OTC Supplements for Cc cht b sung
the Management of OTC cho Qun l
High Cholesterol Cholesterol Cao
Emily M. Ambizas, PharmD, MPH, CGP
Associate Clinical Professor
St. Johns University
College of Pharmacy & Health Sciences
Queens, New York
Clinical Specialist, Rite Aid Pharmacy
Whitestone, New York
US Pharm. 2017;42(2):8-11.
Cardiovascular disease remains the leading cause
of mortality and morbidity in the United States, with
coronary artery disease (CAD) being the number-
one cause of death.1 Dyslipidemia is a major
contributor to the development of CAD and other
forms of atherosclerosis; individuals with high total
cholesterol levels (240 mg/dL) have about twice
the risk for heart disease. Approximately 100
million adults in the U.S. have total cholesterol
levels >200 mg/dL (borderline high), and almost 74
million have high levels of low-density lipoprotein
cholesterol (LDL-C).2,3 Adults aged >20 years
should have their cholesterol measured at least
once every 5 years.2
Treatment Guidelines
There are many pharmacologic therapies to treat
dyslipidemia, including HMG-CoA reductase
inhibitors or statins, cholesterol absorption
inhibitors, niacin, bile acid sequestrants, fibrates,
and omega-3 fatty acids; however, statins are the
mainstay of treatment. In 2013, the American
College of Cardiology (ACC) and the American
Heart Association (AHA) released guidelines for the
treatment of blood cholesterol.4 Rather than
providing specific cholesterol targets, the current
guidelines focus on intensity of statin treatment in
four different groups (TABLE 1). This shift in
treatment can potentially increase the number of
adults who are eligible to take statins by 12.8
million.5 The National Lipid Associations
recommendations released in 2014 provide non
high-density lipoprotein cholesterol (nonHDL-C)
goals, but like the ACC/AHA guidelines, treatment
Emily M. Ambizas, PharmD, MPH, CGP
Ph Gio s lm sng
i hc
Y Dc v Y khoa
i hc St. John's Queens, Chuyn gia v Y
khoa New York
, Rite Aid Pharmacy
Whitestone, New York
US Pharm . 2017, 42 (2): 8-11.
Bnh tim mch vn l nguyn nhn hng u gy
t vong v bnh tt Hoa K, vi bnh mch vnh
(CAD) l nguyn nhn s mt gy t
vong. 1 Chng ri lon lipid mu l mt yu t
chnh ng gp vo s pht trin ca CAD v cc
dng x va ng mch khc;nhng ngi c
mc cholesterol ton phn cao (240 mg / dL) c
nguy c mc bnh tim gp i. Khong 100 triu
ngi trng thnh M c mc cholesterol> 200
mg / dL (gii hn trn), v gn 74 triu ngi c
cholesterol lipoprotein t trng thp (LDL-C) mc
cao. 2,3 Ngi trng thnh> 20 tui nn kim tra
cholesterol t nht 5 nm mt ln. 2
Hng dn iu tr
C rt nhiu liu php dc l iu tr chng ri
lon lipid mu, bao gm cc cht c ch HMG-CoA
reductase hoc statin, cht c ch hp thu
cholesterol, niacin, cc cht c ch acid mt,
fibrate v axit bo omega-3; tuy nhin, statin l tr
ct ca iu tr. Vo nm 2013, Trng Tim mch
Hoa K (ACC) v Hip hi Tim mch Hoa K
(American Heart Association - AHA) a ra
hng dn iu tr cholesterol mu. 4 Thay v cung
cp cc ch tiu cholesterol c th, cc hng dn
hin nay tp trung vo cng iu tr statin
bn nhm khc nhau ( BNG 1) . S thay i trong
iu tr ny c th lm tng s ngi ln iu
kin dng statins 12,8 triu. 5Cc khuyn co ca
Hip hi Lipid Quc gia c a ra vo nm 2014
cung cp cc mc tiu v cholesterol khng c
lipoprotein t trng cao (non-HDL-C), nhng cng
ging nh hng dn ca ACC / AHA, iu tr tp
trung vo cc statins lm tc nhn chnh c la
focuses on statins as the primary agent of choice.6
Despite this, nearly half of treatment-eligible adults
are not taking cholesterol-lowering drugs.7 This can
be attributed to many reasons, including cost,
perceived susceptibility to cardiovascular risks,
and, most commonly, fear and concerns regarding
safety and adverse effects.8,9
OTC Supplements
Some of these patients may be looking for
alternative ways to lower their cholesterol and
reduce their risk for cardiovascular disease. About
34% of adults in the U.S. are using some form of
complementary and alternative medicine
(CAM).10 Cholesterol is included as one of the top
10 conditions for which adults are using
CAM.11 Fish oil and garlic, two supplements
commonly used for the reduction of high
cholesterol, were among the top 10 most frequently
used natural products.10 Pharmacists are in an ideal
position to educate patients about the use of OTC
products for the management of high cholesterol.
