Question

The purpose of this discussion to practice using the diagnostic criteria for metabolic diseases to determine if someone may have a metabolic disease and to apply your knowledge to suggest healthy lifestyle changes.

Below is a case study with questions.

Megan just came back from the physician’s office and has the following results:

Height: 5’6”    Weight: 190 lbs

Test	LDL-C	HDL-C	TG	BMI	Waist Girth	Blood Pressure	Fasting Glucose
Values	175	65	220	30.7	36 in	125/80	128
Risk Category

Megan is a paralegal at a private law firm. Her job doesn’t require much physical activity. She is currently sedentary, doesn’t smoke, only drinks socially 1 or 2 days per week on the weekend, doesn’t cook often and goes out to eat for most lunch and dinner meals on a daily basis.

Create your initial post in response to the following:

• Determine Megan’s risk category for each of his test results (Don’t fill in the provided table as it gets cut off. Points will be deducted from your score if do.)
• Which diseases does Megan have risk factors for?
• Could Megan be diagnosed with any diseases based on these results? If so, which disease(s)?
• What lifestyle interventions could you recommend to Megan to improve her health? General answers like a healthy diet and exercise are not sufficient. Use your accumulated knowledge to help you. This may mean reviewing previous lectures or notes as not all of the answers are provided in the Diet and Health lecture.

Answer 1

In general, the higher your LDL level and the more risk factors you have (other than LDL), the greater your chances of developing heart disease or having a heart attack. Some people are at high risk for a heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes (which is a strong risk factor) or a combination
1of risk factors for heart disease. Follow these steps to find out your risk for developing heart disease.
Check the table below to see how many of the listed risk factors you have; these are the risk factors that affect your LDL goal.
Major Risk Factors That Affect Your LDL Goal
❍ Cigarette smoking
❍ High blood pressure (140/90 mmHg or higher or on blood pressure medication)
❍ Low HDL cholesterol (less than 40 mg/dL)*
❍ Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
❍ Age (men 45 years or older; women 55 years or older)
*If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.
Even though obesity and physical inactivity are not counted in this list, they are conditions that need to be corrected.
2How many major risk factors do you have? If you have 2 or more risk Step 2
factors in the table above, use the risk scoring tables on the back page (which include your cholesterol levels) to find your risk score. Risk score refers to the chance of having a heart attack in the next 10 years, given as a percentage.
3Use your medical history, number of risk factors, and risk score to find your Step 3
risk of developing heart disease or having a heart attack in the table below.
Step
1
(Use the Framingham Point Scores on the back page.)
If You Have
Heart disease, diabetes, or risk score more than 20%*
2 or more risk factors and risk score 10-20%
2 or more risk factors and risk score less than 10%
0 or 1 risk factor
You Are in Category
I. High Risk
II. Next Highest Risk
III. Moderate Risk
IV. Low-to-Moderate Risk
*Means that more than 20 of 100 people in this category will have a heart attck within 10 years.
My 10-year risk score is ________%.
My risk category is ________.

Treating High Cholesterol
The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, see the box for your risk category below. There are two main ways to lower your cholesterol:
■ Therapeutic Lifestyle Changes (TLC)–includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
■ Drug Treatment–if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.
If you are in...
Category I, High Risk, your LDL goal is less than 100 mg/dL. You will need to begin the TLC diet to reduce your high risk even if your LDL is below 100 mg/dL. If your LDL is 100 mg/dL or above, you will need to start drug treatment at the same time as the TLC diet. If your LDL is below 100 mg/dL, you may also need to start drug treatment together with the TLC diet if your doctor finds your risk is very high, for example if you have had a recent heart attack or have both heart disease and diabetes.
Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after
3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.
Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans.
Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if
your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the heart-healthy diet for all Americans.
To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.

Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC)
TLC is a set of things you can do to help lower your LDL cholesterol. The main parts of TLC are:
■ The TLC Diet. This is a low- saturated-fat, low-cholesterol eating plan that calls for less than 7 percent of calories from satrated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain
a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing saturated fat and cho- lesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol- lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power.
■ Weight Management. Losing weight if you are over- weight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being over- weight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
■ Physical Activity. Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone.
It can help raise HDL and lower LDL and is especially
important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
Drug Treatment
Even if you begin drug treatment to lower your choles- terol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower
your risk in other ways as well.
There are several types of
drugs available for cholesterol
lowering including statins, bile
acid sequestrants, nicotinic
acid, fibric acids, and choles-
terol absorption inhibitors.
Your doctor can help decide which type of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people. Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid lowers LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Cholesterol absorp- tion inhibitors lower LDL and can be used alone or in combination with statin drugs.
Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.
Foods low in saturated fat include fat-free or 1 percent dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub vari- eties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats, egg yolks, and full-fat dairy products.
Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegeta- bles (such as brussels sprouts and carrots), and dried peas and beans.

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