Moderate Hypertriglyceridemia Prevention Of Cardiovascular Disease
In the era of statin therapy, it is uncertain whether lowering TG levels in patients on statin therapy will further reduce cardiovascular events. As discussed in detail in the sections on individual drugs, the studies carried out so far have not shown that adding niacin or fibrates to statin therapy is beneficial with regards to cardiovascular disease. As also discussed, the available studies have major limitations because many of the patients in these outcome studies did not have substantial elevations in TGs and therefore the issue is an open question that requires additional studies. Notably, the REDUCE-IT trial, which tested the effect of high dose EPA in patients with elevated TG levels and the JELIS trial which tested the effect of EPA 1.8 grams per day in patients with high cholesterol levels demonstrated a reduction in cardiovascular events. However, in both of these trials the decrease in cardiovascular events was considerably greater than one would expect based on the reduction in TG levels suggesting that the decrease in cardiovascular events was not solely due to lowering TG levels and that other effects of EPA likely played a role.
Who Needs Cholesterol Medicines
- You have already had a heart attack or stroke, or you have peripheral arterial disease
- Your LDL cholesterol level is 190 mg/dL or higher
- You are 40-75 years old, you have diabetes, and your LDL cholesterol level is 70 mg/dL or higher
- You are 40-75 years old, you have a high risk of developing heart disease or stroke, and your LDL cholesterol level is 70 mg/dL or higher
How Does My Health Care Provider Decide Which Cholesterol Medicine I Should Take
When deciding which medicine you should take and which dose you need, your health care provider will consider:
- Your cholesterol levels
- Your risk for heart disease and stroke
- Any other health problems you have
- Possible side effects of the medicines. Higher doses are more likely to cause side effects, especially over time.
Medicines can help control your cholesterol, but they don’t cure it. You need to keep taking your medicines and get regular cholesterol checks to make sure that you cholesterol levels are in a healthy range.
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There Are No Warning Signs
Typically, there are not really warning signs for people with high cholesterol, said Dr. Kirley, noting there are some relatively uncommon disorders where people can get physical symptoms like lesions on their skin, but those are quite uncommon.
For the most part, the only way you can get insight into your cholesterol levels and how they might play into your risk for heart attack and stroke is to be evaluated by your physician and have your levels tested with a blood test, she added.
High Blood Pressure Medication
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They include a certain medications, such as diabetes, and heart failure, heart disease.
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What Is The Difference Between Good And Bad Cholesterol
Bad cholesterol, also known as low-density lipoprotein , will build up in the inner walls of your arteries, making them narrow. This slows down blood flow. If this buildup of plaque breaks off, a clot forms that can completely block the flow of blood, causing a heart attack.
Good cholesterol, also known as high-density lipoprotein , helps protect us from heart attacks and strokes. This type carries the bad cholesterol away from the arteries.
Start Taking A Statin Medication
For most people who have moderate to high risk for heart attacks and strokes, the best thing that we can do to both impact their cholesterol levels and impact their overall risk for stroke and heart attack is start a statin medication, said Dr. Kirley. A statin medication changes the way cholesterol is metabolized in your body so that you ultimately have lower levels of cholesterol circulating in your bloodstream, particularly that LDL cholesterol that we worry about.
We often hear a lot of fear around taking statin medications, she said. Perhaps the biggest misconceptions I see are that these medications are not safe or that they cause other diseases.
Statin medications are among the most studied medications that we use in medicine. They have a wonderful safety profile and great evidence for effectiveness, Dr. Kirley added.
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Garlic And Lemon Juice
2016 study , garlic and lemon juice may be effective at lowering cholesterol.
The study looked at people with moderately high cholesterol levels. It found that people who consumed 20 grams of garlic with 1 tablespoon of lemon juice per day experienced a significant decrease in their LDL and total cholesterol levels compared with those who did not have garlic and lemon juice.
Lowering Triglycerides Without Medication
Unless your triglycerides are extremely high, lifestyle changes are the best place to start. These simple steps can significantly lower triglyceride levels.
- Beware of bad fats. Cutting back on saturated fat and trans fats can lower triglycerides.
- Go for good carbs. Easily digested carbohydrates give triglycerides a definite boost. Eating whole grains and cutting back on soda can help control triglycerides.
- Check your alcohol use. In some people, alcohol dramatically boosts triglycerides. The only way to know if this is true for you is to avoid alcohol for a few weeks and have your triglycerides tested again.
- Go fish. Omega-3 fats in salmon, tuna, sardines, and other fatty fish can lower triglycerides. Having fish twice a week is fine.
- Aim for a healthy weight. If you are overweight, losing just 5% to 10% of your weight can help drive down triglycerides.
- Get moving. Exercise lowers triglycerides and boosts heart-healthy HDL cholesterol.