They can help patients make informed decisions
based on the available data. The following is a
discussion of the more popular OTC agents utilized
in the management of dyslipidemia.
Garlic: Garlic has been used as a medicinal agent
for thousands of years. Today, many people use
garlic for its purported cardiovascular benefits, such
as lowering blood pressure and cholesterol. Garlic
contains the amino acid alliin. When crushed, alliin
is converted to allicin, a substance that inhibits
cholesterol synthesis; however, clinical studies
have demonstrated inconsistent results.12-15 In
pooled analyses of studies, garlic was shown to
improve triglyceride and total cholesterol levels, but
it had no effect on LDL-C or HDL-C.13,15However, a
recent meta-analysis found garlic to have beneficial
effects on total serum cholesterol and LDL-C,
lowering each by 17 6 mg/dL and 9 6 mg/dL,
respectively.12 This effect was seen if garlic was
chn. 6
Mc d vy, gn mt na s ngi iu kin
iu tr khng dng thuc h cholesterol. 7 iu ny
c th l do nhiu nguyn nhn, bao gm c chi
ph, nhn thc nhy cm vi cc nguy c tim
mch, v, ph bin nht, s hi v lo ngi v an
ton v cc tc dng ph. 8,9
B sung OTC
Mt s bnh nhn ny c th ang tm kim cc
cch khc gim cholesterol v gim nguy c
mc bnh tim mch ca h. Khong 34% ngi
trng thnh Hoa K ang s dng mt s loi
thuc b sung v thay th (CAM). 10 Cholesterol
c coi l mt trong 10 iu kin hng u m
ngi ln ang s dng CAM. 11 Du c v ti, hai
cht b sung thng c s dng gim
cholesterol cao, l mt trong 10 sn phm t nhin
hng u c s dng nhiu nht. 10Dc s
ang v tr l tng gio dc bnh nhn v
vic s dng cc sn phm OTC qun l
cholesterol cao. H c th gip bnh nhn a ra
quyt nh da trn s liu sn c. Sau y l mt
cuc tho lun v cc tc nhn OTC ph bin hn
c s dng trong qun l chng ri lon lipid
mu.
Ti: Ti c s dng nh mt tc nhn cha
bnh trong hng ngn nm. Ngy nay, nhiu ngi
s dng ti v li ch tim mch ca mnh, nh gim
huyt p v cholesterol. Ti cha axit amin
anilin. Khi b nghin nt, alliin c chuyn thnh
allicin, mt cht c ch tng hp cholesterol; tuy
nhin, cc nghin cu lm sng cho cc kt qu
tri ngc nhau. 12-15 Trong cc phn tch tng hp
cc nghin cu, ti c chng minh l ci
thin triglyceride v cholesterol ton phn, nhng
khng c nh hng n LDL-C hoc HDL-
C. 13,15 Tuy nhin, mt phn tch tng hp gn y
cho thy ti c tc dng c li ln cholesterol huyt
thanh v LDL-C, mi ln gim 17 6 mg / dL v 9
taken for at least 2 months. Data suggest that the
benefits of garlic on cholesterol may be short-term,
showing no significant benefit after 6 months.16,17
Garlic is associated with several adverse effects
and drug interactions. The most common adverse
effects include bad breath and body odor, upset
stomach, and heartburn. Garlic has antiplatelet
effects and can increase a patients risk for
bleeding. Patients who are on anticoagulants and
antiplatelet agents should be warned about this
potential risk.12-17
Niacin (Vitamin B3 ): Niacin is one of the most
effective agents to raise HDL-C levels; it can raise
HDL-C by almost 35%.18 Niacin also reduces LDL-
C levels by up to 25% and triglycerides by 20% to
50%.18,19 This effect is dose-related, requiring 1 to 4
g per day. There are a variety of niacin products
available: immediate-release, long-acting
(sustained-, controlled-, or timed-release), and
extended-release. The first two products are
available OTC, while the extended-release
products require a prescription. There is also a no-
flush formulation available OTC; however, the
active ingredient is not niacin but inositol
hexaniacinate, which has been shown to be
ineffective as a lipid-lowering agent.20 Nicotinamide
(niacinamide) should not be used in place of niacin
because it does not effectively lower cholesterol or
triglyceride levels.
