Caitlin Whyte (Host): Welcome to To Your Health, the podcast dedicated to building a healthier community through education and awareness. In this episode, we're joined by Kylie Gordash, the Pharmacy Operations Manager at Jefferson Healthcare. With over 15 years of experience in the pharmacy, Kylie brings a wealth of knowledge to the table.

Today, we're discussing how to manage cholesterol and weight along with the safety and effectiveness of medications often prescribed for these conditions. Can you start by explaining importance of managing cholesterol and weight for heart and vascular health?

Kylie Gordash: Cholesterol is one of the risk factors for developing heart disease and somewhat tied to that is maintaining a healthy weight. It is important to know what your targets are for healthy weight and to work with your provider to ensure that your cholesterol labs are in the right range. Because over time, you know, if you have high cholesterol over time, that inevitably can lead to plaque buildup in the arteries, which can result in cardiovascular disease. So, it's one of many, many risk factors, but one that we can certainly do something about.

Host: I feel like cholesterol is a word that everyone, you know, has heard of. It's always in commercials and on TV when people are talking about diets and things. But what are some common misconceptions about cholesterol that you frequently encounter?

Kylie Gordash: You know, that is a great question, and I'm really glad you asked it because I agree. Cholesterol often gets villainized just because of that association with heart disease, but what a lot of people don't realize is that cholesterol is an essential building block for some very important things in our bodies. For example, bile salts. We need bile salts in our digestive tract to absorb fats. And the core part of the bile of salt molecule is the cholesterol molecule. Hormones, for example, whether it be testosterone, estrogen cortisol, which is the stress hormone. If you look at the molecule, at the heart of it, is a cholesterol molecule. And even vitamin D, our bodies have an active form of vitamin D. It's not as obvious when you look at it structurally, but that too has its rooting cholesterol. So, it has an important role, but like many things in life, something can be a good thing, but too much of it in the wrong place becomes a bad thing.

Host: Well, on that note, what are some lifestyle changes that play a role in managing cholesterol and weight?

Kylie Gordash: Lifestyle changes would include healthy diet. Probably diet and exercise, ensuring that a person is active, knowing what the healthy choices are for your diet. Smoking would be a really good one if a person smokes to utilize resources whether it be, you know, doctor, pharmacist to help you quit.

Those I would say are the top three in terms of some lifestyle changes and, you know, like as far as like exercise is concerned, I would recommend like small changes for someone who isn't used to exercising. Try just a walk, once or twice a week and you gradually, you know, build from there.

Host: Well, you do work in the pharmacy, so let's talk about medications. What are some of the most common medications prescribed for cholesterol and weight management, and how do those work?

Kylie Gordash: I would say the most common medications to treat high cholesterol would be the statins, and they work primarily on the liver because that's where the cholesterol synthesis is occurring. And our bodies have an enzyme that is necessary in that process, and it just interferes with it. So, we just make less cholesterol. So, that's the most popular, most common medication.

There are older medications that has fallen out of favor. They're called bile acid sequestrants. They deplete bile. So, your body has to then start using more of the cholesterol to create more bile. They tend to have undesirable side effects, and they do not work as well as statins. So, we don't really see those as much anymore. And then, the newer agents, let's say we have where we are not getting the results that we need with a statin, there is a medication called ezetimibe that works more so on absorption where it reduces the absorption of cholesterol from the diet. It could be added to a statin. And if we weren't getting results with those meds, there are newer meds that are injectable. They're a little more complicated. They're sometimes referred to as PCSK9 inhibitors. That's more of a specialty medication. We don't see that as often due to cost and administrative concerns.

Host: What are some of the warning signs that someone should seek out medical advice regarding their cholesterol or weight management?

Kylie Gordash: Well, that becomes a challenge because historically, like high cholesterol and even high blood pressure, we've often referred to those as silent killers because they don't really have symptoms for the most part until one day, you have a cardiovascular event. And so, what I would recommend is particularly as we age-- because that is a risk factor as well for high cholesterol-- as we age, you know, into our 40s, 50s, and on annual physical where your doctor is just keeping an eye on where your cholesterol levels are, is your good cholesterol in a high enough range? Do we have the bad cholesterol at a low enough range? As far as weight loss is concerned, certainly, if we have a higher body mass index, which indicates we have a higher percentage of body fat, that can also be a risk factor itself. And so, being conscious of what a healthy weight is for your height or a healthy body mass index and then if you need assistance consulting with a dietician or working with your healthcare provider to try and get to a healthy weight.

Host: And on that note, Kylie, when do medications usually come into the conversation with a patient?

Kylie Gordash: Often your healthcare provider, they'll use that body mass index to help guide them. So for example, I guess I should explain what body mass index is. It's a mathematical formula that looks at your weight, looks at your height, and it comes up with a number. So for example, if you are in the, let's say, 19 to 20, 25 range, that's healthy. When we hit 25 to 29, that's considered overweight. Over 30 would be considered obese. So for many of these weight loss medications, your provider most likely won't look at it unless you're in that 30 body mass index range. Now, the exception would be if you have certain medical conditions like diabetes, you could be at, let's say 27 and it might become a consideration. So, it really depends on the degree of body fat and if you have certain medical conditions as far as when that becomes a conversation.

Host: Thank you, Kylie, for all your work and for joining us on the show today. And thank you for listening to this episode of To Your Health with our guest, Kylie Gordash. We hope you found this discussion on managing cholesterol and weight insightful and beneficial. And remember, building a healthier community begins with you.