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Heart Disease and Lowering Cholesterol

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How Is High Cholesterol Treated? continued...

*Risk categories are based on the Framingham Heart Study to estimate 10-year risk for coronary heart disease (heart attack and coronary death). It is based on adults ages 20 and older who do not have heart disease or diabetes. The risk factors included in the Framingham calculation are age, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for high blood pressure, and cigarette smoking.

To reduce your risk for heart disease or keep it low, it is very important to:

  • Control any other risk factors you may have, such as high blood pressure and smoking.
  • Follow a low saturated fat, low cholesterol eating plan
  • Maintain a desirable weight.
  • Participate in regular physical activity.
  • Begin medication therapy as directed by your doctor.

What Drugs Are Used to Treat High Cholesterol?

Cholesterol-lowering drugs include:

  • Statins
  • Niacin
  • Bile-acid resins
  • Fibric acid derivatives
  • Cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a low-cholesterol diet and exercise program.

Statins
Statins block the production of cholesterol in the liver itself. They lower LDL, the "bad" cholesterol, and triglycerides and have a mild effect in raising HDL, the "good" cholesterol. These drugs are the first line of treatment for most people with high cholesterol. 

Statins carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects. It's important to remember that statins may also interact with other medications you take. 

Examples of statins include:

  • Altocor, Altoprev, Mevacor (lovastatin)
  • Crestor (rosuvastatin)
  • Lescol (fluvastatin)
  • Lipitor (atorvastatin)
  • Livalo (pitavastatin)
  • Pravachol (pravastatin)
  • Zocor (simvastatin)

Advicor and Simcor are both combinations of a statin and niacin (see below).

Caduet is a combination of a statin (Lipitor) and a blood pressure-lowering drug called Norvasc. Vytorin is a combination of a statin and a cholesterol absorption inhibitor (simvastatin and ezetimibe).

Niacin
Niacin is a B-complex vitamin. It's found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. These drugs also lower elevated triglycerides. The main side effects are flushing, itching, tingling, and headache, yet aspirin can reduce many of these symptoms. However, speak with your doctor first. Niacin or nicotinic acid, includes the brand names Niacor, Niaspan, or Slo-niacin. Over-the-counter preparations include extended-release, timed-release, and controlled-release. Niacin found in dietary supplements should not be used to lower cholesterol. Your doctor or lipid specialist will let you know if niacin is appropriate for you. Recent research suggests that niacin may improve cholesterol numbers, but may not be associated with prevention of heart attacks.

Bile Acid Sequestrants
These drugs work inside the intestine, where they bind to bile and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by reducing the body's supply of cholesterol, thus lowering total and LDL cholesterol. The most common side effects are constipation, gas, and upset stomach. Examples of bile acid resins include:

  • Colestid (colestipol)
  • Questran and Questran Light (cholestyramine)
  • WelChol (colesevelam)

WebMD Medical Reference

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