Niacin is associated with several side effects. It can
cause hyperglycemia and worsen A1C control, but
these increases are often clinically insignificant or
readily treatable.20 Doses up to 2,000 mg/day have
been well tolerated in diabetic patients with little
increase in fasting plasma glucose.18,21 Other
reported adverse effects include hyperuricemia,
nausea, vomiting, diarrhea, and hypotension.
Hepatotoxicity and flushing are also associated
with its use, but these effects are dependent on the
formulation. OTC long-acting formulations should
never be recommended because they are
associated with hepatotoxicity, evident by abnormal
hepatic enzymes and, in severe cases, jaundice.18
Niacin-induced flushing is a major barrier to its use;
this effect limits niacins utilization and achievement
of therapeutic dosing. Most patients will experience
flushing, which is often more intense with the start
of therapy, but usually subsides with continued use.
Patients taking immediate-release niacin should be
told to gradually increase the dose, take it with
meals, and pretreat with aspirin to help minimize
6 mg / dL. 12Tc dng ny c thy nu s
dng ti trong t nht 2 thng. D liu cho thy
nhng li ch ca ti trn cholesterol c th l ngn
hn, khng c li ch ng k sau 6 thng. 16,17
Ti c lin quan n mt s tc dng ph v tng
tc thuc. Cc tc dng ph thng gp nht gm
hi ming v mi c th, au bng v nng. Ti
c tc dng chng kt tp tiu cu v c th lm
tng nguy c bnh nhn chy mu. Bnh nhn
ang dng thuc chng ng mu v thuc chng
kt tp tiu cu nn c cnh bo v nguy c
tim n ny. 12-17
Niacin (Vitamin B 3 ): Niacin l mt trong nhng
cht hiu qu nht lm tng nng HDL-C; n
c th lm tng HDL-C ln gn 35%. 18 Niacin cng
lm gim nng LDL-C ln n 25% v
triglyceride t 20% n 50%. 18,19 Hiu qu ny lin
quan n liu, i hi t 1 n 4 g / ngy. C rt
nhiu dng bo ch ca niacin nh: phng thch
ngay, hot ng lu di (duy tr, kim sot, hoc
thi gian phng thch), v phng thch ko di. Hai
dng bo ch u tin khng cn ghi toa, trong khi
cc dng bo ch phng thch ko di c yu
cu phi c toa thuc. Ngoi ra cn c mt cng
thc khng x sn OTC; tuy nhin, thnh phn
hot cht khng phi l niacin, nhng inositol
hexaniacinate, m c hin th l khng hiu
qu nh l mt tc nhn h lipid. 20Nicotinamide
(niacinamide) khng nn c s dng thay cho
niacin bi v n khng lm gim c hiu qu mc
cholesterol hoc triglyceride.
