What you should know about treating cholesterol
Health Watch by Rebecca J. Cripps
The North Jefferson News
Almost 110 million Americans over 20 years of age have high cholesterol.
There are many misconceptions about the causes and treatments of high cholesterol. Untreated high cholesterol can lead to coronary heart disease, strokes and heart attacks. Therefore, it is important to be tested regularly and treated if necessary.
All adults 20 years of age or older should have their cholesterol checked every five years. Doctor’s offices and some pharmacies can provide this testing.
There are different types of cholesterol that are tested in a fasting lipid panel including triglycerides, LDL, HDL and total cholesterol.
Triglycerides are often elevated in patients with diabetes. LDL cholesterol is often called the “bad cholesterol” because it directly leads to coronary heart disease.
The primary goal of cholesterol treatment is to get LDL below goal. LDL goals vary by each patient depending on age, cigarette smoking, family history, blood pressure and HDL cholesterol. HDL cholesterol is often called the “good cholesterol” because it has been proven to reduce the risk of coronary heart disease. Total cholesterol is also measured in most cholesterol tests.
Although this number is important, it is not the primary goal of cholesterol treatment like LDL. The total cholesterol measurement includes the HDL cholesterol which as stated before reduces the risk of heart attacks, stroke, etc. The goal measurements for all cholesterol are as follows:
• total cholesterol should be below 200
• HDL should be above 40
• TG should be below 150
Treating cholesterol
There are different methods of treatment for high cholesterol, depending on the suspected cause. Poor diet, alcohol abuse, diabetes, kidney failure and physical inactivity are some preventable causes of high cholesterol.
Another cause that cannot be prevented is genetics or family history of high cholesterol. If the cause is suspected to be preventable, lifestyle changes may be necessary without the need of medication. These lifestyle changes may include better control of diabetes, improved diet, exercise, avoiding alcohol and other healthy improvements in lifestyle.
If the cause is suspected to be unpreventible or if lifestyle changes do not provide sufficient results, medication is necessary.
Many medications exist to treat high cholesterol, including niacin, bile acid sequestrants, fibric acid agents, Zetia, Omega-3 fatty acids and statins.
Niacin can be used to increase HDL (good cholesterol) and decrease LDL and triglycerides. Although it is effective, it can have the intolerable side effect of flushing. It may not be used if patient has gout, diabetes or liver disease.
Bile acid sequestrants, like cholestyramine, colestipol and Welchol can be used to reduce LDL, but they have limited effect on HDL and triglycerides. They also cause severe constipation and can react with many drugs.
Fibric acid agents like gemfibrozil or fenofibrate may be used to lower LDL and triglycerides but do not raise HDL significantly. Zetia can be used to lower LDL and triglycerides but does not greatly increase HDL.
Omega-3 fatty acids like Lovasa are the best drugs for elevated triglycerides. These can naturally be found in fish, nuts, etc. They also can be found in herbal products. However, they are not effective for reducing LDL (bad cholesterol). Also high doses are required which could cause more side effects.
Statins like Lipitor, Crestor, Simvastatin, Lovastatin, etc. are the most commonly used medications for high cholesterol. Although some agents may be more effective for a single type of cholesterol, statins are the most effective for all types of cholesterol when using only one drug.
Statins lower LDL and triglycerides and raise HDL. Many misconceptions exist about statins. One misconception is the effect of statins on the liver. Liver function tests are recommended at the initiation of a statin, but only 0.5-2 percent of patients have been found to have elevated liver enzymes due to a statin. However, patients with liver disease should not take statins as well as many other medications.
Another misconception of statins is muscle pain or myopathy. In trials studying the side effects of statins, the rate of muscle pain reported was only 5 percent. Although it does occur, it is not as common as some people believe.
A serious but extremely rare side effect of statins is rhabdomyolysis, which is essentially the breakdown of muscle tissue which can be fatal. Although serious, only one case has been reported for every million prescriptions of a statin. The risk of heart attack or stroke is much higher than rhabdomyolysis if cholesterol is not reduced.
In conclusion, all patients 20 years of age or older need to have their cholesterol tested according to their primary care physicians recommendation.
If elevated, medication and lifestyle changes may be necessary. Both of these can work to reduce cholesterol as well as the risk for heart attack, stroke and coronary heart disease.
Rebecca J. Cripps, a Pharm D Candidate from Samford’s McWhorter School of Pharmacy, is an intern at The Pharmcy at Mt. Olive. The Pharmacy can be reached at 631-1201.