Alternatives To Statins For Lowering Cholesterol
Your best treatment option for high cholesterol depends on many factors.
Before your doctor recommends a prescription medication, they will look at several things, such as:
- your family medical history
- your risk for heart disease
Many doctors prefer to start with changes to diet and exercise. If those changes dont have enough effect, you might start taking medication to help the process along.
Statins are one commonly prescribed medication for controlling cholesterol, but these drugs might not be right for everyone. There are several treatment options for high cholesterol, including other medications and lifestyle changes.
Hyperlipidemia High Cholesterol High Triglycerides How To Treat
The treatment of hyperlipidemia, high cholesterol, and high triglyceride is mainly divided into two parts: drug treatment and adjustment of daily eating habits.
If the necessity of medication is not reached, most doctors will generally recommend starting with non-medication.
Improve by adjusting the patients life and eating habits. If the blood lipids do not return to normal after 3-6 months, medical treatment should be performed.
The general treatment drugs are Statins, cholic acid-binding resin, nicotinic acid, and fibrate derivatives four kinds, to achieve control to reduce the risk of cardiovascular disease caused by arteriosclerosis.
The treatment of drugs still needs to be discussed with the doctor, so in the next paragraph, I will mainly focus on the second focus of treatment, which is also the root of the daily diet and life maintenance.
Note. Taking the relevant therapeutic drugs requires taking the medicine according to the instructions of the doctor. All kinds of drugs have side effects.
You should discuss with the doctor and design a prescription label according to your own situation. Do not judge the consumption by yourself.
Effect Of Fibrates On Cardiovascular Outcomes
There have been a number of studies that have examined the effect of a variety of different fibrates on cardiovascular disease. We will describe the major studies below.
A separate meta-analysis has focused on the effect of fibrates on cardiovascular disease in patients with pre-existing disease . It included 13 trials involving a total of 16,112 participants. For the primary composite outcome of non-fatal stroke, non-fatal myocardial infarction, and vascular death, fibrate therapy significantly decreased risk by 12% 0.88, 95% 0.83 to 0.94). Fibrates were effective for preventing myocardial infarction . Fibrates were not effective in lowering all-cause mortality , death from vascular causes , or stroke events . Since clofibrate has been discontinued due to safety concerns, the data were reanalyzed excluding clofibrate trials. Without clofibrate, fibrates no longer significantly reduced the primary outcome but were still effective in preventing myocardial infarctions . Subgroup analyses showed the benefit of fibrates on the primary composite outcome to be consistent irrespective of age, gender, and diabetes mellitus.
SUMMARY OF OUTCOME STUDIES
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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.
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.
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Healthy Fats Can Help Lower Cholesterol
Replace unhealthy fats, such as saturated and trans fats, with monounsaturated fats and polyunsaturated fats rich in omega-3 and omega-6 fatty acids. To eat more omega-3 fats, include fatty fish, flaxseed or ground flax, and walnuts in your eating plan. The oils that contain omega-3 fats are olive and canola oils. The ADA recommends eating two servings of omega-3-rich fish per week as part of a heart-healthy diet. The oils high in omega-6 fats are corn, soybean, and sunflower oils.
Eat less of these unhealthful fats:
— Saturated fat: The biggest food contributor to elevated LDL cholesterol is saturated fat. To remedy the cause-and-effect relationship between saturated fat and LDL, the ADA recommends limiting saturated-fat intake to less than 7 percent of your daily calories. So if you’re trying to eat no more than 2,000 calories a day, that would mean eating no more than 140 calories from saturated fat daily, or 15 grams of saturated fat.
— Trans fat: The ADA also recommends avoiding foods that contain trans fat. Although many restaurants and manufacturers advertise products as having zero trans fat, if the ingredients include shortening, partially hydrogenated vegetable oil, or hydrogenated vegetable oil, the food likely contains trans fat. Labels are not required to list trans fat if the total is less than 0.5 grams per serving. Eating multiple servings of such foods means trans-fat intake can add up.
Know The Dangers Of Trans Fats
Trans fats are dangerous for your heart, because they raise low-density lipoprotein cholesterol and triglyceride levels. The chief culprit youll see on product labels is partially hydrogenated oil. Trans fats are the result of adding hydrogen to liquid vegetable oils to increase shelf life. This may make some baked and fried foods taste better, but trans fats are very unhealthy, particularly for people with high triglycerides. In fact, trans fats should make up less than 1 percent of your total calories, according to the World Health Organization. Check your food labels: If a food contains trans fats or hydrogenated oils, leave it on the shelf.
