The Pulse: Risk Factor Modification – Cholesterol and Smoking

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As I alluded to in my last article, part of risk factor modification is about the plaque. Plaque is mostly cholesterol. So it’s easy, don’t eat fats! Simple! That’s what everyone says. I remember a time, not long ago, when we all ate eggs. Then there was the cholesterol scare of 1980, and all of a sudden we weren’t supposed to eat eggs. Nowadays, eggs are okay to eat again. Confused? Me too.

Cholesterol, Workplace of a doctor. Stethoscope on wooden desk backgroundThere are good fats, bad fats, trans fats, fish oils…how do you keep it all straight? For years, data has accumulated regarding the role of blood lipids and cholesterol in plaque formation and subsequent arterial disease, whether it’s HDL, or “good cholesterol,” or LDL, “bad cholesterol.” The role of this blog is not to provide an exhaustive source for lipid management. Rather, it is to allow you a platform to have discussion with your primary care provider regarding appropriate blood lipid management. It is likely that all individuals over the age of 50 should have their lipids drawn and discussed.

A Word About Statins

As a group of medications, statins have a particular role in plaque formation and anti-inflammatory properties. In fact, Blue Cross of Michigan’s Vascular PAD Consortium believes that all patients who undergo a vascular procedure should be started on a statin. Like all medications, there are numerous statin options available. Side effects, while low, can occur. Most often, medication adjustments can be done to ensure that most people can tolerate the medication successfully.

This next section is likely to create anxiety in those who continue to use tobacco. Smoking is a principle cause of plaque formation and the development of PAD. If we look at the current strategies regarding smoking cessation, we know that most of the current campaigns focus on lung- and respiratory-related problems. Lung cancer, COPD, emphysema and asthma are all relevant examples. But there’s more.

Remember that smoking is simply a method to deliver a drug into the body. While many of the products contained within cigarette smoke are toxic and can lead to problems, the main drug being delivered is nicotine. Nicotine is such an addictive drug, that in lab studies using mice, if given a choice between food for survival and nicotine, the mice overwhelmingly chose nicotine, starving to death. This gives you a glimpse into the difficulty encountered in smoking cessation.

Nicotine destroys arteries. In fact, in those individuals who undergo either a surgical or interventional procedure, those who continue to smoke experience results that last only half as long, and their overall outcome is poorer. That makes smoking cessation the single most important risk factor that you could participate in to have the most beneficial effect.

There are many strategies utilized for smoking cessation, including nicotine replacement therapy, drug therapy, behavior modification, hypnosis, etc. One option that I endorse is the medication Verenicline (Chantix). This medication decreases the withdrawal symptoms while reducing the addicting effects of nicotine. In FDA studies, Chantix was more effective in helping patients with cardiovascular disease quit smoking, and more than doubled the chance that they remained abstinent from smoking for as long as one year.

Sweda-Brad-MD-126Vascular Surgeon Brad Sweda, M.D., is dedicated to the diagnosis and treatment of disorders of the circulatory system, including the arteries and veins. His passion for vascular surgery goes beyond treating an ailment, but rather treating the individual. He sees each of his patients as unique, each requiring their own personalized treatment and attention. Dr. Sweda sees patients in Midland and Alpena. To make an appointment, contact his office at (989) 794-5240.



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