HYPERLIPIDEMIA

MANAGEMENT

APN Elizabeth Ho Moon Liang

MN (Singapore), BSc Nur (Australia)

29/ 1 Jan 2008

20 November 2008
Chronic Diseases Management
Course for Health Educators by
Primary Care Academy
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
Overview of Patient Education

Healthy Exercise
Eating

Medications Smoking
Cessation
 Patient-Centered Care
Self
Monitoring Moods

Exercise Money

Healthy
Eating Work

Meds Home
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.

1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol
TC: 6.0 mmol/L ≥ 4.1 mmol/L
2. Cigarette smoking
LDL: 3.8 mmol/L 3. Hypertension (BP ≥ 140/90 mmHg or on anti-
hypertensive medication)
HDL: 1.5 mmol/L 4. Low HDL cholesterol (< 1.0 mmol/L )
5. Family history of premature CHD (Male first
BP: 130/ 80 mmHg 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/L 1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol

LDL: 4.1 mmol/L ≥ 4.1 mmol/L
2. Cigarette smoking
HDL: 0.8 mmol/L 3. Hypertension (BP ≥ 140/90 mmHg or on anti-
hypertensive medication)
BP: 150/ 80 mmHg 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/L

LDL: 4.9 mmol/L 1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol
≥ 4.1 mmol/L
HDL: 0.9 mmol/L 2. Cigarette smoking
3. Hypertension (BP ≥ 140/90 mmHg or on anti-
BP: 130/ 80 mmHg 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/L

LDL: 4.9 mmol/L 1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol
≥ 4.1 mmol/L
HDL: 0.9 mmol/L 2. Cigarette smoking
3. Hypertension (BP ≥ 140/90 mmHg or on anti-
BP: 130/ 80 mmHg 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/L

LDL: 3.8 mmol/L 1. Total cholesterol ≥ 6.2 mmol/L or LDL cholesterol
≥ 4.1 mmol/L
HDL: 1.0 mmol/L 2. Cigarette smoking
3. Hypertension (BP ≥ 140/90 mmHg or on anti-
BP: 130/ 80 mmHg 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
Alternatives to Reduce Cholesterol

Psyllium Grape Seed Extract

(Flax Seed) Turmeric Root

Policosanol Red
(sugar cane Yeast
Wax) Rice
More Alternatives

Fish Oils
Garlics
Apple Cider Vinegar
Others: Vitamin C,
Ho
CoEnzymeQ10, Wh w S
at A
Pantothine, Am FE?
Ginger Root Juice ou
nt?
Royal Jelly
 Green Tea Evidence

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.

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

Green Tea Extract
Evidence from systematic review

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.
(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

The incidence of side effects

is low, consisting mainly of a
rise in the liver enzymes and
myopathy.

Myopathy the considerably

rarer but much more serious
complication of
rhabdomyolysis are both
more likely to occur with
high dosages of statins.
 Statins Side-effects
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.

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

Pitching it Right
PROTECT YOUR HEART & BRAIN NOW!! “保护你的心脏和脑!!”
Singapore MOH Recommends
LDL (Bad Cholesterol): 新加坡卫生部推荐糖尿病者
“坏”胆固醇指数保持在
less than 2.6mmol/L
2.6mmol/L以下
A compilation of research of 90,000 patients on
anti-cholesterol medications shows 研究显示
Decrease by 1mmol/L 降低 1 mmol/L

20% less chance of heart problems 减少20%心脏病机率

20% less chance of stroke 减少20%中风机率

STATINS (anti-cholesterol medicine) 抑制素(Statins)

Helps to lower the LDL by 25% to
• 降低胆固醇的药物
60%
<1% has muscle diseases • 降低胆固醇 25%到60%
<2% result in liver damage • <1%会导致副作用如:肌肉疾
Dr will check your liver function 病及
Liver enzymes raised due to Statins • <2%会导致肝病
can be reversible by stopping the
• 医生会按时检查你的肝酶
drug
(ALT/AST)
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