Weight Loss Can Lower Triglycerides And Ldl Cholesterol
It doesn’t 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 don’t 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.
How Do Statins Work
Statins work by slowing down the production of LDL-cholesterol in the liver, where its made. Because the liver isn’t making so much cholesterol, it then takes cholesterol out of your blood to make bile with, so your blood cholesterol levels fall.
Statins slow down LDL-cholesterol production by blocking an enzyme called HMG-CoA-Reductase the medical name for statins is HMG-CoA Reductase inhibitors. Enzymes are proteins in the body which speed up normal processes. In this case, LDL production.
Statins can lower your triglycerides
As well as lowering your LDL-cholesterol, statins can lower your triglycerides too, and high triglycerides are linked to liver disease, heart disease and diabetes.
Statins can raise HDL cholesterol
Statins can sometimes raise your HDL-cholesterol the type of cholesterol which helps to clear the fat from of your arteries.
What Causes High Triglycerides
Aside from consuming a high-fat and/or high-carb diet, other lifestyle factors can contribute to high triglycerides, specifically excess weight, lack of exercise, drinking too much alcohol and smoking. Dr. Malaney adds that it can also be a side effect of certain medications, such as some birth control pills, beta blockers, antipsychotics medications, and corticosteroids.
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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 week’s supply of medicines and copies of your prescriptions in case you need to get a refill.
A note from Cleveland Clinic
Types Of Statins Available
There are several types of statins available. They include:
High intensity statins:
- pravastatin
- simvastatin
Although all statins work in the same way, your body might respond better to one type than another. This is why doctors sometimes try several types of statins before they find the right one for you.
Some are more likely to interact with other drugs or organic compounds. For example, the statins Lipitor and Zocor can interact with grapefruit juice, according to the Food and Drug Administration .
The interaction can be very dangerous. Mixing these drugs with grapefruit can increase the amount of medication in the bloodstream and cause serious side effects.
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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 .
Why Should You Treat High Cholesterol
Most people with high cholesterol wont experience any adverse symptoms at first. This might make you think you dont need to worry about your cholesterol levels, but this isnt the case.
Untreated high cholesterol puts you at increased risk of significant health problems, some of which can be fatal. These complications include :
- Coronary artery disease
- High blood pressure
Clinical trials have shown that if you and your provider decide to use a cholesterol-lowering medication, you can cut your risk of heart disease by as much as 2030% .
High cholesterol is often a lifelong condition, but it is usually easily managed through a heart-healthy diet, lifestyle changes, and cholesterol medications. Talk with your healthcare provider about when to have your cholesterol levels tested and whether starting on a cholesterol-lowering medication is right for you.
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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
Cholesterol Medication: Types Benefits And Side Effects
Elevated cholesterol levels affect millions of adults across the United States and Europe. While you may not feel any health effects of high cholesterol at first, over time it can lead to a host of health problems, especially heart disease. Fortunately, this condition is easily managed with diet, lifestyle changes, and medication. Your healthcare provider can help you decide which of the many types of cholesterol medications is right for you.
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What Do Your Cholesterol Levels Tell You
If you have high cholesterol, your doctor may recommend you take medication. This chart explains what your cholesterol levels tell you:
|
If your Total Cholesterol level is: |
This is considered: |
|
OK, but less than optimal |
|
|
60 mg/dL and above |
Good, helps lower risk |
The numbers alone wont tell you or your doctor the entire story, however. If the only risk factor you have is high cholesterol, you may not need medication. Often high cholesterol can be lowered by exercise and a healthy diet. High cholesterol is only one of a number of risk factors for heart attack and stroke. Other risk factors include:
- Family history of high cholesterol or cardiovascular disease
- Inactive lifestyle
- High blood pressure
- Ageolder than 55 if youre a man, or older than 65 if youre a woman
- Poor general health
|
Inhibits production of triglycerides in the liver |
Lovaza |
Belching, fishy taste, increased infection risk |
*Livalo became available on the market in mid-2010. Livalo is new and does not have the long track record of some of the other statins, so you may want to avoid this drug until more is known about it.
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:
- diabetes
- rosuvastatin .