- Stop smoking. It isnt good for triglyceride levels or for anything else.
About the Author
Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing
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Effect Of Alipogene Tiparvovec On Lipid And Lipoprotein Levels
In patients with plasma TG levels > 880mg/d, treatment with alipogene tiparvovec resulted in an approximately 40% decrease in fasting plasma TGs with half of the patients having > 40% decrease in fasting plasma TG levels at 3-12 weeks post treatment . By week 16-26, fasting TG levels returned to baseline values but chylomicron levels were reduced . While fasting TG levels returned to baseline, postprandial TG levels were reduced by approximately 60% suggesting that there are long term effects that are not reflected by fasting TG levels . In fact, in some patients treated with alipogene tiparvovec, lipoprotein lipase expression was demonstrated in muscle biopsies at 26 weeks .
Effect Of High Dose Omega
It should be noted that in this trial mineral oil was used as the placebo. In the placebo group the LDL-C, non-HDL-C, and CRP levels were increased during the trial . The impact of these adverse changes on clinical outcomes is uncertain and whether they contributed to the apparent beneficial effects observed in the individuals treated with EPA is unknown.
4) The OMEMI trial was a randomized trial of 1.8 grams per day of omega-3-fatty acids vs. corn oil placebo in patients aged 70 to 82 years with a recent myocardial infarction . Baseline LDL-C was approximately 76mg/dL, HDL-C was 49mg/dL, and TGs 110mg/dL. The primary endpoint was a composite of nonfatal myocardial infarction, unscheduled revascularization, stroke, all-cause death, and heart failure hospitalization after 2 years of follow-up. The primary endpoint occurred in 21.4% of patients on omega-3-fatty acids vs. 20.0% on placebo . TGs levels decreased 8.1% in the omega-3-fatty acid group and increased 5.1% in the placebo group while changes in LDL-C were minimal in both groups. Thus, similar to the STRENGTH trial no benefits on cardiovascular disease were observed with EPA + DHA treatment.
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What Are The Precautions For Taking Cholesterol Medication
Looking for the best cholesterol medication means you need to know what precautions to take. Each drug has side effects like diarrhea, constipation, nausea, muscle soreness/pain/weakness, stomach pain, bloating, gas, fatigue, cramps, abdominal pain, flushing , peptic ulcers, vomiting, gout, high blood sugar, dizziness, heart palpitations, sweating, shortness of breath, chills, indigestion, belching, swelling, itching, rashes, hives, flu, and swelling of nasal passages.
Additionally, statins can negatively react when taken in combination with grapefruit juice. Injectable medications may also cause some bruising or pain on the area that was injected.
These side effects do not show up together or all at once. Most of them are also mild. To properly manage these, you need to consult with your doctor before taking any medication. Even the best cholesterol medication can only efficiently work if taken correctly, in correct dosages and amounts.
Side effects like these are the primary reason why some people including doctors prefer to go more natural on their cholesterol medication choices.
Your Body Naturally Makes Cholesterol
One of the biggest things we see is that people think their cholesterol levels are more tied to what they eat than they really are, said Dr. Kirley, adding that people tend to think if my cholesterol levels are high, that means I should eat less cholesterol.
The amount of cholesterol that you eat, doesn’t actually impact your own cholesterol very much, she noted. And that’s because your body is making cholesterol. It makes cholesterol no matter what. Even if you eat no cholesterol, your body makes cholesterol.
What you eat matters, but it has less impact on cholesterol levels than a lot of people might realize, Dr. Kirley said.
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Effect Of Niacin On Cardiovascular Outcomes
MONOTHERAPY
COMBINATION WITH FIBRATES
In the Stockholm Ischemic Heart Disease Secondary Prevention Study survivors of a myocardial infarction below 70 years of age were randomized to a control group and a group treated with clofibrate and immediate release nicotinic acid . Serum cholesterol and TG was lowered by 13% and 19%, respectively, in the treatment group compared to the control group. Recurrent myocardial infarction was reduced by 50% within one year . Total mortality was decreased by 26% in the group treated with clofibrate + niacin while ischemic heart disease mortality was decreased by 36% . Notably, the benefit of clofibrate + niacin was only observed in patients with a baseline TG level > 143mg/dl. In the age of statins, the clinical implications of this early study are unclear.
COMBINATION WITH STATINS
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Increase Your Physical Activity
Physical activity increases levels of HDL cholesterol the good cholesterol that removes LDL cholesterol from the blood. Vigorous aerobic exercise is best.
If you havent been exercising much lately, gradually build up to the recommended amount of physical activity:
- People aged 18-64 years should do 30 to 60 minutes of moderate-intensity physical activity on most days of the week.
- People aged 65 years and over should aim for a total of 30 minutes of moderate physical activity on most days .
