We are constantly bombarded with
ads for products that lower cholesterol, but how do these medications work
and who should be taking them? Cholesterol testing is a routine part of
preventive health care. Usually, the cholesterol screening test is completed
on adults at least once every 5 years, unless you are already taking medications
to lower your cholesterol.
Why do I need to lower my
cholesterol?
Lowering your cholesterol can reduce
the risk of heart attacks caused by coronary heart disease. For every 10%
reduction in LDL (low density lipoproteins) "bad cholesterol" levels, you
decrease the possibility of coronary artery disease by 20% to 30%. People
who have other risk factors, such as family history of heart disease, cigarette
smoking, high blood pressure, and being overweight should especially watch
their cholesterol levels.
How can I lower my cholesterol?
The best ways to lower cholesterol
and prevent coronary artery disease are to restrict your consumption of
high cholesterol foods, lose weight, limit or eliminate alcohol intake,
and increase physical activity. If you have tried these methods and your
cholesterol level is still high, then medication can be prescribed.
Drug options
Medications that lower cholesterol
are called antihyperlipidemic agents. Hyperlipidemia is an elevation of
serum cholesterol, triglycerides, or both. Using antihyperlipidemic agents
can help to arrest or reverse atherosclerosis, a risk factor in developing
heart disease (Fig. 1).
The most widely used medications are
the statins (lovastatin, simvastatin, pravastatin, fluvastatin, and atorvastatin),
marketed under names like Lipitor, Mevacor, and Zocor. These drugs inhibit
an enzyme, HMG-CoA reductase, that controls the rate of cholesterol production
in the body. Besides reducing LDL cholesterol and triglycerides, they also
produce a slight increase in the "good cholesterol" HDL (high density lipoproteins).
Nicotinic acid or niacin, a form
of vitamin B, can also lower total cholesterol and triglyceride levels.
You should use nicotinic acid to lower cholesterol only under the supervision
of a physician because of potential complications and side effects.
Another type is the fibric acid
derivatives, or fibrates. These drugs, like gemfibrozil (Lopid) and fenofibrate
(Tricor), lower triglyceride levels but are less effective at lowering
LDL cholesterol.
Finally, bile acid sequestrants,
like cholestyramine (LoCholest) and colestipol (Colestid), bind with cholesterol-containing
bile in the intestines and cause the cholesterol to be eliminated from
the body.
Because the different medications
act differently to reduce cholesterol and triglyceride levels, your physician
may prescribe a combination therapy of 2 medications. These medications
are taken once to twice daily and should only be taken as directed by your
physician. Never take any medication more often than prescribed.
Once you start taking any of these
medications, your doctor will measure your LDL cholesterol levels after
4 to 6 weeks and then again after 3 months. When the cholesterol levels
are within normal range, testing is done every 4 months until the therapy
is stabilized.
Side effects
All medications can have side effects,
and the antihyperlipidemic agents are no exception. The medications may
cause sensitivity to sunlight, so you should avoid prolonged exposure to
the sun or ultraviolet light. Wear sunscreen and protective clothing to
avoid sunburn and sun glasses to protect your eyes. If you experience unexplained
muscle pain, tenderness, or weakness or have an elevated temperature, you
should call your doctor. Other reported side effects include digestive
system disturbances and skin flushing (redness of the face or neck).
Watching your diet, exercising,
and taking prescribed medications can get your cholesterol levels and triglyceride
levels into normal range and provide a lifestyle that reduces the risk
of heart disease.
Nancy Chaffee, RPh, MSHA
Columbus, Georgia
Further Reading:
Practical Lipid Management Newsletter
published by AstraZeneca. June 2003. Drug Facts and Comparisons, published
by Wolter Kluwer Company, updated monthly. November 2003.
National Heart, Lung, and Blood
Institute - National Institutes of Health. http://www.nhlbi.nih.gov/index.htm. |