Niacin c lin quan n mt s tc dng ph. N
c th gy tng ng huyt v lm trm trng
thm s kim sot Hb A1C, nhng s gia tng ny
thng khng ng k v mt lm sng hoc d
iu tr. 20 liu ln n 2.000 mg / ngy c
dung np tt nhng bnh nhn i tho ng
vi lng glucose huyt tng khng tng
ln. 18,21 Cc tc dng ph khc c bo co bao
gm tng nn tc, bun nn, nn ma, tiu chy
v h huyt p.Nhim c gan v xi ra cng lin
quan n vic s dng n, nhng nhng nh
hng ny ph thuc vo cng thc. Khng nn
khuyn co cc cng thc tc dng ko di OTC v
chng c lin quan n c gan, r rng l do cc
enzyme gan bt thng, v trong trng hp
nng, vng da. 18
Tim bt do cht Niacin l mt ro cn ln i vi
vic s dng n; hiu qu ny lm hn ch vic s
dng niacin v t c liu iu tr. Hu ht cc
bnh nhn s b bng, thng nng hn khi bt
u iu tr, nhng thng gim xung khi tip tc
the occurrence of flushing.21
Omega-3 Fatty Acids/Fish Oils: Omega-3 fatty
acids are the most frequently used natural product
among adults, with consumption increasing almost
10-fold this past decade.10,22 Omega-3 fatty acids
include alpha-linolenic acid (ALA),
eicosapentaenoic acid (EPA), and
docosahexaenoic acid (DHA). The most studied
forms of omega-3 fatty acids are EPA and DHA.
They have shown to be effective in lowering serum
triglycerides up to 50%; however, DHA can raise
LDL-C and HDL-C.23
There are over 400 OTC products currently
marketed as omega-3 fish oil dietary
supplements.24 These products not only contain
EPA and DHA, but may also include saturated fats,
fat-soluble vitamins, and cholesterol.25 Fish oil
supplements vary in their EPA and DHA
concentrations, ranging anywhere from 20% to
>80%. The AHA recommends 2 to 4 g per day of
EPA plus DHA to lower triglycerides; if patients
require more than 3 g they should be under a
physicians supervision.26 On average, patients
would need to take 11.2 servings per day (1 to 3
capsules per serving) to achieve this higher
recommended dose.23 Many patients will have
difficulty with this high pill burden; they should
speak with their healthcare providers about a
prescription omega-3 product.
Overall, these products are generally well tolerated.
The most common adverse effects include stomach
upset, diarrhea, and reflux. Many patients will
complain about a fishy taste, especially if they are
taking higher doses. Advising them to take enteric-
coated formulations or freezing the capsules may
help reduce this. Another effect associated with
omega-3 supplement use is excessive bleeding.
Patients on anticoagulants or antiplatelet agents
should use omega-3 fatty acids cautiously.21-25
Red Yeast Rice (RYR): RYR is produced by
culturing a yeast, Monascus purpureus, on white
rice. Chinese culture has used this agent as a food
preservative and food colorant, and to make rice
wine.27 This fermented product contains a group of
compounds called monacolins, substances that
inhibit cholesterol synthesis via HMG-CoA
reductase. One of the produced monacolins,
monacolin K, is an analogue of the FDA-approved
medication lovastatin. Clinical trials have
demonstrated significant reductions in total
cholesterol, LDL-C, and triglycerides and increases
in HDL-C.19,20,27,28 However, the FDA has determined
s dng. Bnh nhn dng niacin ngay lp tc
phng thch cn c cho bit dn dn tng
liu, dng n vi ba n, v dng th aspirin
gip gim thiu s xut hin ca bng. 21
Axit bo Omega-3 / Du c: Cc axit bo Omega-
3 l sn phm t nhin c s dng nhiu nht
ngi ln, vi mc tiu th tng gn 10 ln trong
thp k qua. 10,22 Axit bo omega-3 bao gm axit
alpha-linolenic (ALA), axit eicosapentaenoic (EPA),
v axit docosahexaenoic (DHA). Cc dng axit bo
omega-3 c nghin cu nhiu nht l EPA v
DHA. H cho thy c hiu qu trong vic lm
gim triglycerides huyt thanh n 50%; tuy nhin,
DHA c th lm tng LDL-C v HDL-C. 23
Hin c hn 400 sn phm OTC hin ang c
bn trn th trng di dng b sung ch n
ung b sung du c omega-3. 24 Cc sn phm
ny khng ch cha EPA v DHA, m cn c th
bao gm cht bo bo ha, vitamin tan trong du,
v cholesterol. 25 Cht b sung du c khc nhau
nng EPA v DHA, dao ng t 20% n>
80%. AHA khuyn co t 2 n 4 g mi ngy EPA
cng vi DHA gim triglyceride; nu bnh nhn
cn nhiu hn 3 g th phi theo s gim st ca
bc s. 26 Trung bnh, bnh nhn cn phi ung
11,2 phn n mt ngy (t 1 n 3 vin / khu
phn) t c liu cao hn ny. 23Nhiu bnh
nhn s gp kh khn vi s lng thuc ln nh
th ny; h nn ni chuyn vi cc nh cung cp
dch v y t ca h v mt sn phm omega-3 theo
toa.
