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Lowering Your Cholesterol
Cholesterol Medications
We will review the different types of medications available for the treatment of high
cholesterol as well as natural remedies. Your doctor may decide that you need help in
controlling your cholesterol if you are not able to reduce it using natural treatments.
Even if your doctor prescribes any of these medications, you must still follow through with
healthy lifestyle treatments that we will discuss further on.
There are several different types of medications used to lower cholesterol. They are called
statins, bile acid sequestrants, cholesterol absorption inhibitors, nicotinic acid agents
and fibrates and we will review them one by one.
Statins
What are they and how do they work? Statins repress the enzyme HMG-CoA reductase. This
enzyme controls the rate that cholesterol produces itself in the body. These drugs can
lower cholesterol from 20 to 60%. They slow the production while they increase the liver's
ability to withdraw LDL. Statins lower the LDL levels better than any other type of drug.
They can also produce a modest increase of HDL while decreasing total cholesterol and
triglycerides. Positive results are usually seen after just 4 to 6 weeks of beginning the
medication.
Overall statins are proven for lowering heart attack risks, strokes and other coronary
diseases related to high cholesterol levels. You should not take statins if:
- You are allergic to statins themselves or their ingredients
- You are pregnant or breastfeeding
- You have liver disease
- You consume excessive amounts of alcohol
- Have a history of myopathy
- Have renal failure
Brand names of statins that you might recognize are Lipitor, Lescol, Mevacor, Altocor,
Pravahol, Zocor and Crestor.
There are some drug and/or food interactions that you should be aware of. More than one
quart of grapefruit juice per day can decrease the ability of the liver to process some
statins. More importantly there may be other medications that can interact and cause
serious side effects. It's important to let your doctor know about any other medication
you are taking, whether prescription or non-prescription including vitamins, herbal
supplements, medication for the immune system, other cholesterols drugs, medication for
infections, birth control pills, medication for heart failure, HIV or AIDs, or Coumadin.
Side effects from statins are rare. If you experience muscle soreness, pain, weakness,
vomiting, stomach pain, discolored urine, stop taking the medication and contact your
doctor immediately.
Bile Acid Sequestrants
Bile acid sequestrants bind with bile acids that contain cholesterol in the intestines and
are then eliminated in the stool. They are proven to reduce LDL by 10 to 20%. Small doses
produce decent reductions in LDL. They are sometimes prescribed along with a statin to
enhance reduction. When combined, their effects are counted together and lower LDL by
more than 40%. They do not lower triglycerides.
People who are allergic to bile acid sequestrants should not take this medication nor should
anyone who has a medical history of bile obstruction.
There may be interactions with other drugs so make certain your doctor has a complete list
of all prescribed and non-prescribed medications you are taking.
Bile acid sequestrants do not become absorbed from the gastrointestinal tract. It has been
used for 30+ years and is considered safe for long term use.
Cholesterol Absorption Inhibitors
A newer drug class, Zetia is a cholesterol absorption inhibitor that was approved in 2002 by
the FDA. By itself it reduces LDL by 18 to 20%. It does this by decreasing absorption of
cholesterol and other drugs within this class also mildly lower triglycerides.
Very useful for prescribing to people who cannot take statins or as another drug that can
be taken if those who take statins have side effects if the statin dose is increased.
Adding a cholesterol inhibitor to a statin increased the lowering effect by a 2 to 3
fold factor.
There may be interactions with other drugs so make certain your doctor has a complete list
of all prescribed and non-prescribed medications you are taking.
Nicotinic Acid Agents
Niacin, Niacor and Slo-Niacin are common names for nicotinic acid agents.
Nicotinic acid, which is also called niacin, is a water soluble vitamin B. It improves
levels of all lipoproteins when the doses are given far above the vitamin requirement.
Nicotinic acid reduces total cholesterol, LDL and triglycerides at the same time raising
HDL. It reduces LDL by 10 to 20%, triglycerides by 20 to 50% and raises HDL by 15 to 35%.
Nicotinamide is a niacin by product after the body breaks it down. Nicotinamide has
no effect in lowering cholesterol and should not be used in place of nicotinic acid.
Individuals who are allergic to nicotinic acid, and those who have liver disease, active
peptic ulcer, or arterial bleeding, should not use nicotinic acid agents.
There are two types of nicotinic acid. One for immediate release and one for extended
release. Immediate release is inexpensive and widely available without a prescription.
However, because of potential side effects it must not be used for lowering cholesterol
without being monitored by a doctor.
Niacin that is extended release is often tolerated better than crystalline niacin. But
has a greater chance of causing damage to the liver.
If you are taking medication for high blood pressure, the results may be increased while
taking niacin. You should have a system available to monitor your blood pressure when
beginning a new niacin regimen.
Again, there may be side effects when mixed with other medications or foods. Discuss with
your doctor and make certain you make him aware of all medications prescribed or otherwise.
Fibrates
Primary effectiveness is lowering triglycerides. There is a lesser effect in increasing
HDL levels.
Some serious side effects may occur so be sure and discuss these with your doctor. If you
are allergic to fibrates or have liver disease or kidney disease, you should not take
these agents.
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