Would a Cholesterol Drug Help?

You've tried to lose weight, eat a low-fat diet and exercise, as your doctor recommended, and still your cholesterol level is high. What can you do?

Making lifestyle changes and modifying diet - as most doctors advise to lower cholesterol levels - isn't enough for some people who may be genetically predisposed to high blood cholesterol. For these people, powerful cholesterol-lowering medications can help.

These medications are prescribed for people who have coronary artery disease and high cholesterol. These studies have shown that these drugs also can help those who do not have coronary artery disease but have high cholesterol. Research shows that medication decreases the risk of heart attacks and strokes in both groups and deaths in people with coronary heart disease.

Cholesterol isn't the only factor that puts people at risk for heart disease, but it is a major culprit. Eating foods that are high in saturated fats and cholesterol causes arteriosclerosis, or hardening of the arteries. These fats build up in the walls of the arteries, slowing or blocking blood flow to the heart.

The National Cholesterol Education Program estimates that as many as 13 million Americans take some form of cholesterol-lowering drug.

What are the most commonly prescribed cholesterol-lowering drugs?

The most commonly prescribed cholesterol drugs nowadays are in the statin family, which includes MevacorŽ (lovastatin), LescolŽ (fluvastatin), PravacholŽ (pravastatin), ZocorŽ (simvastatin), LipitorŽ (atorvastatin) and CrestorŽ (rosuvastatin). Statins have become the most widely prescribed drugs to lower cholesterol. Depending on the drug and dosage, statins can lower LDL cholesterol (known as the "bad cholesterol") as much as 60 percent.

A study in the journal Circulation found that lowering a person's cholesterol may help everyone, including people with average or low cholesterol levels. The study examined 500 people with atherosclerosis and average cholesterol levels who were given pravastatin. The research found that for every 10 percentage points cholesterol was reduced, the risk of heart disease dropped by 15 percent.

The Air Force/Texas Coronary Atherosclerosis Prevention Study showed lovastatin helped prevent a first heart attack or unstable angina (chest pain) in people with average cholesterol levels but with below-average HDL - or "good" cholesterol.

Taken in tablet or capsule form, statins (also known as HMG-CoA reductase inhibitors) block the formation of a substance your liver needs to make cholesterol. That not only depletes cholesterol in your liver cells, but it causes the cells to remove cholesterol from circulating blood more rapidly. Statins also may help your body reabsorb cholesterol from plaques, slowly unplugging blood vessels.

Except for atorvastatin, which can be taken any time of day, statins usually are taken in a single dose at dinner or at bedtime. These medications must be taken in the evening to take advantage of the fact that the body makes more cholesterol at night.

Statins are well tolerated by most people, and serious side effects are rare. People may have an upset stomach, gas, constipation, abdominal pain or cramps, and muscle aches. These symptoms usually are mild or moderate and generally go away. Patients rarely develop abnormalities in blood tests of the liver. However, most manufacturers of statins recommend initial blood tests for liver damage and periodic follow-up checks. The greatest risk of statins is the development of severe muscle inflammation and damage (rhabdomyolysis) that may release proteins that damage the kidneys.

What other types of treatment are available?

Eating healthy and exercising should go along with any cholesterol-lowering medications. Talk to your doctor about starting a program, particularly if you have heart disease.

You may have heard about supplements that can help lower cholesterol. Plant sterols, which are in certain orange juices and margarines, may interfere with absorption of bad cholesterol. Experts advise you to get these from food and not as supplements. Psyllium - a fiber supplement - may lower total and LDL cholesterol by as much as 7 percent. Talk to your doctor before taking any supplement.

Other types of cholesterol-reducing treatments:

Niacin is a vitamin that lowers LDL cholesterol and trigycerides, and raises HDL cholesterol. However, the dose needed for treatment is about 100 times more than the Recommended Daily Allowance for niacin and can be dangerous. The drug must be taken under a doctor's care.

Resins have been used as cholesterol-lowering drugs for more than two decades. QuestranŽ (cholestyramine), ColestidŽ (colestipol) and WelCholŽ (colesevelam HCl) lower cholesterol by binding with bile acids in your intestinal tract and preventing their recycling through the liver. Bile acids are made in your liver from cholesterol.

Fibrates (or fibric acid derivatives) are used mainly to lower triglycerides. These drugs, LopidŽ (gemfibrozil) and TricoŽ (fenofibrate), also are associated with a small increase in HDL levels.

A newer cholesterol-lowering drug ZetiaŽ (ezetimibe) lowers cholesterol levels about 15-25 percent by partially blocking the absorption of cholesterol from the intestine.

External Sources National Cholesterol Education Program Air Force/Texas Coronary Atherosclerosis Prevention Study

This article was reviewed and updated June 2007.

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