Ni chung, nhng sn phm ny ni chung dung
np tt. Cc tc dng ph thng gp nht bao
gm kh chu d dy, tiu chy v tro
ngc. Nhiu bnh nhn s phn nn v mi v
"mi v", c bit nu h dng liu cao hn. T vn
cho h dng cc cng thc bc nim mc rut
hoc ng bng cc vin nang c th gip gim
bt tnh trng ny. Mt hiu ng khc lin quan
n b sung omega-3 l chy mu qu mc. Bnh
nhn v thuc chng ng mu hoc thuc chng
tiu cu nn s dng axit bo omega-3 mt cch
thn trng. 21-25
Red Yeast Rice (RYR): RYR c sn xut bng
cch nui cy mt men, Monascus purpureus, trn
go trng. Vn ha Trung Quc s dng i l
ny nh mt cht bo qun thc phm v cht
mu thc phm, v lm cho ru go. 27 Sn
phm ln men ny cha mt nhm cc hp cht
gi l monacolins , cht c ch tng hp
cholesterol thng qua HMG-CoA reductase. Mt
trong nhng loi monacolins c sn xut,
that any product that contains more than a trace
amount of monacolin K cannot be sold legally as a
dietary supplement.29
There are many OTC preparations containing RYR;
it is unknown whether these agents have any
cholesterol-lowering effects. To avoid being
considered a drug, manufacturers do not disclose
the amount of monacolin in their products, if any.
Another concern is that there is no standardization
across manufacturers. If the product is fermented
incorrectly, citrinin is produced, a toxic byproduct
known to be nephrotoxic. Studies have analyzed
various RYR products and have demonstrated
great variability in monacolin and citrinin
contents.27,28,30 Some products, if ingested
accordingly with the daily recommended dose,
would provide the equivalent of lovastatin 20.5 mg
daily.27 This can be a concern, especially if patients
are already on a statin or on medications that may
potentially increase the risk of muscle-related side
effects. These products should not be
recommended until improved oversight by the FDA
and standardization of products have been
implemented to ensure equivalence of active
ingredient contents and limitation of harmful
byproducts.
Soluble Fiber: The use of soluble fibers, such as
oats, psyllium, pectin, and guar gum, have been
associated with lowering total cholesterol and LDL-
C. Psyllium husk fiber appears to be one of the
most effective soluble fibers with the least adverse
effects.31 Consuming 7 to 10 g of psyllium per day
demonstrated a reduction in total cholesterol levels
by 4% to 15% and LDL-C levels by 6% to
18%.31,32 Although most individuals will require a
larger reduction than what fiber monotherapy can
provide, it is probably best when used in
combination with other therapies.
