Therapeutic Life Changes

Discuss therapeutic life changes and how they affect cholesterol levels. 

The primary care provider may initially seek to control the cholesterol level by encouraging therapeutic life changes (TLC). This includes a cholesterol-lowering diet (TLC diet), physical activity, quitting smoking (if applicable), and weight management. The TLC diet is a... 

TABLE iliii iyPL Cholesterol Goals and Cut Points for Therapeutic Life-Style Changes (TLC) and Drug Therapy in... 

Risk Category LDL Goal (mg/dL) LDL Level at Which to Initiate Therapeutic Life Style Changes (mg/dL) LDL Level at Which to Consider Drug Therapy (mg/dL)... 

Figure 26-23 Model of steps in therapeutic life-style change. LDL, Low-density lipoprotein. (Mod/f/ed from Executive summary of the third report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents, National Cholesterol Education Program. Upid Metabolism Branch, Division of Heart, Lung, and Blood Institute. NIH Publication No. 01-3670. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Bethesda MD National Institutes of Health, 2003.)...

CHD or CHD equivalents. Specific models for therapeutic life-style changes and drug therapy in the primary prevention of CHD have been recommended by ATP III (Figures 26-23 and 26-24). As for the management of patients with metabolic syndrome, a combination approach of weight reduction, increased physical activity, and appropriate control of lipid levels is recommended. 

In a cost-benefit analysis, both costs and consequences are valued in dollars and the ratio of cost to benefit (or more commonly benefit to cost) is computed. Cost-benefit analysis has been used for many years to assess the value of investing in a number of different opportunities, including investments (or expenditure) for health care services. Cost-effectiveness analysis attempts to overcome (or avoid) the difficulties in cost-benefit analysis of valuing health outcomes in dollars by using nonmonetary outcomes such as life-years saved or percentage change in biomarkers like serum cholesterol levels. Cost-minimization analysis is a special case of cost-effectiveness analysis in which the outcomes are considered to be identical or clinically equivalent. In this case, the analysis defaults to selecting the lowest-cost treatment alternative. Cost-utility analysis is another special case of cost-effectiveness analysis in which the value of the outcome is adjusted for differences in patients preferences (utilities) for the outcomes. Cost-utility analyses are most appropriate when quality of life is a very important consideration in the therapeutic decision. 

Family members may also want to continue on their own healing paths, which can include continued support-group involvement or even individual therapy. Using support groups or seeking therapeutic help over the long term offers the opportunity for positive change that will likely help both the family member and the client. Family members also may find a need to focus on their own quality-of-life problem areas after treatment has ended for their loved one, and therapy can provide them with this opportunity. 

Two other compounds have been examined for therapeutic action in animal (rat) models of chlordecone poisoning. Sporopollenin, a carotenoid polymer derived from the cell walls of the alga Chlorella prothecoides, was reported to bind to chlordecone (Pore 1984). In animal studies using rats, sporopollenin decreased the half life of chlordecone from 40 days to 19 days. The excretion rate in control animals fed a-cellulose, in the same bulk amount as sporopollenin, did not change. Prevention of enterohepatic recirculation of chlordecone was also evaluated with liquid paraffin. 

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