Statin Use During A Heart Attack
If youve had a heart attack or are dealing with any other type of acute coronary event, such as interventions like bypass surgery or angioplasty, chances are your physician will prescribe a statin during and immediately after the event, and for good reason. It is generally accepted in the medical community that statins may have some value independent of lowering LDL cholesterol, probably anti-inflammatory in nature.
But doctors do not have clear answers to the following: What statin is best? What dosage? How long should the patient be on it? Usually, high doses are prescribed immediately after the event and are then tapered to doses necessary to maintain target values .
There is much about statins we physicians do not know, states Dr. Ronald Scheib, MD, FACC, FACP, former Chief of Section of Cardiovascular Medicine at the Miami Heart Institute. We do know that toxicity is a clear danger.
Mechanism Accounting For The Lomitapide Induced Lipid Effects
Lomitapide is a selective inhibitor of microsomal triglyceride transfer protein . MTP is located in the endoplasmic reticulum of hepatocytes and enterocytes where it plays a key role in transferring triglycerides onto newly synthesized apolipoprotein B leading to the formation of VLDL and chylomicrons . Loss of function mutations in both alleles of MTP results in abetalipoproteinemia, which is characterized by the virtual absence of apolipoprotein B, VLDL, chylomicrons, and LDL in the plasma due to the failure of the liver and intestine to produce VLDL and chylomicrons . Lomitapide by inhibiting MTP activity reduces the secretion of chylomicrons by the intestine and VLDL by the liver leading to a decrease in LDL, apolipoprotein B, triglycerides, non-HDL-C, and Lp .
Who Can Take Statins
You might be prescribed a statin if you have heart disease or another disease of the heart and blood vessels, or if you are at risk of developing them in the next 10 years.
If you have high cholesterol
You should be offered a statin if you have high cholesterol and lifestyle changes havent been enough to bring it under control.
Depending on your cholesterol levels and how healthy you are otherwise, you and your doctor or nurse might want you to try to bring your cholesterol levels down with a healthy diet and lifestyle first, before starting statins.
If you are at risk of developing heart disease
You will probably be prescribed a statin if you are at high risk of developing heart disease or a disease of the blood vessels. For example, if you have:
- rosuvastatin .
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Reducing Heart Disease Naturally
One thing that this study does show is that cardiovascular disease is complicated.
The study also brings to light another fact about cholesterol drugs are not the only way to lower your LDL levels.
Most doctors who prescribe statins for high cholesterol will also recommend that patients exercise more and eat healthier foods.
But more hospitals and doctors offices are starting to promote lifestyle changes as a way for patients to reduce their risk of cardiovascular disease and LDL levels using diet and exercise alone.
Often this approach involves a whole food or plant-based diet rich in vegetables, fruits, whole grains, beans, legumes like chickpeas and lentils, healthy fats like those in olive oil and avocado, and dairy alternatives.
For many, this diet will be a challenge to switch to. But there is a growing body of research on its benefits.
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Myth #: Statins Frequently Cause Memory Loss
Truth: In 2012, the FDA changed statin drug labels to include information that some people had experienced memory loss and confusion while taking the medications.
Unfortunately, that change was based on some poor-quality studies and evidence, Martin explains. People became seriously concerned that lower cholesterol levels could affect the brains function. But in fact, the brain makes its own cholesterol. It doesnt depend on the cholesterol in the blood.
My colleagues and I at Johns Hopkins specifically researched the issue of statins impacting cognitive dysfunction or dementia, says Martin. We reviewed all the studies that had been done, and found that the most rigorous studies show that statins do not commonly cause memory loss. If anything, long-term use of statins might have a beneficial effect on the brain since they help prevent strokes and protect the health of arteries in the brain.
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Effect Of Bempedoic Acid On Clinical Outcomes
Currently there are no outcome studies determining the effect of bempedoic acid on atherosclerotic cardiovascular disease. The effect of bempedoic acid on cardiovascular disease is currently being evaluated in a large ~3.5-year clinical trial . In animal models of atherosclerosis, treatment with bempedoic acid had favorable effects on atherosclerosis . Moreover, genetic variants that mimic the effect of ATP citrate lyase inhibitors lower LDL-C levels and are associated with a decrease in cardiovascular disease suggesting that bempedoic acid will have favorable effects on reducing the risk of cardiovascular disease .
What About Using Red Rice Yeast Or Plant Stanols Instead Of Prescription Drugs To Lower Cholesterol
Many people say they prefer to take natural medicines over prescription drugs. However, just because something is natural doesnt mean that its safe. In the U.S., supplements are not regulated as closely as medicines. Supplements can also interfere in dangerous ways with medications that you already take.
