What Is High Cholesterol
Your cholesterol levels tell you whether your body is able to properly flow enough blood to your arteries. Mayo Clinic describes cholesterol as a waxy substance found in your blood and that its necessary to build healthy cells.
The problem is that if your cholesterol levels are too high, fatty deposits appear in your blood vessels. These deposits can grow and make it harder for blood to flow throughout your body. Getting a blood test is the only way to find out about your cholesterol health since there are no symptoms of high cholesterol.
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Effect Of Bile Acid Sequestrants On Lipid And Lipoprotein Levels
The major effect of bile acid sequestrants is to lower LDL-C levels in a dose dependent fashion. Depending upon the specific drug and dose the decrease in LDL-C ranges from approximately 5 to 30% . The effect of monotherapy with bile acid sequestrants on LDL-C levels observed in various studies is shown in .
Mechanisms Accounting For Bile Acid Sequestrants Induced Lipid Effects
Bile acid sequestrants bind bile acids in the intestine, preventing their reabsorption in the terminal ileum leading to the increased fecal excretion of bile acids . This decrease in bile acid reabsorption reduces the size of the bile acid pool, which stimulates the conversion of cholesterol into bile acids in the liver . This increase in bile acid synthesis decreases hepatic cholesterol levels leading to the activation of SREBPs that up-regulate the expression of the enzymes required for the synthesis of cholesterol and the expression of LDL receptors . The increase in hepatic LDL receptors results in the increased clearance of LDL from the circulation leading to a decrease in serum LDL-C levels . Thus, similar to statins and ezetimibe, bile acids lower plasma LDL-C levels by decreasing hepatic cholesterol levels, which stimulates LDL receptor production and thereby accelerates the clearance of LDL from the blood.
The mechanism by which treatment with bile acid sequestrants improves glycemic control is unclear .
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How Do Doctors Decide Who Is Prescribed A Statin
- Have clinical atherosclerotic cardiovascular disease , including those with a personal history of stroke, heart attack, or peripheral vascular disease, and also those who suffer from chest pains
- Have high cholesterol
- Are age 40 to 75 and have diabetes
- Are age 40 to 75 and have an estimated 10-year risk of an ASCVD event greater than 7.5 percent
What Can I Expect In The First Few Days Or Weeks Of Starting A Statin
Most people don’t feel any different or notice any side effects after starting a statin. Some people may feel muscle aches and pains in the first 6 months. In rare cases, statins can cause serious problems with your muscles and liver. Tell your doctor immediately if you have signs of problems with your muscles and liver such as muscle pain, muscle tenderness or weakness, dark coloured urine, yellowing of the skin or eyes, sharp pain in your stomach area.
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Indications For Using Statins
Statin drugs are generally prescribed for the treatment of high cholesterol levels. Statins have been found to be highly effective for patients who are at risk of cardiovascular disease and can lower the risk of a patient having a heart attack, stroke, or other cardiovascular event. Statins are generally prescribed for patients who have not had success with a cholesterol-lowering diet.
I Do Not Get The Necessary Result But Im Only Interested In A Non
There are a number of excellent herbal or natural cholesterol busters on the market. Herbal varieties usually contain either red yeast rice or guggul gum extract, both of which have been used for centuries and are effective in regulating blood lipids. The non-herbal natural busters usually contain ingredients that either absorb cholesterol themselves or inhibit the absorption of cholesterol from foods. Read our article on natural cholesterol-lowering foods, herbs, vitamins and supplements. They are safe and are a good alternative to prescription drugs, especially when combined with a proper diet and exercise.
In conclusion, how long to reduce cholesterol will depend on your commitment and discipline to working actively towards your goal. Finally, we must say that all these current polemics and the surrounding hysteria around cholesterol do not really help to approach the subject objectively enough. But at least we know that we have bet on the right cards when we take care to eat and live healthily.
Medical Disclaimer
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Myth: I Dont Need Statins Or Other Medicines For My Cholesterol I Can Manage My Cholesterol With Diet And Exercise
Fact: Although many people can achieve good cholesterol levels by making healthy food choices and getting enough physical activity, some people may also need medicines called statins to lower their cholesterol levels. Guidelinesexternal icon also suggest that other medicines in addition to statins may be needed to help control cholesterol.2
People who may need statins or other medicines to manage cholesterol levels include the following:
- People with familial hypercholesterolemia or people with very high levels of bad cholesterol. FH is a genetic condition that causes very high LDL cholesterol levels beginning at a young age. If left untreated, cholesterol levels will continue to get worse. This greatly raises the risk for heart disease, heart attack, and stroke at a young age.
- People with cardiovascular disease . People with CVD may already have narrowed arteries because of too much plaque. Medicines that lower cholesterol may help reduce the risk for heart attack or stroke.
- People with diabetes.Type 2 diabetes lowers HDL or good cholesterol levels and raises bad cholesterol levels. This combination raises your risk of heart disease and stroke.
