HYPERLIPIDEMIAMANAGEMENT

29/ 1 Jan 200820 November 2008

Chronic Diseases Management Course for Health Educators by

Primary Care Academy

APN Elizabeth Ho Moon LiangMN (Singapore), BSc Nur (Australia)

Objectives

At the end of the session you’ll be able to:

Understand the overview of nursing management for Hyperlipdemia patients

Calculate patient’s risk factors and determine LDL goal level.

Aware of barriers to Statins compliance

Formulate an exercise action plan for Patient

ExerciseHealthy Eating

Medications Smoking Cessation

Overview of Patient Education

Exercise

Healthy Eating

Meds

Patient-Centered Care

Home

Self Monitoring

Money

Moods

Work

Useful Conversion

Glucose: mg/dl to mmol/l divide by 18

LDL and HDL: mg/dl to mmol/l divide by 38.6

TG: mg/dl to mmol/l divide by 88.5

Activity

Case 1

What is the LDL target?

Mdm Wong with diabetes

Mdm Goh with a previous CABG

Mr Tan who has a PTCA done

Mrs Chia who has atrial fibrillation

Mr Heng who has a TIA

Mrs Kong with abdominal aortic aneurysm

Mrs Teo with peripheral artery disease

Mr Tang with COPD

Case 2

Mdm Kong, 62 years old. No significant medical history. Both parents have hypertension and hyperlipidemia. Mother had ESRF on dialysis.

Non-smoker. Does Yoga 3 times a week.

TC: 6.0 mmol/LLDL: 3.8 mmol/LHDL: 1.5 mmol/LBP: 130/ 80 mmHg

1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol ≥ 4.1 mmol/L

2. Cigarette smoking3. Hypertension (BP ≥ 140/90 mmHg or on anti-

hypertensive medication)4. Low HDL cholesterol (< 1.0 mmol/L )5. Family history of premature CHD (Male first

degree relative < 55 yr; Female first-degree relative < 65 year)

6. Age (men ≥ 45 years; women ≥ 55 yrs)7. Indian ethnicity

Case 3

Mr Goh is 62 years old came to screening unit today. No family history.

Smokes 30 sticks a day. Has a background history of COPD.

TC: 5.2 mmol/LLDL: 4.1 mmol/LHDL: 0.8 mmol/LBP: 150/ 80 mmHg

1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol ≥ 4.1 mmol/L

2. Cigarette smoking3. Hypertension (BP ≥ 140/90 mmHg or on anti-

hypertensive medication)4. Low HDL cholesterol (< 1.0 mmol/L )5. Family history of premature CHD (Male first

degree relative < 55 yr; Female first-degree relative < 65 year)

6. Age (men ≥ 45 years; women ≥ 55 yrs)7. Indian ethnicity

Case 4

Mrs Teo is 49 years old came to screening unit today. Sister has IHD at age 64 years old.

Smokes 10 sticks/ day.

TC: 6.0 mmol/LLDL: 4.9 mmol/LHDL: 0.9 mmol/LBP: 130/ 80 mmHg

1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol ≥ 4.1 mmol/L

2. Cigarette smoking3. Hypertension (BP ≥ 140/90 mmHg or on anti-

hypertensive medication)4. Low HDL cholesterol (< 1.0 mmol/L )5. Family history of premature CHD (Male first

degree relative < 55 yr; Female first-degree relative < 65 year)

6. Age (men ≥ 45 years; women ≥ 55 yrs)7. Indian ethnicity

Case 5

Ms Devi is 49 years old came to screening unit today. Sister has IHD at age 64 years old.

Smokes 10 sticks/ day.

TC: 6.0 mmol/LLDL: 4.9 mmol/LHDL: 0.9 mmol/LBP: 130/ 80 mmHg

1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol ≥ 4.1 mmol/L

2. Cigarette smoking3. Hypertension (BP ≥ 140/90 mmHg or on anti-

hypertensive medication)4. Low HDL cholesterol (< 1.0 mmol/L )5. Family history of premature CHD (Male first

degree relative < 55 yr; Female first-degree relative < 65 year)

6. Age (men ≥ 45 years; women ≥ 55 yrs)7. Indian ethnicity

Case 6

Mr Gunthi, 29 years old came to screening unit today. Aunite has IHD at age 52 years old.

