Linda Li

Unit 2
Christen Enos
10/17/14
Cover Note:
Hello, I worked in a pharmacy in New York City over the summer for my first co-op. I
was a pharmacy intern but I am writing as a pharmacist with a doctorate degree. Working
in a fast, busy and crowded city made me realize high cholesterol is becoming an
alarming issue. I am writing an article about the dangers of high cholesterol and a
proposal to help implement ways to help promote healthy life styles to help prevent high
cholesterol. The article, published before the letter was written, will be a summary of a
report that will include statistics, risk factors, and forms of treatments. The article will be
attached to the proposal in order to reiterate the problems associated with high
cholesterol. I am writing this letter to the State Board of Medicine and Pharmacy to seek
help. I am asking the State Board of Medicine and Pharmacy to help make it a priority to
promote high cholesterol awareness to patients. The letter will also include suggestions in
which medical and pharmacy professionals can incorporate in their daily contact with
patients. All medical and pharmacy professionals will receive a copy of the article and
letter via email from the State Boards of Medicine and Pharmacy. Most professionals do
not take the time to explain the dangers of high cholesterol. Therefore most patients do
not know about it until it is too late. When patients are diagnosed with high cholesterol, it
can also lead to other health issues as well. By not spreading awareness, medical and
pharmacy professionals are putting people at risk for not only high cholesterol but other
risks as well.

September 1st, 2014

What is high cholesterol? Why do so many people have high

cholesterol?
Published by Linda Li, PhD

What does high cholesterol do? Why are so many people diagnosed with high
cholesterol? As a matter of fact, what is cholesterol? Cholesterol is a waxy substance that
is found in all cells of your body. Cholesterol comes from two different sources. Your
body makes cholesterol and circulates it throughout the body through blood. Cholesterol
is also found in the food you eat. Having excess cholesterol in your blood can lead to
serious complications. The excess cholesterol will build up and form plaque between the
layers of the artery walls. Thus making it harder for the heart to circulate blood since
there will be less surface area. A decreased surface in the artery will ultimately decrease
the rate at which blood is circulated. If enough plaque builds up blood clots will form.
Blood clots will block arteries that circulate blood to the brain and cause a stroke.
Similarly, when a blood clot blocks an artery that circulates blood to the heart, a heart
attack will follow. Unfortunately, patients do not necessarily know about these conditions
until after it occurs. Therefore it is critical for health professionals to spread awareness of
the dangers of high cholesterol.
There are two types of cholesterol, low density lipoproteins (LDL) and high
density lipoproteins (HDL.) It is imperative to have a healthy balance. Too much of either
types of cholesterol can put a patient at risk for coronary heart disease, heart attack or
stroke. Coronary heart disease arises when plaque builds up inside the coronary arteries.
A patient will have atherosclerosis when plaque builds up in the coronary arteries over

many years. LDL is considered as the bad cholesterol since it builds up in the artery
walls, making them hard and narrow while HDL or good cholesterol takes the excess
cholesterol and brings it back to the liver. A patient with high cholesterol will not have a
healthy level of oxygenated blood. High cholesterol can also be inherited however it is
often caused by unhealthy life styles.
High cholesterol can be prevented if patients are aware of the dangers of high
cholesterol. Most patients do not even know what cholesterol is until they get their blood
results. When patients are told they have high cholesterol, they start to panic. Patients
wonder why they have high cholesterol even though they have no symptoms. The reason
is that high cholesterol doesnt show symptoms. The only way to detect high cholesterol
is through a blood test.
There are a lot of risks that factor into the development of high cholesterol such as
smoking, obesity, poor diet, lack of exercise, high blood pressure, diabetes and family
history of heart disease. Smoking can damage the artery walls making it more likely to
accumulate cholesterol or plaque while lowering the good cholesterol. Having a body
mass index of thirty or greater will put a patient at risk of high cholesterol. Inactivity and
ingestion of food with high levels of cholesterol are also factors that cause an imbalance
of cholesterol levels. High blood pressure is often confused with high cholesterol. High
blood pressure damages the artery walls and can speed the accumulation of plaque, which
in turn can lead to high cholesterol. Diabetes also contributes to the damages of the artery
walls. As briefly stated before, high cholesterol can be inherited putting families with a
history of heart disease at risk. Medical and pharmacy professionals should pay closely
attention to these individuals because they are at risk from the start.