The recommended amount of daily dietary fiber
intake is 25 to 38 g per day; most people are only
consuming about half that amount.33,34Examples of
high-fiber foods include whole grains, oats, fruits,
and vegetables. Fiber supplements may be helpful
to those patients who are having difficulties in
achieving this daily goal. Pharmacists need to
ensure that they are recommending fiber
supplements containing a soluble viscous, gel-
forming fiber (psyllium), although there are some
data to indicate that inulin may be beneficial in
reducing cholesterol levels.35,36
Adverse effects associated with fiber supplements
include gastrointestinal upset, bloating, diarrhea,
monacolin K, l mt cht tng t ca lovastatin
c FDA chp thun. Cc th nghim lm sng
lm gim ng k lng cholesterol ton phn,
LDL-C, v triglycerides v tng HDL-C. 19,20,27,28 Tuy
nhin, FDA xc nh rng bt k sn phm c
cha nhiu hn mt lng du vt ca monacolin
K khng th bn mt cch hp php nh l mt b
sung ch n ung.29
C rt nhiu ch phm OTC c cha RYR; n
khng c bit liu nhng cht ny c bt k tc
dng h cholesterol no. trnh b coi l ma ty,
cc nh sn xut khng tit l lng monacolin
trong sn phm ca h, nu c. Mt mi quan tm
khc l khng c tiu chun ha gia cc nh sn
xut. Nu sn phm c ln men khng ng,
citrinin c sn xut, mt sn phm ph c hi
c bit n l c c c. Cc nghin cu
phn tch cc sn phm RYR khc nhau v
chng minh s thay i ln v hm lng
monacolin v citrinin. 27,28,30 Mt s sn phm, nu
ung theo liu hng ngy, s cung cp tng
ng vi lovastatin 20,5 mg mi ngy. 27y c
th l mt mi lo ngi, c bit nu bnh nhn
ang dng statin hoc thuc c th lm tng nguy
c cc phn ng ph lin quan n c. Cc sn
phm ny khng nn c khuyn co cho n khi
FDA c ci tin v tiu chun ha sn phm
c thc hin m bo s tng ng ca
cc thnh phn hot cht v hn ch cc sn
phm ph c hi.
Cht x ha tan: Vic s dng cc si ha tan,
nh yn mch, psyllium, pectin, v guar gum,
lm gim cholesterol v LDL-C.Si x Psyllium
dng nh l mt trong nhng loi si ha tan c
hiu qu nht vi t tc dng ph nht. 31 Tiu th 7
n 10 g cht x mi ngy chng t gim mc
cholesterol ton phn t 4% xung 15% v mc
LDL-C t 6% xung cn 18%. 31,32 Mc d hu ht
cc c nhn s cn mt s gim ng k so vi
nhng g n tr liu bng si c th cung cp, c
l tt nht khi c s dng kt hp vi cc liu
php khc.
Lng khu phn n hng ngy c ngh l
25 n 38g mi ngy; hu ht mi ngi ch tiu
th khong mt na s tin .33,34 V d v thc
phm giu cht x bao gm cc loi ng cc
nguyn ht, yn mch, tri cy v rau ci. Cht b
sung cht x c th hu ch cho nhng bnh nhn
gp kh khn trong vic t c mc tiu hng
ngy ny. Dc s cn phi m bo rng h ang
ngh cc cht b sung cht x c cha cht x
do nht, tan trong cht tan (psyllium), mc d c
mt s d liu cho thy rng inulin c th c li
constipation, and flatulence. Fiber should be
increased gradually and taken with plenty of water.
Patients should also be told to separate fiber
supplements from other medications by at least 2
hours to avoid potential drug interactions.36
Conclusion
Dyslipidemia is a prevalent condition affecting over
100 million patients that can more than double a
persons risk for the development of cardiovascular
disease.1,2 Because of this, many individuals are
seeking alternative ways to lower their cholesterol.
Pharmacists can play a vital role in this process by
educating patients and helping them make
informed decisions regarding the use of the various
available supplements.
Supplements that are supported by clinical
evidence and guidelines include immediate-release
niacin, omega-3 fatty acids, and soluble fiber.
Pharmacists should keep in mind, however, that
these products are not regulated by the FDA and
there may be inconsistencies between different
manufacturers and batches. Pharmacists should
also avoid recommending garlic, RYR, sustained-
release niacin, no-flush niacin, and niacinamide
due to lack of efficacy or documented adverse
effects. A strong emphasis should be placed on the
benefits associated with therapeutic lifestyle
changes, such as maintaining a healthy weight,
eating a low-fat, low-cholesterol, high-fiber diet, and
exercising regularly. Patients should also be
reminded to inform their healthcare providers of
any supplements they may be taking.
