 tsp parsley
- 1 lemon wedge
- sea salt and fresh ground pepper to taste
Preheat oven to 425°F. If thawing a frozen filet, first squeeze out excess water and pat dry with a paper towel. Drizzle the fillet with olive oil and season with salt and pepper. Brush on the mustard and bake for about 10 minutes or until filet easily flakes with fork. (My fillet from Whole Foods was very thin, and was easily done in 5-7 minutes so beware of cooking too much!). Season with parsley and serve with lemon.
When looking for symptom relief from allergies, the common cold, or the flu and depending on the patient’s specific needs, I recommend trying nonpharmacologic treatment options such as using a humidifier especially in the case of infants and small children where cough and cold products are not recommended for use. Humidifiers can help soothe airways by adding moisture to inspired air. With the numerous options available on the market, there is a lot of confusion over whether to try a warm or cool mist humidifier, vaporizer, or if distilled water is needed. Below are some pros and cons of each to help you make the best selection.
A vaporizer is a type of humidifier that contains a cup for medicated liquid that will emit a medicated vapor. Depending on the brand, an anesthetic such as menthol or camphor is used which is not recommended for young children under 2 years of age. Medicated liquids such as Vicks® VapoSteam® and inhalant pads such as Vicks® VapoSteam® can be purchased separately or are sometimes included with warm mist humidifiers.
When it comes to stuffy noses, cooler air will not make nostrils swell up as with warm moisture that would make it even more difficult to breather over the congestion. Cool moisture humidifiers can be evaporative by using a wick with antimicrobial (kills bacteria) properties that draws up water and has a fan to blow the treated water into the air. Impeller humidifiers use a rotating disk that dispenses water droplets into the air while ultrasonic humidifiers use ultrasonic vibrations. Distilled water should be used unless the humidifier has a cartridge or wick that demineralizes regular water. Ultraviolet technology, that is used in both cool or warm humidifiers, also works to kill 99.9% of germs in the water. They are also typically silent, and have no risk for injury if knocked over.
The steam in warm moisture humidifiers is created by either adding boiled water (can add medicated liquids) or electrically boils water (allows for use of medicated pads). These humidifiers are simpler and usually cheaper than the cool mist. Medicated inhalants or pads can be added for extra congestion relief.
Instructions & Cleaning
Overly humidifying the air can result in an increase in mold production. The goal range for a safe humidity level is 40-60% to kill off bacteria and air-borne viruses without promoting mold growth or dust-mites. Follow the manufacturer’s specific instructions for cleaning the product, but water should be changed daily in all and products disinfected weekly.
“Update in managing cough, cold and flu.” Pharmacist CE Lession, September-October 2012.
This dish coincides with my current love affair with cauliflower. It was also inspired by a recent trip to Proof, a wine bar and restaurant near the Verizon Center in D.C., that I finally had the chance to check out before I headed over to watch a Washington Capitals game. As a side dish (of course along with a great glass of Cabernet Sauvignon), I tried the caramelized cauliflower with lemon, tahini, and mint. Tahini is most commonly known for being used to make hummus and is a paste made from ground sesame seeds, so it is vegan. It is a good source of healthy unsaturated fats (the kind that lower cholesterol), fiber, and essential vitamins (riboflavin, folate) and minerals (copper, iron, phosphorous). I have been making this creamy dressing at least once a week since then! For a quick lunch today, I used a variety of vegetables for this stir fry and made a variation on the dressing by improvising with what I had in my kitchen.
- 1/2 head of cauliflower, cut into florets
- 1/2 small head of broccoli, cut into florets
- 1/2 green pepper, sliced
- 1/4 white onion, sliced
- 3 small carrots, peeled and sliced
- 1 tbsp olive oil
- 1 tsp minced garlic
Heat oil in a large frying pan on medium heat; then, add sliced vegetables and garlic. Saute until softened. (Depending on your available time, you can also bake vegetables in the oven on a baking sheet, coating with olive oil first.)
Lemon tahini dressing
- 1 tbsp of tahini
- 1 1/2 tbsp lemon juice
- 1 tbsp of water
- 1 tsp minced garlic
- ground black pepper to taste
- paprika to taste for extra spice (other seasonings to try are cumin, parsely, or cayenne pepper)
- * can add additional water or olive oil to thin it out if desired
Makes 2-3 servings.