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Effect On Clinical Outcomes
As described above in the description of the effect of volanesorsen on lipid/lipoprotein levels in patients with FCS and hypertriglyceridemia there is suggestive evidence that lowering the very high TG levels with volanesorsen treatment will reduce the risk of pancreatitis and improve the quality of life.
The effect of volanesorsen on cardiovascular disease has not been determined. However, epidemiologic studies have demonstrated that increased Apo C-III levels are associated with an increased risk of cardiovascular events and coronary artery calcification . Moreover, carriers of rare heterozygous loss-of-function mutations in Apo C-III have reduced TG levels and reduced cardiovascular disease risk . One can speculate that lowering Apo C-III and TG levels with volanesorsen will have beneficial effects on the development of cardiovascular disease.
Why Is It Important To Lower Cholesterol Levels
As it was said, high bad cholesterol levels may lead to heart attacks and strokes. And thats the most important reason to lower cholesterol levels of all. When its level becomes too high, it starts to stock up in your body, forming lesions, particularly in blood vascular system, and it gets harder for the blood to get to your heart and back. Which mean, you become oxygen deficient and your tissues and organs dont get enough blood. And when these lesions split, they can form clots, which causes thromboembolic disease, heart attacks, and strokes and can lead to a fatal outcome.
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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 To Take Your Cholesterol
When youre taking medicines, its important to follow your healthcare providers advice carefully. If you dont take medicines exactly as prescribed, they can harm you. For example, you could unknowingly counteract one medicine by taking it with another one. Medicines can make you feel sick or dizzy if not taken properly.
Taking your cholesterol meds correctly
Medicine can only help you reduce cholesterol if you take it correctly.
- You should take all medicines the way your provider instructs you to do.
- Dont decrease your medication dosage to save money. You must take the full amount to get the full benefits. If your medicines are too expensive, ask your provider or pharmacist about finding financial assistance. Some companies provide discounts for certain medications.
- Dont hesitate to let your provider know if you dont think the medication is working or if you have side effects of cholesterol medicine that concern you.
Working with your pharmacy
Your pharmacy can be your partner in ensuring youre sticking with your cholesterol meds.
Keeping track of your high cholesterol medication
There are now many ways to keep track of medication schedules.
When traveling, keep your medicines with you so you can take them as scheduled. On longer trips, take an extra weeks supply of medicines and copies of your prescriptions in case you need to get a refill.
A note from Cleveland Clinic
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Stop Smoking To Lower Cholesterol
The ADA recommends if you smoke to quit to improve diabetes management. Quitting smoking can also improve your overall health and reduce your risk of cancer.
There are numerous programs, support systems, and medications available to help you quit smoking. Studies show it might take a few tries to quit your smoking habit for good. Not smoking when you have diabetes can help you reduce your risks of cardiovascular disease and other diabetes complications.
Weight Loss Can Lower Triglycerides And Ldl Cholesterol
It doesnt take dramatic weight loss to lower LDL and triglyceride levels. Just 5 to 10 pounds can make a difference, says Jerry Blaine, M.D., who specialized in cholesterol management, lipid disorders, hypertension, and preventive medicine, including at the Lipid Clinic at Lahey Hospital and Medical Center in Burlington, Massachusetts, before retiring in 2013.
The same applies to triglycerides. The more calories you eat and dont burn off, the more you store, which can lead to higher-than-normal triglyceride levels.
Additionally, there are other trim-down steps you can take to lower your LDL cholesterol and triglycerides:
Set a goal to lose 5-10 percent of your total body weight. For example, a 200-pound adult would aim to lose 10-20 pounds. Once the weight is off, keep up your healthy lifestyle to maintain your new weight.
Cut 200-500 calories a day from the number of calories it takes to maintain your weight. Reducing caloric intake will lower both LDL and triglycerides.
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Otc Supplements For The Management Of High Cholesterol
Emily M. Ambizas, PharmD, MPH, CGPAssociate Clinical ProfessorCollege of Pharmacy & Health SciencesQueens, New YorkClinical Specialist, Rite Aid PharmacyWhitestone, New York
US Pharm. 2017 42:8-11.
