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Bad cholesterol could pose bigger problems for those with diabetes

SPRINGFIELD — The news about cholesterol just got worse, especially for those who suffer from type 2 diabetes, according to Baystate Medical Center.
In a study published in a recent issue of the journal “Diabetes,” researchers found something they are calling “ultra-bad” cholesterol, which is stickier than normal bad cholesterol, known as LDL, and more likely to attach itself to a person’s arteries.
“Patients with diabetes and pre-diabetes are particularly susceptible to developing this type of ultra-bad cholesterol,” Dr. Saby Sen from the Department of Endocrinology, Diabetes and Metabolism at Baystate Medical Center, said.
According to Sen, the dangerous ultra-bad cholesterol is formed by adding sugar groups (glycation) to bad cholesterol or LDL.
“The process changes the shape and character of LDL making it smaller, denser and stickier, rendering it more likely to penetrate into blood vessel walls. The result is the formation of plaque and ultimately blockage of narrowed arteries resulting in stroke and heart disease,” he said.
High blood cholesterol is one of the major risk factors for heart disease, the number one killer of men and women in the country. Many risk factors contribute to having high or low cholesterol, including heredity, diet, lack of exercise, overweight, age and sex, alcohol and stress levels. Also, racial and ethnic minorities, including African Americans and Hispanics, are at greater risk for developing high cholesterol.
All adults should have their cholesterol measured, to know their cholesterol numbers and their risk for heart disease, and to follow a heart-healthy lifestyle to lower their risk and keep it down, Dr. Aaron Kugelmass, chief, Division of Cardiology, Baystate Medical Center, noted.
He said lowering bad cholesterol (LDL) is an important factor in helping to prevent heart disease. “At one time doctors simply measured total cholesterol levels for management, but we’ve known for a while now that the breakdown of its components, including low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglycerides is very important,” Kugelmass said.
It is now equally important to know the levels of good (HDL) and bad (LDL) cholesterol. The levels of each can greatly impact one’s risk for heart disease.
If a person’s total cholesterol is 200mg/dL or more, or if his or her HDL is less than 40 mg/dL, a lipoprotein profile should be done to further assess that person’s risk and the need for treatment. The higher the HDL number the better since “good” cholesterol protects against heart disease. Any level less than 40 mg/dL is considered a major risk factor for developing heart disease, while levels of 60mg/dL or more can help reduce a person’s risk.
Lower LDL “bad” cholesterol numbers are better since it is the main source of cholesterol buildup and blockage in the arteries. Less than 100mg/dL is optimal, but if those who have cardiovascular disease, peripheral vascular disease, or diabetes, their doctors may recommend lowering LDL to 70mg/dL or less. While at the other end of the scale, 160 to 189 mg/dL is high and 190 mg/dL and above is very high.
When blood contains too much LDL cholesterol, it builds up in the artery walls. Over time, this buildup causes the arteries to harden and become narrowed, resulting in slower blood flow to the heart or even a complete blockage.
Blood carries oxygen to the heart, and when insufficient amounts of blood and oxygen reach the heart, chest pain may occur. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.
High blood cholesterol does not have any symptoms and most people are unaware of their high levels. Lowering high cholesterol levels lessens the risk for developing heart disease and reduces the risk of heart attack or dying of heart disease.
While this is true for all patients, it is particularly true for those with known coronary artery disease, all patients with diabetes, and those with peripheral vascular disease, including patients who have had strokes.
Heart disease and stroke are the leading causes of death and disability among people with type 2 diabetes. In fact, at least 65 percent of people with diabetes die from some form of heart disease or stroke, according to the American Heart Association.
    For anyone who wants to reduce his or her risk of developing heart disease or diabetes, Kugelmass offers the following simple steps:
  • Get a fasting lipoprotein profile to find out what your total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride numbers are. Adults older than 20 years of age should obtain this test a minimum of every five years. Patients with coronary artery disease, diabetes, or peripheral vascular disease will need to have their lipid profile obtained more often. Patients already being treated for lipid abnormalities will usually have their lipid profiles checked more often and should be checked for diabetes.
  • Ask your physician ways to reduce your risk factors for heart disease.
  • Learn how to read a food label and choose foods that are low in saturated fat, trans fat, and cholesterol.
  • Participate in physical activity of moderate intensity — like brisk walking — for at least 30 minutes on most, or preferably, all days of the week. If you don’t have the time, break the 30 minutes into three, 10-minute segments during the day. One hundred and fifty minutes per week of moderate exercise has been shown to prevent progression from pre-diabetes to diabetes.
  • Don’t smoke. If you do, contact your physician to discuss ways to quit.
  • Reducing saturated fat and cholesterol helps lower blood cholesterol levels. Those overweight are at high risk for heart disease and tend to have increased cholesterol levels and diabetes. Many patients through a combination of exercise, weight control and healthy eating, along with the use of prescription medications like Statins or other lipid lowering agents, are able to successfully lower their cholesterol today.
“Remember, lowering your cholesterol should be approached as a team effort between you and your physician, who together can determine what your target values should be and plan a strategy to achieve them,” Kugelmass said.
Baystate Medical Center offers a Lipid Management Program for patients interested in guided help in making the right lifestyle changes to lower their cholesterol.
The program is staffed by an experienced and supportive team of cardiologists, an endocrinologist, a nurse practitioner, and a registered dietitian, who specialize in evaluating and treating people with high cholesterol. Participants are tested for their lipid levels and receive counseling from a team on lifestyle changes and medicine that can lower their levels to a heart-healthy range. Patients must obtain a referral for the program from their primary care physician.
“Our goal is to help people get motivated to make positive lifestyle changes. We identify problem areas that are preventing patients from making changes and counsel them on ways to overcome obstacles and achieve success with exercise, healthy eating and weight loss goals,” Lori Anne Lyne ACNP, a nurse practitioner in the Lipid Management Program, said.
Registered dietitian Allison Roy, from the Department of Food and Nutrition Services at Baystate Medical Center, is part of the Lipid Management Program team.
“We know that eating fish is healthy for you. However, some folks may be wary about eating shellfish because they have heard it is high in cholesterol. The fact is that it is low in saturated fat and can still be included in a heart-healthy diet. But, saying no to liver, which is high in iron and might be good for you, may be a wise decision for some because it is high in cholesterol,” Roy said.
“People think they can’t eat eggs because of the cholesterol in the yolk. But, they have no saturated fat and are a great source of protein. So, even if your cholesterol is challenged and depending on your lab values, you may be able to have three to seven eggs per week,” Roy added.
The Baystate dietitian also noted the preparation of low-fat meat choices, such as chicken, can turn a healthy choice into a cholesterol nightmare if prepared with butter or a cream sauce.
“Frying your chicken and leaving the skin on it can be as bad as eating a hamburger. And, skip the dark meat, it’s higher in fat,” Roy said.
Also, there is some evidence that eating more soybeans and nuts, fatty fish, oatmeal and oat bran, as well as foods fortified with plant sterols or stanols, can actually help control a person’s cholesterol.
To further encourage patients, Lyne said she reminds them their hard work is not just about lowering their cholesterol. “I tell patients that they are making a lifestyle change which is going to improve their overall health and well-being,” she said.
For more information on Baystate Medical Center’s Lipid Management Program, call 794-0849.
For more information on the hospital’s Heart and Vascular Program, visit Bay State Medical Center’s website located at baystatehealth.org/heart.
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