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Effect Of Volanesorsen On Lipid And Lipoprotein Levels
FAMILIAL CHYLOMICRONEMIA SYNDROME
A double-blind, randomized 52-week trial evaluated the ability of volanesorsen vs. placebo to decrease TG levels in 66 patients with FCS . The primary end point was the percentage change in fasting TG levels at 3 months. As expected, there was a marked reduction in Apo C-III levels in the volanesorsen group and a small increase in the placebo group. Most importantly patients treated with volanesorsen had a 77% decrease at 3 months in TG levels whereas patients receiving placebo had an 18% increase in TG levels. The decrease in TGs in patients treated with volanesorsen persisted for 52 weeks . Significantly, 77% of the patients in the volanesorsen group vs. only 10% of patients in the placebo group had TG levels of less than 750 mg/dl, a level that would greatly reduce the risk of pancreatitis. In addition, patients who received volanesorsen had decreases in levels of chylomicron TG by 83%, apolipoprotein B-48 by 76%, nonHDL-C by 46%, and VLDL-C by 58% and increases in levels of HDL-C by 46%, apolipoprotein A1 by 14%, LDL-C by 136% , and total apolipoprotein B by 20%.
HYPERTRIGLYCERIDEMIA
DIABETES
Will A Keto Diet Lower Triglycerides And Cholesterol
No, keto diets have been shown to increase cholesterol levels. The Mediterranean diet, however, has been shown to lower cholesterol levels and reduce the risk of cardiac events.
The Mediterranean diet promotes eating vegetables, fruits, whole grains, and healthy fats daily eating fish, poultry, beans, and eggs weekly reducing portions of dairy and limiting red meat.
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What Are The Side Effects Of Fibrates
The side effects of fibrates include nausea, stomach upset, and sometimes diarrhea. Fibrates can irritate the liver. The liver irritation usually is mild and reversible, but it occasionally can be severe enough to require stopping the drug.
Fibrates can cause gallstones when used for several years.
Fibrates can increase the effectiveness of blood thinners, such as warfarin , when both medications are used together. Thus, the dose of warfarin should be adjusted to avoid over-thinning of the blood which can lead to excessive bleeding.
Fibrates can cause muscle damage particularly when taken together with statin medications. Gemfibrozil interferes with the breakdown of certain statins , resulting in higher statin blood levels, and hence a higher likelihood of muscle toxicity from the statin. Doctors generally avoid combining a statin with fibrates because of concern over the higher risk of muscle damage with the combination. Gemfibrozil should not be combined with simvastatin and if combined with lovastatin the dose of lovastatin should not exceed 20 mg daily. However, fenofibrate does not interfere with the breakdown of statins and should be the safer fibrate to use if it is necessary to use a fibrate with a statin. Furthermore, pravastatin seems to have fewer muscle toxic effects than the other statins when combined with fibrates, but the risk still exists.
What Does Research Say About Cholesterol
There are so many medications to choose from, but knowing which one is best for your body and health can be confusing. You will decide together with your doctor, but doctors are often not aware of all the latest research. Below is a summary of some of the most important studies on cholesterol medication, with conclusions that may help steer you away from drugs with greater risks or drugs that may lower your cholesterol without reducing your chances of heart attack or stroke!
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Buying Guide For Best Cholesterol
Maybe your doctor has warned you that your cholesterol is too high. Maybe youre simply concerned about keeping your heart and circulatory system as healthy as possible. In either case, you may have wondered if there are alternatives to cholesterol-lowering prescription drugs. In fact, there are several natural alternatives that have proven effective in some studies.
Youll find a lot of cholesterol-lowering supplements on sale today, and with these products comes a lot of marketing hype. Its hard to know what to believe.
Medications Can Lower Ldl And Triglycerides
To get cholesterol and triglycerides into the target zone, many people with diabetes need to add medications to their healthy eating and exercise plans. Reducing elevated LDL cholesterol is typically the top priority. To achieve the target goals, many people need to take a medication in the statin category.
The American Diabetes Association recommends that statin therapy be added for people who have:
- a lower risk of cardiovascular disease and whose LDL cholesterol doesn’t hit the target of 100 mg/dl or less with healthy lifestyle change.
- cardiovascular disease and who don’t reach the LDL cholesterol target of 70 mg/dl or less.
Statin medications are most effective at lowering LDL cholesterol. All medications should be prescribed and monitored by a health care provider.
Common statins include:
Other medications that lower both LDL cholesterol and triglycerides:
- Advicor
- Vytorin
- Prescription-strength niacin
Other medications prescribed to lower LDL cholesterol:
- Bile acid sequestrants, such as Questran or Colestid
- Welchol , a bile acid sequestrant that can also lower blood glucose
- Zetia
Other medications prescribed to lower triglycerides:
- Prescription-strength fish-oil pills
Other medications to lower cholesterol and blood pressure:
- Caduet
Medications that have been found to increase triglycerides:
- Birth-control pills
- Tamoxifen, a breast cancer drug
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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.
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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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 .
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
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