PATIENT INFORMATION
What Is Cholesterol?
trong vic lm gim mc cholesterol.35,36
Tc dng ph lin quan n cht b sung cht x
gm c kh chu ng tiu ha, y hi, tiu
chy, to bn, v y hi. Cht x nn c tng
dn v ly ra vi rt nhiu nc. Bnh nhn cng
nn c cho bit b sung cht x ring bit t
cc loi thuc khc t nht l 2 gi trnh tng
tc thuc c th xy ra. 36
Phn kt lun
Chng ri lon lipid mu l mt tnh trng ph bin
nh hng n hn 100 triu bnh nhn c th
tng gp i nguy c ca mt ngi i vi s
pht trin ca bnh tim mch. 1,2 V l do ny, nhiu
ngi ang tm cch thay th gim cholesterol
ca h.Dc s c th ng mt vai tr quan trng
trong qu trnh ny bng cch gio dc bnh nhn
v gip h a ra cc quyt nh sng sut v vic
s dng cc cht b sung c sn khc nhau.
Cc cht b sung c h tr bng cc bng
chng v hng dn lm sng bao gm niacin,
niacin, axit bo omega-3, v cht x ha tan. Tuy
nhin, cc dc s nn lu rng cc sn phm
ny khng c quy nh bi FDA v c th c s
khng thng nht gia cc nh sn xut v l khc
nhau. Cc dc s cng nn trnh ngh ti,
RYR, niacin, niacinamide khng nia, v
niacinamide do thiu hiu qu hoc cc tc dng
bt li. Cn ch trng n li ch lin quan n
thay i li sng iu tr, chng hn nh duy tr cn
nng khe mnh, n mt ch n t cht bo,
cholesterol thp, cht x cao v tp th dc u
n. Bnh nhn cng nn nhc nh thng bo
cho cc nh cung cp dch v chm sc sc kho
v bt k cht b sung no m h c th dng.
THNG TIN BNH NHN
Cholesterol is a substance that your body needs to
remain healthy. It comes from two sources: our
bodies themselves and the food we eat, such as
meat, poultry, and dairy products. Too much
cholesterol can increase your risk for heart disease.
What Is the Difference
Between Good and Bad
Cholesterol?
Bad cholesterol, also known as low-density
lipoprotein (LDL), will build up in the inner walls of
your arteries, making them narrow. This slows
down blood flow. If this buildup of plaque breaks
off, a clot forms that can completely block the flow
of blood, causing a heart attack.
Good cholesterol, also known as high-density
lipoprotein (HDL), helps protect us from heart
attacks and strokes. This type carries the bad
cholesterol away from the arteries.
What Are Normal
Cholesterol Numbers?
Everyone aged 20 years and older should have his
or her cholesterol levels checked at least once
every 5 years. The blood test should be taken after
fasting for 9 to 12 hours.
You should aim for a total cholesterol level of <200
mg/dL. Levels of 240 mg/dL or above are
considered high. For LDL, lower levels are better,
and the goal should be below 130 mg/dL, with
<100 mg/dL being optimal. For HDL, higher
numbers are better. An HDL level <40 mg/dL is a
major risk factor for developing heart disease. You
want to aim for levels of 60 mg/dL or better to help
lower this risk.
How Can I Improve my
Cholesterol?
Eating healthy foods, maintaining a healthy weight,
and staying physically active are all ways to help
improve your cholesterol.
What Foods Should I Eat? Ti nn n g? Ti nn Trnh
What Foods Should I Avoid? nhng thc n no?
Cholesterol l g?
Cholesterol l cht m c th bn cn duy tr
sc khe. N xut pht t hai ngun: c th chng
ta v thc phm chng ta n, nh tht, gia cm, v
cc sn phm t sa. Qu nhiu cholesterol c th
lm tng nguy c mc bnh tim.
S khc bit gia "Tt" v
"xu" Cholesterol l g?