Moderate-intensity exercise is a level that increases your heart rate and breathing but allows you to keep talking. Vigorous intensity exercise makes your heart rate higher and makes you breathe more heavily.
Resistance training and muscle-toning exercises can increase HDL cholesterol. Aim to do this twice a week.
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How Quickly Can I Lower My Cholesterol
Your cholesterol levels may lower as quickly as a few weeks to a few months, depending on your treatment plan.
If your levels are very high, your healthcare provider may recommend taking medications at the start of your treatment plan. This may help lower your cholesterol levels more quickly. The sooner you can lower your bad cholesterol levels, the sooner you can lower your risk for plaques to form.
You can also lower your cholesterol through lifestyle and diet changes alone, but it may take three to six months to see results. Talk with your healthcare provider to figure out the best treatment plan for you.
Cholesterol And High Bp Run Together
It is important to note that high cholesterol and high blood pressure tend to run together, said Dr. Kirley. One doesnt necessarily cause the other, but its very common to see both in an individual.
And certainly, both of them contribute to raising somebodys risk for heart attack and stroke, she added, noting that the interventions to helpthings like more physical activity and nutritioncan impact both your blood pressure and your cholesterol.
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How Long Does It Take To Lower Triglycerides
Depending on whats causing your high triglyceride levels, you may be able to lower them in just a few days. A night out drinking or eating foods high in sugar can cause a spike in your triglyceride levels. Limiting alcohol and sugar intake can bring your levels back to normal within a few days.
If you have consistently high triglycerides, it may take a few months for them to return to a healthy range. How fast they lower depends on the lifestyle changes, diet, and medications youre taking.
What Are Normal And High Triglyceride Levels
The National Cholesterol Education Program sets guidelines for triglyceride levels:
- Normal levels: Less than 150 milligrams per deciliter
- Borderline high:150 to 199
- High: 200 to 499
- Very high: 500 or more
Elevated levels may lead to heart disease, especially in people with low levels of “good” cholesterol and high levels of “bad” cholesterol. The same is true if you have type 2 diabetes.
Experts once debated how important triglycerides are, but it now seems clear that higher levels are linked to problems such as heart disease.
One thing is clear, though: A good diet and exercise plan can lower triglyceride levels, improve cholesterol, and decrease the chance of heart disease.
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Which Medicines Can Lower Triglycerides
For some people, good habits may not be enough. Medication might be needed. The decision for you and your doctor can be complicated because other health conditions are usually involved. Several types of medicine can improve levels. They include:
- High doses of omega-3s are needed to lower triglycerides and should be taken only under a doctor’s care. Epanova, Lovaza, and Vascepa are prescription forms of omega-3s.
Your doctor may also prescribe a class of drugs called âstatinsâ that lower cholesterol. Examples include: atorvastatin , rosuvastatin , and simvastatin .
You may feel side effects from these drugs. Be sure to talk it over with your doctor or pharmacist.
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Atherosclerosis And Cardiovascular Disease
Despite being called good cholesterol, research suggests that very high levels of HDL may increase your risk of mortality.
In a 2017 Danish study , researchers analyzed the rate of mortality in groups of 52,268 European men and 64,240 women over an average of 6.4 years.
The researchers found the lowest mortality rates at HDL levels of 73 mg/dL in men and 93 mg/dL in women. Mortality rates increased significantly with HDL levels above 97 mg/dL in men and 135 mg/dL in women.
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Lifestyle Factors To Maintain Heart Health
Taking steps to improve your cardiac health is an action that you will never regret. The heart serves as a vital role in the overall function of the body. When it comes to learning how to strengthen your heart and maintaining heart health, you can talk with your doctor about recommended methods or try any of the following:
- Practice regular cardiovascular exercise such as walking, running or using an elliptical.
- Swap out the potato chips for heart-healthy snacks like fresh fruit, nuts or whole grain crackers.
- Maintain a healthy weight and work to lose any excess weight.
- Practice proper stress management and self care.
- Avoid smoking and excessive alcohol usage.
- Maintain a healthy blood pressure.
- Keep cholesterol levels under control.
- Visit your cardiologist regularly to have blood levels checked and heart health monitored.
Unfortunately, heart disease of all kinds is on the rise in todays society, so taking steps to maintain your heart health is more important now than ever before.
What Causes Levels To Fluctuate
Triglyceride levels fluctuate naturally in response to many factors, including calorie intake and time of day. Eating a meal can cause an increase in triglycerides, which the body may store to use later when it needs energy.
These fluctuations are typically short-lived, but they are part of the reason why doctors may ask a person to fast before getting a lipid profile blood test.
Some health conditions may increase the risk of higher triglyceride levels. According to the
- hormone medications
- immunosuppressant drugs
Anyone who is uncertain about the side effects of their specific medication should speak with their doctor.
A person can use a few treatments to help lower their triglyceride levels.
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