Non Statin Drugs To Lower Triglycerides

Who Can Take Statins

Forget LDL-Cholesterol, Low Triglycerides More Important (here’s why)

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:

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

How Do Doctors Decide Who Is Prescribed A Statin

In preventive cardiology, its up to us to help patients avoid suffering from a sudden, serious cardiovascular event, such as a heart attack or stroke, or a long, grueling ailment such as atherosclerosis . We determine on an individual basis which patients have the greatest need and who would benefit most from taking statins. We weigh these benefits against the known risks for each patient before we consider prescribing the medication.

Like all medications with risks and benefits, there are specific guidelines we follow to ensure that we prescribe statins only to people who really need them.

The American College of Cardiology and American Heart Association developed these rational guidelines in 2013 after carefully reviewing the decades of published studies about statins. First, we determine a patients overall risk of cardiac disease, taking into account their cholesterol levels as well as other risk factors such as blood pressure, smoking history, diabetes, age, and sex.

There are four general categories recommended to determine who is at high risk for a cardiovascular event, such as a heart attack or stroke.

We may recommend statins for other people, even if they dont fit in these categories. For example, if a close relative has suffered a heart attack and your own cholesterol levels are getting higher regardless of lifestyle improvements, we may recommend that you take a statin.

Recommended Reading: Does Apple Cider Vinegar Lower Cholesterol

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:

How Do I Decide The Best Next Step For Me

There are a number of things you might want to consider and talk with your health care team about as you think about whether to add a non-statin therapy.

First, are you on the most potent and highest amount of such statin you can take already?
How well have you managed to make lifestyle changes, including eating heart healthier and getting regular physical activity?
What is your personal risk of ASCVD, and how much more would a non-statin lower that risk beyond what has been achieved on a statin alone?
Possible drug-drug interactions, especially if you have other health issues.
What you prefer for treatment once you know or understand your risk.

Effect Of Low Dose Omega

Initial studies of the effect of fish oil administration on cardiovascular outcomes were favorable, demonstrating a reduction in events including all-cause mortality. However, more recent studies have failed to confirm these favorable results. In these more recent studies the use of other drugs, such as statins, that reduce cardiovascular disease were more intensively utilized. The outcomes studies that will be described below were carried out with doses of EPA and DHA that are lower than the doses used to lower plasma TGs. We will limit our discussion to the administration of fish oil as a drug and not discuss diet studies, such as DART, which had patients increase fatty fish intake .

The above results indicate that low dose fish oil do not significantly and consistently reduce the risk of cardiovascular disease.

Whos More Likely To Have Side Effects From Statins

Not everyone who takes a statin has side effects. According to a , youre more likely to experience side effects if you:

were assigned female at birth
are 65 years old or older
have type 1 or 2 diabetes
take multiple medications to lower your cholesterol
have a smaller body frame
have liver or kidney disease
consume too much alcohol

If youre experiencing side effects, a doctor or other healthcare professional may want you to try another statin, change your dosage, or try a different medication.

How To Lower Triglycerides Fast Without Medications

Unlike many illnesses, much of the treatment centered around how to lower triglycerides actually has a lot to do with lifestyle factors like diet and physical activity. In fact, moderate to slightly high levels of triglycerides may be managed in this way alone, without the use of prescription medications. Since what raises triglycerides in the first place is often the foods that we eat, it is not a wonder that a mere change in ingestibles can provide long term benefits in the form of lower triglycerides levels. And, the long term management of the amounts of these fats circulating in the blood can often be well managed with a diet to lower triglycerides combined with an increase in moderate exercise.

Fats are also best left alone as much as possible for anyone trying to stave off ever rising levels of the manufactured blood fats. As such, fried foods and those that contain trans fat or saturated fat should be eliminated from diets entirely. Not only does this decrease the likelihood that triglycerides will remain on the rise, a low fat diet also contributes to a reduced risk of obesity. Being overweight or obese is a major contributing factor to the increase of triglycerides in the blood, and adhering to a low fat diet can reduce this risk dramatically.