Other groups of people may also need medicines to manage their cholesterol, including people who have a high risk for CVD. Always talk to your health care provider about the best ways to manage your cholesterol.
Ask About Cholesterol Medication
Cholesterol medications such as statins may be the fastest way to lower cholesterol for some people usually within 6 to 8 weeks. This allows a person to quickly reduce their heart disease risk while cultivating a healthy lifestyle. During this period, a person can focus on lowering cholesterol over time with lifestyle and dietary changes.
Because high cholesterol is a risk factor for serious heart health issues, the American Heart Association and American College of Cardiology recommend statins for many groups of people with high LDL cholesterol.
If LDL cholesterol does not drop enough with diet and lifestyle changes and statins, a person might need additional medications.
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Does Lowering Your Cholesterol Protect You From Ever Having A Heart Attack
Not necessarily. Since their arrival in the 1990s in Americans medicine cabinets nationwide, statin drugs have indeed proven very effective for reducing high LDL levels, and they do slow the progression of cholesterol-filled plaques. But sadly, the #1 cause of death in Americans taking statins to lower their elevated LDL levels is still heart attacks, states Kimberly Gomer, MS, RD, LDN, one of the many faculty who teach wellness education and nutrition workshops at the Pritikin Longevity Center.
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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Effect Of Lomitapide On Clinical Outcomes
There are no clinical outcome trials but it is presumed that lowering LDL-C levels in patients with Homozygous Familial Hypercholesterolemia will reduce cardiovascular events. After initiating lomitapide therapy 1.7 cardiovascular events per 1000 patient months on treatment was observed vs. 26.1 cardiovascular events per 1000 patient months in a comparison cohort .
How And When To Take It
Take atorvastatin once a day. You can choose to take it at any time, as long as you stick to the same time every day.
Sometimes doctors may recommend taking it in the evening. This is because your body makes most cholesterol at night. If you’re not sure when to take your medicine, ask a pharmacist or your doctor for advice.
Atorvastatin doesn’t upset the stomach, so you can take it with or without food.
Swallow atorvastatin tablets whole with a glass of water. If you’ve been given chewable tablets, you can chew them or swallow them whole with a glass of water.
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What Are Some Possible Side Effects Of Pcsk9 Inhibitors
Possible side effects include pain, including muscle pain and back pain, or swelling at the injection site and cold-like symptoms. Another drawback may be cost as these products may be expensive.
Fibric acid derivatives
Fibric acid derivatives make up another class of drugs that reduce blood lipid levels, especially triglycerides. Triglycerides are fats that come from food that are created when you consume calories that are not spent.
Fibric acid derivatives may also increase the level of HDL, also called the good cholesterol, while lowering liver production of LDL, the bad cholesterol. People who have severe kidney disease or liver disease should not take fibrates.
Myth #: You Could Get Cataracts From Taking Statin Drugs
Truth: Some studies have indicated that there may be a relationship between statin drugs and an increased risk for developing cataracts. However, these investigations have been either conducted in animals or in less-than-rigorous studies.
The best evidence we have comes from high-quality clinical trials in humans, which showed that statin drugs do not increase risk of cataract formation, reports Martin. In fact, some studies even performed eye exams in people over time and showed no difference in eye health between those taking and not taking statins.
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Myth: All Cholesterol Is Bad For You
Fact: Some types of cholesterol are essential for good health. Your body needs cholesterol to perform important jobs, such as making hormones and building cells. Cholesterol travels through the blood on proteins called lipoproteins. Two types of lipoproteins carry cholesterol throughout the body:
- LDL , sometimes called bad cholesterol, makes up most of your bodys cholesterol. High levels of LDL cholesterol raise your risk for heart disease and stroke.
- HDL , or good cholesterol, carries cholesterol back to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.
When your body has too much LDL cholesterol, it can build up in the walls of your blood vessels. This buildup is called plaque. As your blood vessels build up plaque over time, the insides of the vessels narrow. This narrowing can restrict and eventually block blood flow to and from your heart and other organs. When blood flow to the heart is blocked, it can cause angina or a heart attack.
Why You May Want To Come Off Statins
Not everyone needs to stop taking statins. Many people take statins for decades without having any side effects or issues. For those individuals, the medications can be a very effective form of treatment and prevention for cholesterol problems.
Others may not have the same experience with statins. People who decide to quit taking statins may have several different reasons for doing so. The following are some of the most common reasons for quitting statins.
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Effect On Bempedoic On Lipid And Lipoprotein Levels
EFFECT WITHOUT STATINS
In a study that randomized 345 patients with hypercholesterolemia .and a history of intolerance to statin to bempedoic acid or placebo bempedoic acid decreased LDL-C by 21.4%, non-HDL-C by 17.9%, and apolipoprotein B by 15% . One third of patients were on background non-statin therapy most commonly ezetimibe and fish oil. Triglyceride levels were not altered but there was a small decrease in HDL-C levels that was statistically significant .
