Medication in the Cholesterol-Managing Arsenal

01/17/08 Treatment Options

Statins are one of the most common treatments for cholesterol. They block a substance produced in the liver that the body uses to make cholesterol, according to the Mayo Clinic. Statins also help eliminate cholesterol that may have accumulated on blood vessel walls. Those two effects make statins a powerful weapon against high cholesterol.

Lifestyle is still the most important factor in cholesterol management. However, if lifestyle changes have failed to lower cholesterol levels, or LDL (bad) cholesterol is still high, doctors will consider prescribing statins. Before penning a prescription, doctors will also review their patients' cholesterol levels, risk factors, and medical history.

The decision to start statin therapy is not one that should be taken lightly. While they are extremely successful, statins should be considered a lifelong treatment commitment. Lowering cholesterol levels using statins means patients will usually have to keep taking them to keep their cholesterol down. Some major lifestyle changes may keep cholesterol low without statins, but therapy adjustments should always be discussed with a physician.

There are potential side effects associated with statins. Those include nausea, diarrhea, muscle and joint ache, and constipation. Statins can also have harmful effects on the liver, but regular testing can help detect such complications. Muscle aches can also be indicative of a more serious problem that can lead to kidney damage. Patients taking statins who experience new muscle pain should tell their doctor. 

Niacin is simply a type of B vitamin that helps the body convert carbohydrates to glucose (sugar). It also helps increase HDL (good) cholesterol levels. Niacin has been shown to raise HDL levels by 15 to 35 percent when used alone and by 50 percent when coupled with statin therapy, according to the Mayo Clinic.

Many multivitamins contain niacin, or niacin is sold as a separate dietary supplement. There are prescription treatments as well that are given specifically for the purpose of increasing HDL cholesterol. However, prescription niacin cannot be replaced with over-the-counter dietary supplements. Before adding or beginning niacin supplements—even over-the-counter ones—patients should discuss potential side effects with their physicians. 

Bile acid binding resins work in the intestines to promote cholesterol disposal. By disposing of cholesterol, less is absorbed back into the blood. Resins lower cholesterol, but are not as effective as statins, nor are they tolerated as well. Still, when used in higher doses, resins can be an effective tool in reducing cholesterol. Resins may interfere with how the body absorbs other medications, so patients should consult with their physicians before adding resins to their treatment schedule.

Cholesterol absorption inhibitor are similar to bile acid binding resins. They work in the small intestines to limit the amount of cholesterol that is reabsorbed into the body. They work best for people who cannot tolerate higher doses of statins or for people who cannot take statins at all. They can also be combined with statins for even more cholesterol control.

Fibrates, unlike the above listed treatments, do not interact well with statins. Combining the two may cause myopathy (muscle weakness) and rhabdomyolysis (weakening of skeletal muscle). However, they are an effective way to lower triglyceride levels and to some extent, increase HDL cholesterol. They are not advisable for people with kidney disease, liver disease, or gall bladder disease.

For more treatment options, the best resource any patient can access is his or her primary care physician or cardiologist.

Sources:

Mayo Clinic 

Healthy Heart Program, St. Paul’s Hospital, Vancouver, British Columbia 

eMedicineHealth.com