Most patients should strive to have a LDL of 130 mg/dL. Target LDL levels for
patients with other risk factors for heart disease may be 100 mg/dL. The more risks a
patient has the lower the cholesterol level the patient should strive for. For patients who
had a previous heart attack or stroke, it is imperative to monitor LDL levels since they are
at greater risks of another one. Based on data from 2005- 2008, there are about 71 million
adults in the United States who have high cholesterol. That is about 33.5% of the
population in the United States. Most health professionals are not aware about the
statistics nevertheless the patients.
There is an increasing widespread level of LDL with increasing age. 11.7%,
41.2% and 58.2% of the age groups 20-39, 40-64, and 65 and older have high levels of
LDL respectively. It is 58.2% of age group 65 and older! Therefore it is imperative to
take action and help promote high cholesterol awareness. These statistics involving age
groups can be altered if it was based on health insurance. This also means there is a need
for advertisement. Those without health insurance lack professional help overall.
Although high cholesterol is very complicated since there are no symptoms until
it is too late, there are treatments for it. A change in life style choices is very important
such as exercising more, eating healthier food, increasing the intake of fruits and
vegetables and quitting smoking. Medication can be prescribed by a medical professional
depending on each patients individual profile. Common medications include the statin
class drugs to help lower cholesterol. A combination of a statin drug with a cholesterol
absorption inhibitor is often used. The cholesterol absorption inhibitor drug will help
reduce cholesterol by limiting the absorption rate. Therefore it is imperative to promote
awareness even though there is medication to help control cholesterol levels. All

medication, including cholesterol medication, have side effects. Help patients avoid more
complications that may develop due to side effects.

LL Pharmacy INC
50 5th Avenue New York, NY
Linda Li, PhD
(646) 637-7951
lindali@llpharmacy.com

October 17th, 2014

State Board of Medicine of New York
State Board of Pharmacy of New York

To whom it may concern,

Hello, my name is Linda Li. I am a pharmacist in Manhattan. I am overly
concerned with the lack of awareness about high cholesterol amongst patients. I highly
suggest a reform of the priorities medical and pharmacy professionals uphold. 33.5% of
adults in the United States have high cholesterol. That is roughly one in three people!
58.2% of the age group 65 and older have high levels of LDL. That is over half the
population of people 65 and older! This is a serious problem that most professionals
overlook. I highly recommend medical and pharmacy professionals should promote
awareness and healthy life styles in their daily contact with patients to prevent statistics
from going up. The United States cannot afford to have more people affected by high
cholesterol. Treatment and diagnosis is very expensive especially when high cholesterol
can be preventable.

I suggest medical professionals to start handing out food pyramids every time a
patient visits the hospital or medical office. As patients are waiting for a medical
professional to see them, patients would something to look at. The majority of the
population is unaware or will not come across the food pyramid at all. The only time I
recall seeing the food pyramid is in textbooks. The food pyramid can provide a lot of
helpful information about the daily portions of food that should be incorporated to have a
balanced diet. When patients get their medication at pharmacies, there should be a food
pyramid poster, in case patients did not get a chance to see it before.
Blood tests are the only way to detect high levels of cholesterols or levels that are
approaching high. There are no symptoms for high cholesterol. Therefore, I suggest
medical professionals to highly encourage patients to get blood tested annually. For
patients with a family history of heart disease, encourage more frequent blood test to help
monitor cholesterol levels. Also keep records of these patients at higher risks and call to
remind them about blood tests. By doing so, patients will be more alert about the dangers
of high cholesterol. Medical professionals can also inform patients if they are close to
having LDL levels of 130 mg/dL. For patients with more risk factors, they should be
alerted when their LDL levels are close to 100 mg/dL. For these patients, there should be
an emphasis on healthier life style choices.
As mentioned in the article, there is an increasing LDL level with increasing age
group. Therefore medical and pharmacy professionals should pay close attention to age
groups at higher risk. Therefore patients who are older should be recommended blood
work frequently. People without health insurance is also at risk. I also suggest medical
offices or hospitals to reserve a day for free or reduced cost for blood exams or regular

check ups. Another suggestion is a health fair in which pharmacy professionals can also
participate as well.
There are different ways to promote healthy life styles. Start recommending ways
to increase activity. When patients think of exercising they think of running. Walking,
biking, swimming, playing sports, yoga and etc. are other alternatives to running that are
just as effective to increase activity. It is important for medical professionals as well as
pharmacy professionals to help promote healthier diets. Try asking patients what they ate
last night for dinner, what they ate for lunch or what they ate for breakfast. If patients say,
I ate a bacon double patty cheese burger, it should be a flashing alert to medical and
pharmacy professionals. Recommend alternatives to fatty foods. Give ideas like veggie
milk shakes, fruit shakes, roasted almonds, pretzels with hummus, fruit salads, grilled
salmon, salads, chicken breast and etc. Also try recommending brown rice instead of
white rice. Also it is not a good idea to ask patients to go cold turkey. It should be a
gradual change to healthier alternatives.
In the pharmacy, pharmacy professionals should make sure patients are
compliant. Pharmacy professionals can go over directions and duration with the patient.
Most patients take the medication until they feel better even though they are directed to
take the medication for a few more days. Although patients feel better, there may still be
traces of clots of plaque in the walls of the artery. It is not fully treated. It is imperative to
remind patients that they should take the medication as directed. Complications may
occur as a result of noncompliance and chronic diseases may develop. These are just
some suggestions that I recommend for medical and pharmacy professionals to
incorporate to help raise awareness of high cholesterol. I am not asking for a new law but

if reminders were sent out frequently to all members of the state board, it would help
decrease the statistics of high cholesterol. Thank you in advance.

Best,
Linda Li