Smokes 20 sticks/ day.

TC: 4.0 mmol/LLDL: 3.8 mmol/LHDL: 1.0 mmol/LBP: 130/ 80 mmHg

1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol ≥ 4.1 mmol/L

2. Cigarette smoking3. Hypertension (BP ≥ 140/90 mmHg or on anti-

hypertensive medication)4. Low HDL cholesterol (< 1.0 mmol/L )5. Family history of premature CHD (Male first

degree relative < 55 yr; Female first-degree relative < 65 year)

6. Age (men ≥ 45 years; women ≥ 55 yrs)7. Indian ethnicity

Psyllium(Flax Seed)

Grape Seed ExtractTurmeric Root

Alternatives to Reduce Cholesterol

Red Yeast Rice

Policosanol(sugar cane

Wax)

Fish Oils

GarlicsApple Cider Vinegar

Others: Vitamin C, CoEnzymeQ10, Pantothine, Ginger Root Juice

Royal Jelly

More Alternatives

How SAFE?

What Amount?

Catechin decreased the plasma oxidized LDL concentration without significant change in plasma LDL concentration.

The mechanism of the beneficial effects of green tea on coronary artery disease might result from a decrease in plasma oxidized

LDL.

Green Tea Extract

Green Tea Evidence

(International Heart Journal 2007; 48: 725-732)

Catechins are in vitro and in vivo strong antioxidants. However, although all the evidence from research on green

tea is very promising, future studies are necessary to fully understand its contributions to human health, and

advise its regular consumption in Western diets, in which green tea consumption is nowadays limited and sporadic.

Evidence from systematic review

(Cabrera et al. Journal of American College of Nutrition.2006; 25:79-99.)

Medications Non-Compliance

Fear of side-effects

Do not like being medication-dependent

Wants autonomy

Perception of drug’s effectiveness

Cost

Ability to fit medication regimen into schedules

Desire to take the least amount of medications

Plenty of OTC alternatives or natural ways to reduce cholesterol

Statins Side-effects

Myopathy the considerably rarer but much more serious

complication of rhabdomyolysis are both more likely to occur withhigh dosages of statins.

The incidence of side effects is low, consisting mainly of a rise in the liver enzymes and

myopathy.

The statins are well tolerated by most patients. There are few definite contraindications to their use; reasonable long-term safety has been established

and serious side effects rarely occur.

Myopathy occurs in less than 1% of patients and increased serum hepatic transaminases occurs in less than 2% of patients. The incidence of side effects is dose-dependent and almost always

reversible by withdrawal of the drug.

Statins Side-effects

(Journal of American Academy of Nurse Practitioners, 2003, 13 (5), 200 – 207)

PROTECT YOUR HEART & BRAIN NOW!!

Singapore MOH Recommends LDL (Bad Cholesterol):

A compilation of research of 90,000 patients on anti-cholesterol medications shows

20% less chance of heart problems 20% less chance of stroke

STATINS (anti-cholesterol medicine)

Helps to lower the LDL by 25% to 60%

<1% has muscle diseases <2% result in liver damage Dr will check your liver function Liver enzymes raised due to Statins

can be reversible by stopping the drug

less than 2.6mmol/L

Decrease by 1mmol/L

“ 保护你的心脏和脑!!”

新加坡卫生部推荐糖尿病者 “ 坏” 胆固醇指数保持在

研究显示

减少20%心脏病机率 减少20%中风机率

抑制素(Statins) 降低胆固醇的药物 降低胆固醇 25%到60% <1%会导致副作用如:肌肉疾病及

<2%会导致肝病 医生会按时检查你的肝酶

(ALT/ AST)

2.6mmol/L以下

降低 1 mmol/L

Pitching it Right

Activity

Pitching it Right for Exercise

Increased self-esteem

Increased self-efficacy

Improved psychological well-being

Fewer depressive symptoms

More energy

Reports of less stress and

Fewer “Sick” days

Creative Exercises

Creative Exercises

Resources