However, red rice yeast extract does contain lovastatin, which is the same chemical that is in Mevacor. In some cases, you and your healthcare provider might agree that you should try the supplement with monitoring.
Plant stanols are another nonprescription choice for lowering cholesterol. Plant stanols work by stopping the body from absorbing cholesterol in the intestines. One brand is CholestOff® capsules, while plant stanols are also available in margarine substitutes like Benecol®.
How to take your cholesterol-lowering medicines
When you are taking medicines, it is 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 medicine
Dont decrease your medicine 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.
A note from Cleveland Clinic
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What If I Forget To Take It
If you occasionally forget to take a dose, take your next dose the next day at the usual time. Never take 2 doses at the same time. Never take extra doses.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
How Are Doctors Sure That Statins Really Are Safe And Beneficial
Statins have been studied more than nearly any other drug that people take. In fact, more than 170,000 people who take statins have been studied in detail and for extended periods of time. We certainly know the benefits of statins.We also understand the risks of statins. In some instances, after doctors have prescribed a drug for 10 years or more, it is taken off the market because of unforeseen, adverse side effects. Weve been prescribing statins since the 1990s for patients at high risk for stroke and heart disease. With statins, the side effects actually are well known. But how can we put that in perspective?Any focus on statin side effects needs to be counterbalanced by the fact that statins reduce peoples risk of dying from heart attack, heart disease, or stroke. Data from the 2008 JUPITER Trial suggest a 54 percent heart attack risk reduction and a 48 percent stroke risk reduction in people at risk for heart disease who used statins as preventive medicine. The data are not speculative rather, they reflect statins real potential to save lives and avoid illness.There are many varieties of brand name and generic statins available. All statins work in more or less the same way to lower bad cholesterol in patients at high risk for cardiac events.Below are a few of the common brand names you may recognize, along with their generic counterparts:
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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.
How Can I Accelerate My Results
Sometimes diet, exercise, weight management, and smoking cessation are simply not enough or can not produce the quick results needed by these people in the high-risk category of heart attack or stroke. In these cases, your doctor will prescribe you probably one of the several types of cholesterol-lowering medications. The most likely candidate will be one of the statins which significantly reduce the amount of cholesterol produced by the liver. Statins can reduce LDL by 30 to 60 percent in a matter of weeks. Although they can produce impressive results, they come with a long list of side effects that need to be discussed with your doctor before making a decision.
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Effect Of Bile Acid Sequestrants On Clinical Outcomes
The Lipid Research Clinics Coronary Primary Prevention Trial of cholestyramine vs. placebo was the first large drug study to explore the effect of specifically lowering LDL-C on cardiovascular outcomes . LRC-CPPT was a multicenter, randomized, double-blind study in 3,806 asymptomatic middle-aged men with primary hypercholesterolemia. The treatment group received cholestyramine 24 grams per day and the control group received a placebo for an average of 7.4 years. In the cholestyramine group total and LDL-C was decreased by 8.5% and 12.6% as compared to the placebo group. In the cholestyramine group there was a 19% reduction in risk of the primary end point accounted for by a 24% reduction in definite CHD death and a 19% reduction in nonfatal myocardial infarction. In addition, the incidence rates for new positive exercise tests, angina, and coronary bypass surgery were reduced by 25%, 20%, and 21%, respectively, in the cholestyramine group. The reduction in events correlated with the decrease in LDL-C levels . Of note, compliance with cholestyramine 24 grams per day was limited with many patients taking much less than the prescribed doses. These results indicate that lowering LDL-C with bile acid sequestrant monotherapy will reduce cardiovascular disease.
Natural Ways To Lower Your Cholesterol Levels
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Cholesterol is made in your liver and has many important functions. For example, it helps keep the walls of your cells flexible and is needed to make several hormones.
However, like anything in the body, too much cholesterol or cholesterol in the wrong places creates problems.
Like fat, cholesterol does not dissolve in water. Instead, its transport in the body depends on molecules called lipoproteins, which carry cholesterol, fat and fat-soluble vitamins in the blood.
Different kinds of lipoproteins have different effects on health. For example, high levels of low-density lipoprotein result in cholesterol deposits in blood vessel walls, which can lead to clogged arteries, strokes, heart attacks and kidney failure .
In contrast, high-density lipoprotein helps carry cholesterol away from vessel walls and helps prevent these diseases .
This article will review 10 natural ways to increase the good HDL cholesterol and lower the bad LDL cholesterol.
