Cholesterol Medication:
Know The Choices And Risks

Cholesterol Medication

Controling our cholesterol does not equal drug therapy.

When we were kids my brother used to say, "Do drugs." I think he was kidding.

For many of us drug therapy has become the first line of defense. It has become a way of life on many levels of our culture. When we feel blue or lonely or sick we run to the medicine cabinet.

Cholesterol medication does not have to be our first line of defense.

The last thing I want to do is discourage anyone from taking cholesterol medication that is necessary for health. On the rare occasion my doctor prescribes medication I do not argue with him. I trust my doctor and I do what he says.

Medical science has produced a long list of lifesaving drugs and procedures. Many of these apply to cholesterol management. It is a great blessing to have some of these drugs available.

However, along with blessing comes responsibility. Optimal heart health does at times require drug therapy. But we should not have the mindset that drugs provide our first solution to a healthy heart. I believe a better way is to make whatever lifestyle changes are necessary for good health.

ATP III agrees with my analysis.

Perhaps I should say that I agree with ATP III.

ATP III is the third report of the Adult Treatment Panel associated with the National Cholesterol Education Program’s (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.

You can read about it in the CHD Risk Assessment section by clicking here.

For ATP III, the primary focus for cholesterol management and reducing risk for coronary heart disease (CHD) is lifestyle modifications. In other words, we should eat right, stop smoking and get some exercise.

But there is no question that cholesterol medication is often necessary to bring us back to an acceptable point of health. When a person’s short-term or long-term risk for CHD is high, drug therapy is required in addition to therapeutic lifestyle changes.





Notice I said, "… in addition to therapeutic lifestyle changes." I didn’t want you to miss that. It is of supreme importance.

However, our focus for right now is on drug therapy, especially in relation to cholesterol management. Therefore we will leave lifestyle modifications for the moment… but only for the moment.

So what are the…

Drugs of Choice to Reduce Cholesterol

As we discuss in the section on LDL Lowering Therapy in Three Risk Categories, not everyone has the same LDL cholesterol goals. In short if you are in a high risk category for coronary heart disease you will have the lowest goal for LDL cholesterol.

What does this mean? It means that those of us who are in the highest risk categories for coronary heart disease must get our LDL cholesterol lower than someone else who has less risk for developing CHD. Sometimes achieving that goal requires cholesterol medication. Here are the most popular choices.

Statins

We see statins advertised on television. They include such drugs as…

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Rosuvastatin Calcium (Crestor)
• Simvastatin (Zocor)

Statin drugs are very effective for lowering LDL cholesterol levels. But there are a number of statin side effects.

Statins are otherwise known as HMG CoA reductase inhibitors.

HMG CoA reductase is a liver enzyme that is responsible for producing cholesterol. Statins work to prevent this enzyme from making more cholesterol.

When properly used statins can…

• Lower your LDL cholesterol by 18-55%
• Raise HDL cholesterol 5-15%
• Help lower triglycerides 7-30%

• Major coronary events
• Deaths due to CHD
• Total mortality
• The number of procedures related to heart disease and stroke

But there are some precautions we should be aware of. As hinted above drugs are not a replacement for proper diet. (O.K. I did more than hint at it.)

For many people diet and exercise is enough to control their cholesterol. Medications are for additional, short-term help. Also if someone is very overweight statins, as well as other drugs, may not work as effectively.
Some people will have allergic reactions to these drugs. Some allergies to foods, dyes or preservatives can also affect the way a person might react to statins.

The good news is statins block the formation of cholesterol. However, that is bad news for women who are pregnant or will be pregnant in the near future.

Developing fetuses require cholesterol for proper development.

It is important to make your doctor aware of any other medications you might be taking when considering adding statins to your arsenal. Some drugs should never be used in combination with statins. Others may cause a reaction but can be used with statins if certain safeguards are put in place.



Below is a list of medications you should be wary of if you are also using statins. We will not belabor the details of possible reactions. But if you are using any of these medications please alert your doctor.

• Niacin (actually a B-vitamin not a drug)
• Nefazodone (Serzone)
• Verapamil (Calan, Isoptin)
• Digoxin (Lanoxin)
• Oral contraceptives
• Cyclosporine (Sandimmune)
• Gemfibrozil (Lopid)
• Clofibrate (Atromid-S)
• Fenofibrate (Tricor)
• HIV protease inhibitors

There are a few other considerations you should …well…consider before using statins.

Liver problems can be worsened by the use of statins. Statins tend to increase liver enzymes. Usually the increase is mild. If it becomes severe you may need to stop taking the drug. If you have liver disease or a history of alcohol abuse, please advise your doctor.

Statin myopathy is also a potential side effect of the medication. Myopathy involves muscle pain and tenderness. In some cases the muscle cells can break down releasing a protein called myoglobin which in turn can impair kidney function.