IN COMBINATION WITH STATINS
Notably, the addition of bempedoic acid to atorvastatin 80mg per day was still capable of significantly decreasing LDL-C , non-HDL-C , and apolipoprotein B compared to placebo . The addition of bempedoic acid to high dose atorvastatin therapy did not cause meaningful changes in atorvastatin pharmacokinetics.
IN COMBINATION WITH STATIN AND EZETIMIBE
Myth #: Taking Statin Drugs Leads To Diabetes Out Of The Blue
Truth: In clinical trials, statins appear to accelerate a diagnosis of adult-onset diabetes because they cause a slight elevation in blood sugar. However, people experiencing this side effect already have higher than normal blood sugar, or prediabetes, explains Martin. For those who are borderline diabetic, the mild increase in blood sugar can lead to a diabetes diagnosis about five weeks earlier than it would be otherwise.
Research indicates that statin drugs do not induce diabetes in someone who isnt already nearing a diabetes diagnosis. Additionally, the benefits of reducing cardiac events in someone who has prediabetes or is diabetic greatly outweigh the mild increase that might occur in their blood sugar, says Martin.
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Does Walking Reduce Cholesterol
Walking raises your good cholesterol and lowers your bad cholesterol. A brisk 30-minute walk three times per week is enough to raise your good cholesterol and lower your bad cholesterol a few points. This amount of exercise, even without weight loss, is shown to improve your cholesterol levels.
Are There Any Food Or Drinks I Should Avoid
Some foods affect the way your liver can process the statin, increasing the risk of side effects. Grapefruit is a common food that has this effect with some statins. Doctors generally recommend that you eat no more than half a grapefruit or drink no more than a 200ml glass of grapefruit juice each day if you are taking some statins. Check with your pharmacist if this applies to the statin you are taking.Statins can affect your liver, so you should avoid regularly drinking large quantities of alcohol while taking them. This can increase your risk of muscle problems.
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Adopting A Diet And Exercise Program
Your doctor may suggest that you implement certain lifestyle changes before stopping the statin, or directly in place of the drug. These changes might include adopting an exercise program or modifying your diet. For example, the AHA suggests following a Mediterranean diet or vegan diet.
Keep in mind, though, that these changes likely wont work as quickly or as effectively as a statin in lowering your cholesterol. A healthy diet and exercise program can have many benefits for your overall health, but it may not be enough to replace the cholesterol-lowering effects of a statin.
You and your doctor should closely monitor your cholesterol levels to make sure the diet and exercise changes are having the necessary effects on your cholesterol.
Is There Any Difference Between The Different Statins
There are a few statins available in New Zealand atorvastatin , pravastatin , rosuvastatin and simvastatin . Rosuvastatin is not subsidized – you will need to pay for the cost of this medicine in full. In New Zealand, atorvastatin is the preferred statin and is most widely used. If you have side effects with atorvastatin, your doctor may consider lowering the dose or changing to another statin.
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Can Statins Increase My Risk For Memory Loss Or Dementia
Memory and cognitive symptoms from statin use are very uncommon, and it is unclear if statins are really the culprit. When symptoms have been reported, theyre typically not severe and usually resolve when the statin dosage is adjusted or the medication is switched.Affected patients have reported feeling unfocused or fuzzy in their thinking, but these experiences are rare. Concerns about long-term cognitive problems and memory loss due to use of statins have not been proven. On the contrary, most recent data actually point to potential prevention of dementia due to statin use.These data are logical because one of the major causes of dementia is atherosclerosis, which is hardening of the arteries in the brain. There is strong evidence that statins protect against atherosclerosis. Its one of the invisible benefits of taking a statin medication.Also, keep in mind that increasingly high cholesterol and memory problems both are common symptoms of aging. Sometimes its difficult to disentangle these two, and thats why statin use and memory problems may seem related at times.If youre concerned about statins and memory loss, dont stop taking your medication without consulting your doctor. There may be other reasons for your memory symptoms, or alternate treatments for your high cholesterol can be considered.
Mechanisms Accounting For Bempedoic Acid Induced Lipid Effects
Bempedoic acid is a potent inhibitor of ATP-citrate lyase, which catalyzes the formation of acetyl-CoA in the cytoplasm . Acetyl-CoA is a precursor for the synthesis of cholesterol . The inhibition of ATP-citrate lyase by bempedoic acid decreases cholesterol synthesis in liver reducing hepatic intracellular cholesterol levels . Of note, bempedoic acid is a pro-drug and conversion to its CoA-derivative by very-long-chain acyl-CoA synthetase-1 is required for inhibition of cholesterol synthesis . Very-long-chain acyl-CoA synthetase-1 is highly expressed in the liver but is not expressed in adipose tissue, kidney, intestine or skeletal muscle . The inability of bempedoic acid to be activated in muscle and inhibit cholesterol synthesis suggests that bempedoic acid is unlikely result in muscle toxicity.
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