Mc cholesterol "xu", cn c gi l lipoprotein
mt thp(LDL), s tch t trong cc thnh ng
mch ca bn, lm cho chng hp. iu ny lm
chm lu thng mu. Nu s tch t ca mng
bm v ra, mt cc mu ng c th ngn chn
dng chy ca mu, gy ra cn au tim.
Cholesterol "Tt", cn c gi l lipoprotein mt
cao (HDL), gip bo v chng ta khi cc cn
au tim v t ques. Loi ny mang cholesterol xu
ra khi cc ng mch.
S Cholesterol "bnh
thng" l g?
Mi ngi t 20 tui tr ln nn kim tra mc
cholesterol ca mnh t nht mi nm mt ln trong
nm nm. Xt nghim mu nn c thc hin
sau khi nhn n t 9 n 12 gi.
Bn nn nhm ti mc cholesterol ton phn <200
mg / dL. Cc mc 240 mg / dL tr ln c coi l
cao. i vi LDL, mc thp hn th tt hn, v
mc tiu di 130 mg / dL, vi <100 mg / dL l ti
u. i vi HDL, s lng cao hn th tt
hn. Mc HDL <40 mg / dL l mt yu t nguy c
chnh gy ra bnh tim. Bn mun t n mc 60
mg / dL hoc tt hn gip gim nguy c ny.
Lm th no ti c th ci
thin Cholesterol ca ti?
n cc thc phm lnh mnh, duy tr cn nng
khe mnh v hot ng th cht l cch ci
thin cholesterol.
Maintaining a healthy diet can help lower your
cholesterol. Recommended foods include fruits and
vegetables; whole grain foods; fat-free, 1%, or low-
fat milk products; poultry without skin and lean
meats; fatty fish such as salmon, trout, albacore
tuna, and sardines; and unsalted nuts, seeds, and
legumes.
A diet high in cholesterol, saturated fats, and trans
fats should be avoided. This includes high-sodium
foods; sweetened or sugary beverages; red, fatty,
or processed meats; full-fat dairy products; baked
goods with saturated and trans fats (e.g., cakes,
cookies); solid fats or fried foods; and
hydrogenated and saturated oils.
Can Supplements Help?
There are a few things you can take to help you
lower your cholesterol, but you should speak with a
healthcare provider before starting. Supplements
that may have some benefit include immediate-
release niacin, omega-3 fatty acids/fish oil, and
soluble fibers (psyllium). Supplements that should
be avoided include red yeast rice, garlic, sustained-
release niacin, no flush niacin, and niacinamide.
These supplements have no data to support their
use in lowering cholesterol levels or have been
associated with liver damage.
Remember, if you have Questions, Consult
Your Pharmacist.
Duy tr mt ch n ung lnh mnh c th gip
lm gim cholesterol ca bn. Cc loi thc phm
c ngh bao gm tri cy v rau ci; thc
phm ng cc; cc sn phm sa t bo, 1% hoc
t cht bo; gia cm khng c da v tht nc; c bo
nh c hi, c hi, c ng albacore v c mi; v
cc ht, ht, v u khng c m.
Nn trnh ch n giu cholesterol, cht bo bo
ha v cht bo chuyn v. iu ny bao gm thc
phm c hm lng natri cao; ung ngt hoc
c ng; cc loi tht , bo hay ch
bin; cc sn phm sa bo; cc sn phm nng
c cht bo bo ha v trans (v d: bnh ngt,
bnh quy); cht bo hoc thc n chin; v du
bo ha v bo ha.
Can b sung gip ?
C mt vi iu bn c th lm gip gim
cholesterol, nhng bn nn ni chuyn vi nh
cung cp dch v y t trc khi bt u. Cc cht
b sung c th c mt s li ch bao gm niacin,
kali pht trin nhanh, axit bo omega-3 / du c v
cht x ha tan (psyllium). B sung cn trnh bao
gm go nm men , ti, niacin nng phng
thch, khng niacin niacinam v
niacinamide. Nhng cht b sung ny khng c d
liu h tr vic s dng chng trong vic lm
gim mc cholesterol hoc c lin quan n tn
thng gan.
Hy nh rng, nu bn c thc mc, hy tham
kho kin dc s ca bn.