Statins may cause problems with organ transplants or other recent surgery. Also, if you are prone to seizures, statins can make the problem worse.

One further caution you should know about. Statins can cause the depletion of Coenzyme Q 10. CoQ10 – as it is commonly called – is a coenzyme absolutely essential to heart muscle function. As we age we do not produce sufficient amounts of CoQ10. It is well documented that statins further deplete our supply of this important coenzyme.

If you do not supplement with CoQ10 already you will certainly want to consider it when taking statin drugs.

Use this link for more information on CoQ10 and Cholesterol.




Bile Acid Sequestrants

Bile acid sequestrants are also used for cholesterol management. Bile acids are produced in the liver by cholesterol and secreted into the small intestine. They function to aid in the absorption of fat and cholesterol.

Bile acid sequestrants bind these bile acids and carry them out of the body. This in turn causes the body to make more bile acids which requires using up more cholesterol. The end result is lower cholesterol levels.

On average bile acid sequestrants, such as cholestyramine (Questran) and colestipol (Colestid), reduce LDL cholesterol 15-30% and raise HDL cholesterol 3-5%. The research on triglycerides is inconclusive; however, there is some indication triglyceride levels may rise.

Speaking of triglycerides, people with unusually high triglycerides should not take bile acid sequestrants. Nor should people with dysbetalipoproteinemia (a rare lipid disorder characterized by high levels of blood cholesterol and triglycerides in adults). Also constipation and gastrointestinal distress can be worsened with these drugs.

• Folic acid
• Vitamin-A
• Vitamin-D
• Vitamin-E
• Vitamin-K
• Beta-carotene
• Calcium
• Zinc

Nicotinic Acid

Nicotinic acid (or niacin) is not really a drug but a B-vitamin. It is, however, useful in cholesterol management.

Unfortunately to be effective in favorably adjusting cholesterol levels it must be taken in high dosages. Niacin can…

• Lower LDL cholesterol 5-15%
• Raise HDL cholesterol 15-35%
• Lower triglycerides 20-50%

Nicotinic acid is inexpensive and easy to obtain. It should not be confused with another form of niacin, nicotinamide, which does not lower cholesterol.

Because nicotinic acid is effective and inexpensive – not to mention natural – it may seem like the perfect solution to high cholesterol. However, it should not be taken in high dosages without the oversight of your doctor because of certain side-effects.

If you have chronic liver disease you should not take this vitamin. Nicotinic acid in high amounts can cause liver damage. Nor should you take it if you have severe gout. Other conditions such as…

• Diabetes
• Peptic ulcer disease
• Hyperuricemia…

The use of fibric acids in cholesterol management is a bit controversial. It has been suggested that they can reduce LDL cholesterol 5-20%. However they may also raise LDL in people with high triglycerides.

They can raise HDL cholesterol 10-20% and lower triglycerides 20-50%. They have also been shown to reduce major coronary events.

People with severe kidney or liver disease should not take fibric acids. Also fibric acid use has been linked to the development of gall stones and myopathy (skeletal muscle disorder).

In a World Health Organization (WHO) study, fibrates were associated with a significant reduction in major coronary events; however, the overall mortality was higher due especially to gastrointestinal disorders.

In the Helsinki Heart Study a similar association with overall mortality was observed. Because of these studies the safety of fibric acids has been raised.

What General Approach Should I Take To Lower My Cholesterol?

There is a balance you and I should strike when it comes to taking drugs for cholesterol management.

First, we should not be quick to run to the medicine cabinet. Drugs are a great provision. But they are no substitute for smart living. Drugs cannot undo all the wrong we do to ourselves.

Many of us are too dependent on drug therapy as a fix-all. Most of the time using prescription drugs can cause other negative side-effects. When there is a choice between drug use and more natural means choose nature's way.

Second, we should not hesitate to use prescribed drugs when properly advised. If using a statin will decrease your risk of coronary heart disease, then by all means take it. But consider it a short-term solution. We should take advantage of science when it is appropriate.


A Good Plan

If your doctor recommends the use of any cholesterol medication to reduce short-term or long-term risk of heart disease then listen. But listen with caution. Ask questions about safety and be as thorough as possible in revealing any conditions you may have and all medications you are taking. Realize that drug therapy is not the ideal long-term solution.

A Great Plan

An ounce of prevention is worth a pound of cure. Old sayings have been around for a long time for a reason. They are true. Lifestyle therapy is both preventive and curative. For my part I prefer to start here. It is up to us to do everything we can to take care of ourselves. There is much we can do to undo the heart damage we may have caused.

Click here for a natural cholesterol care supplement.


Consider your Lifestyle Therapy choices by using this link. It is the best way to optimal heart health.


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