Certain factors place us at risk for the development of cardiovascular disease.
Which of the following are modifiable risk factors? Select all that apply.

Nitroglycerin is a medication that dilates the blood vessels and improves blood flow to the heart. It is used to treat angina, a condition that causes chest pain due to reduced oxygen supply to the heart. However, nitroglycerin can lose its effectiveness over time if it is used continuously. This is called tolerance, and it means that the patient will need higher doses of the medication to achieve the same relief. To avoid tolerance, patients who use transdermal nitroglycerin patches are instructed to remove the patch at bedtime and apply a new one in the morning. This creates a nitrate-free interval of about 8 to 12 hours, which allows the body to restore its sensitivity to nitroglycerin.

Choice A is wrong because an allergic response is not a common side effect of nitroglycerin. Some patients may experience skin irritation or rash at the site of application, but this is usually mild and does not require discontinuation of the medication.

Choice C is wrong because overdosage is unlikely with transdermal nitroglycerin patches. The patches deliver a controlled amount of nitroglycerin through the skin over a period of time. The risk of overdosage is higher with other forms of nitroglycerin, such as tablets or sprays, which are taken as needed for acute angina attacks.

Choice D is wrong because forgetting to remove the patch in the morning is not a serious problem. The patch will continue to deliver nitroglycerin until it is removed, but it will not cause harm to the patient. However, it may reduce the effectiveness of the next patch if there is no nitrate-free interval between them.

LDL cholesterol is sometimes called “bad” cholesterol because it can build up on the walls of the blood vessels and cause health problems, such as heart disease and stroke.High levels of LDL cholesterol raise your risk for cardiovascular disease. Therefore, decreasing LDL cholesterol levels can lower your risk and improve your health.

Choice A is wrong because increasing LDL cholesterol levels would have the opposite effect of decreasing them.It would increase your risk for cardiovascular disease and plaque buildup in your arteries.

Choice B is wrong because increasing HDL cholesterol levels is not enough to decrease the risk of cardiovascular disease.HDL cholesterol is sometimes called “good” cholesterol because it can move LDL cholesterol from the blood to the liver, where it is broken down and removed from the body.

However, HDL cholesterol levels alone are not a good indicator of your cardiovascular health.You also need to consider your total cholesterol, LDL cholesterol and triglyceride levels.

Choice D is wrong because decreasing HDL cholesterol levels would also increase your risk for cardiovascular disease.HDL cholesterol helps to lower LDL cholesterol levels and protect your blood vessels from plaque buildup.

Therefore, decreasing HDL cholesterol levels would reduce this protective effect and make you more vulnerable to heart disease and stroke.

The ideal ranges for cholesterol levels are as follows:

• Total cholesterol: below 200 mg/dL

• LDL cholesterol: less than 100 mg/dL

• HDL cholesterol: above 40 mg/dL for men and above 50 mg/dL for women

You can lower your LDL cholesterol levels and increase your HDL cholesterol levels by making healthy lifestyle changes, such as eating a balanced diet, exercising regularly, quitting smoking, managing stress and taking medication if prescribed by your doctor.