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Are There Any Other Good Options For Lowering My Bad Cholesterol
Not really. has been a non-statin option. Zetia will lower LDL cholesterol by about 13% and is well tolerated. However, Zetia took a hit after the updated 2013 guidelines for treating high cholesterol were released. Its expensive, and added to a statin it provides no known benefit in prevention of heart disease. There may be more options on the horizon though, in new injectable cholesterol medications Praluent and Repatha.
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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Understanding Your Cholesterol Results
The results of a cholesterol test can be as confusing as they are important. Learn the difference between LDL and HDL, and how to lower your cholesterol. What do my cholesterol results mean?
Thats because lowering heart attack risk is not just a matter of lowering cholesterol. There are many other factors that damage artery walls and increase the risk of a heart attack or stroke, including:
- High glucose levels
- High blood pressure
- Carbon monoxide from cigarette smoke
- Increased tendency towards blood clotting
- High triglycerides
- Remnants of triglycerides, called VLDL and chylomicrons, that flood the blood right after a fatty meal and promote the growth of cholesterol-filled plaques
- Elevated high-sensitivity C-reactive protein levels, which are associated with inflammation that weakens and destabilizes plaques, leading to plaque rupture and a heart attack
- Excess weight, especially abdominal weight
- Stress associated with anger and hostility
- A sedentary lifestyle
How long does it take to lower cholesterol with medication? It depends on the dosage. The higher the dosage, the greater the reductions, but higher dosages often bring greater risk of side effects.
- Decreased LDL and non-HDL cholesterol levels, and
- Loss of excess body fat
Effect On Evinacumab On Lipid And Lipoprotein Levels
HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA
A double-blind, placebo-controlled trial randomly treated patients with Homozygous Familial Hypercholesterolemia with an intravenous infusion of evinacumab 15 mg/Kg every 4 weeks or placebo . The individuals in this trial were on lipid lowering therapy and the mean baseline LDL-C level was approximately 250-260mg/dL. After 24 weeks of treatment patients in the evinacumab group had a 47% reduction in LDL-C levels vs. a 1.9% increase in the placebo group . This decrease in LDL-C levels was observed after 2 weeks of therapy and was observed regardless of concomitant use of other lipid lowering drugs or apheresis. Notably, in individuals with null-null LDL receptor variants evinacumab resulted in a 43% decrease in LDL-C levels indicating that evinacumab therapy was effective in the absence of functional LDL receptors. As expected, total cholesterol, non-HDL-C cholesterol, and apo B levels were also decreased. Moreover, triglyceride levels decreased 55% and HDL-C levels decreased 30% with evinacumab administration while Lp levels were unchanged.
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Effect Of Statin Therapy On Clinical Outcomes
A large number of studies using a variety of statins in diverse patient populations have shown that statin therapy reduces atherosclerotic cardiovascular disease. The Cholesterol Treatment Trialists have published meta-analyses derived from individual subject data. Their first publication included data from 14 trials with over 90,000 subjects . There was a 12% reduction in all-cause mortality in the statin treated subjects, which was mainly due to a 19% reduction in coronary heart disease deaths. Non-vascular causes of death were similar in the statin and placebo groups indicating that statin therapy and lowering LDL-C did not increase the risk of death from other causes such as cancer, respiratory disease, etc. Of particular note there was a 23% decrease in major coronary events per 1 mmol/L reduction in LDL-C. Decreases in other vascular outcomes including non-fatal MI, coronary heart disease death, vascular surgery, and stroke were also reduced by 20-25% per 1 mmol/L reduction in LDL-C. Additionally, analysis of these studies demonstrated that the greater the reduction in absolute LDL-C levels the greater the decrease in cardiovascular events. For example, while a 40mg/dl decrease in LDL-C will reduce coronary events by approximately 20%, an 80mg/dl decrease in LDL-C will reduce events by approximately 40%. These results support aggressive lipid lowering with statin therapy.
Statins And How Statins Work
Doctors also prescribe, usually if lifestyle changes are falling short, drugs like statins. Brand names include Lipitor, Crestor, Mevacor, Pravacol, and Zocor. Statins have been clearly shown to reduce blood cholesterol and prevent atherosclerosis, or heart disease. They work by reducing the livers production of cholesterol. They block an enzyme called HMG CoA Reductase that the liver uses to make cholesterol.
But other things are happening in the liver that statins do not affect. In addition to producing cholesterol, the liver helps clear excess cholesterol from the blood. It has tiny receptors that capture LDL bad cholesterol particles that are floating around. Like vacuum cleaners, these receptors suck this excess cholesterol up and out of the blood, which means theres much less cholesterol seeping into our artery walls, building plaque.
The problem is, a diet full of saturated fats, trans fat, and dietary cholesterol reduces the number and effectiveness of these LDL receptors. And theres nothing statins can do to counteract this process.
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