Cardiovascular disease remains the leading cause of mortality and morbidity in the United States, with coronary artery disease being the number-one cause of death.1 Dyslipidemia is a major contributor to the development of CAD and other forms of atherosclerosis individuals with high total cholesterol levels have about twice the risk for heart disease. Approximately 100 million adults in the U.S. have total cholesterol levels > 200 mg/dL , and almost 74 million have high levels of low-density lipoprotein cholesterol .2,3 Adults aged > 20 years should have their cholesterol measured at least once every 5 years.2
What Are Normal Cholesterol Numbers
Everyone aged 20 years and older should have his or her cholesterol levels checked at least once every 5 years. The blood test should be taken after fasting for 9 to 12 hours.
You should aim for a total cholesterol level of < 200 mg/dL. Levels of 240 mg/dL or above are considered high. For LDL, lower levels are better, and the goal should be below 130 mg/dL, with < 100 mg/dL being optimal. For HDL, higher numbers are better. An HDL level < 40 mg/dL is a major risk factor for developing heart disease. You want to aim for levels of 60 mg/dL or better to help lower this risk.
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Do I Need Cholesterol Medication
- Moving your body for 30 minutes each day. Exercise can help raise HDL cholesterol and lower LDL cholesterol, especially for anyone who is overweight.
- Quitting smoking. Smoking raises LDL cholesterol and lowers HDL cholesterol, especially in women.
When lifestyle changes arent enough to control your cholesterol, medication can be an option.
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 .
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Mechanisms Accounting For The Fibrate Induced Lipid Effects
Fibrates are ligands that bind and activate PPAR alpha, a member of the family of nuclear hormone receptors that are activated by lipids . PPAR alpha is highly expressed in the liver and other tissues important in fatty acid metabolism. PPAR alpha forms a heterodimer with RXR and together the PPAR alpha:RXR complex when activated binds to the PPAR response elements in a large number of genes and regulates the expression of these genes . The natural ligands of PPAR alpha are fatty acid derivatives formed during lipolysis, lipogenesis, or fatty acid catabolism .
TRIGLYCERIDES
HIGH DENSITY LIPOPROTEINS
The increase in HDL induced by fibrates is due to PPAR alpha activation stimulating Apo A-I and A-II transcription . This leads to the increased production of HDL . In addition, a decrease in TG rich lipoproteins may result in a reduction in CETP mediated transfer of cholesterol from HDL to VLDL and of TG from VLDL to HDL . This would lead to less TG enrichment of HDL and a decrease in the opportunity of hepatic lipase to remove TG leading to small HDL particles that may be rapidly catabolized.
LOW DENSITY LIPOPROTEINS
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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Effect Of Evinacumab On Clinical Outcomes
There are no cardiovascular outcome studies.
Homozygosity for loss-of-function mutations in ANGPTL3 is associated with significantly lower plasma levels of LDL-C, HDL-C, and triglycerides . Heterozygous carriers of loss-of-function mutations in ANGPTL3, which occur at a frequency of about 1:300, have significantly lower total cholesterol, LDL-C, and triglyceride levels than noncarriers . Moreover, patients carrying loss-of-function variants in ANGPTL3 have a significantly lower risk of coronary artery disease . Additionally, in an animal model of atherosclerosis treatment with evinacumab decreased atherosclerotic lesion area and necrotic content . Taken together these observations suggest that inhibiting ANGPTL3 with evinacumab will reduce cardiovascular disease.
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Pharmacokinetics And Drug Interactions
Omega-3 ethyl esters and fatty acids are absorbed by the GI tract similar to other dietary lipids. It is worth noting that omega-3-free fatty acids are directly absorbed by the small intestine and are not dependent on pancreatic lipases for absorption. Thus, absorption of omega-3-fatty acids is not decreased in patients with pancreatic insufficiency and therefore may be preferred in patients with pancreatic disease. Additionally, the bioavailability of omega-3-fatty acids with a low fat diet was greater than omega-3-ethyl esters while there was little difference between these different formulations with a high fat diet .
Drug interactions have not been seen with omega-3-fatty acids .
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How To Lower Your Cholesterol And Triglycerides Levels With No Medications
Heart disease becomes very common when it comes to aging. But getting one in young age is a thing no one wants to happen. Still, there are diseases that cause this and there are ways to prevent them. One of these diseases is a lipid disorder, the one that happens when you have high blood levels of Low Density Lipoprotein cholesterol or fats that are called Triglycerides, or both. Lets see how to deal with it and how to lower triglycerides and cholesterol levels.