References:

Bempedoic Acid: Clinical Trials

Reducing Risk in Hypertriglyceridemia (REDUCE-IT Trial)

The efficacy and safety of BDA has been evaluated by five CLEAR trials: Harmony, Wisdom, Serenity, Tranquility, and Outcomes . The CLEAR Harmony and CLEAR Wisdom trials evaluated the safety and efficacy of BDA in patients already on maximally tolerated statins. Both CLEAR Harmony and CLEAR Wisdom demonstrated BDA significantly reduced LDL-C levels at week 12 by an additional 16.5 and 15.1% respectively, compared to placebo at week 12 . In both trials, BDA significantly reduced total cholesterol, ApoB, non-HDL-C, and high-sensitivity C-reactive protein compared to placebo . Though not powered to evaluate CV outcomes, the CLEAR Harmony trial noted a difference in the rates of MACE between the BDA arm and placebo arm .

Table 4. Landmark trials for bempedoic acid .

A CV outcomes trial, CLEAR Outcomes is underway with BDA, and results are expected to be released in 2023. The primary endpoint of the study is the effect of BDA on MACE. Though no study results to-date indicate whether BDA provides CV benefit, several trials note that BDA has resulted in significant reductions in hsCRP . Elevations in hsCRP have been linked to increased risk for coronary heart disease and adverse CV outcomes, therefore a reduction hsCRP may lead to positive CV outcomes.

Also Check: Does Crab Meat Have Cholesterol

Types Of Statins Available

There are several types of statins available. They include:

High intensity statins:

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.

How To Lower Triglycerides

Your doctor will determine if you need treatment to lowering triglycerides by talking with you about your current diet and lifestyle, and evaluating your triglyceride level, your LDL cholesterol level, and your potential risk factors for coronary heart disease.

Here are some of the reasons your doctor might discuss medications to lower triglycerides with you:

You have metabolic syndrome. This condition includes a combination of abdominal obesity, high triglycerides, and high blood pressure. If you have metabolic syndrome and tried diet and lifestyle changes for three months without success, triglyceride-lowering medications may be needed.
Previous medication lowered your total cholesterol but not your triglycerides. If your cholesterol is well controlled, but your triglyceride level is still too high, at or above 200 mg/dL, triglyceride-lowering medications may help.
You have very high triglycerides. If your triglyceride level is at or higher than 500 mg/dL, you may need to start medications to lower triglycerides even before reaching lower cholesterol levels.

Read Also: Is Ginger Good For Cholesterol

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

Your Personal Risk Of Heart Attack Or Stroke

Your health care team may have already talked with you about how a risk calculator can be used to find your risk of developing ASCVD or having a heart attack or stroke. This calculator factors in things like:

Systolic blood pressure
If you have diabetes

Your care team may also consider other factors that play a role or affect your risk.

Because your risk can change over time, its important to keep talking with your health care team about what steps you can take to stay healthy as you age. Keep in mind that making lifestyle changes in addition to taking a statin or other medication can help protect your heart and improve your overall health.

Truths About Statins And High Cholesterol

For every drop of scientific evidence that statins are safe and effective, there is a tidal wave of misinformation. Our patients are concerned about statin side effects theyve heard about from family or friends, or read about on the Internet.

Statins are the gold-standard for high cholesterol treatment. Theyre a powerful medication, and theyve been proven to save the lives of many men and women living with or having a high risk of heart attack or stroke.

But if statins are so effective, why are some people afraid to take them?

As with any medication, there are risks associated with taking statins, but the benefits far outweigh the risks for the vast majority of high-risk patients.

In an effort to put statin side effects into context and provide honest, scientific answers about statins and their use, weve put together a list of common questions our patients ask us:

Do Statins Cause Muscle Pain And Weakness

Muscle aches occur in about 10 percent of people who take statins. Its the most common side effect of statins, but another way to look at it is that nine out of 10 patients dont experience it at all.

When patients do have muscle pain:Actual muscle damage occurs in only 1 in 10,000 patients. In the rare event that muscle damage occurs, it is almost always reversible. To correct it while still protecting you from heart attack or stroke, we can adjust your medication or try a different statin. There also are many strategies to effectively manage muscle symptoms while continuing to take your medication.

If you experience muscle pain while taking a statin, dont stop taking it without first talking with your doctor. For almost all patients, were able to find an effective medication that the body can tolerate. If you simply cant tolerate statins, there are other cholesterol medications we can prescribe.

The symptom is often resolved by adjusting the medication dosage or switching to a different statin.
Occasionally, the statins have to be stopped altogether.
When the medication is switched or stopped, the symptoms go away and there is no damage to the muscle.

Risks And Side Effects

Although most people benefit from statins, these drugs can have side effects. The most serious side effects occur in people who are taking other medications or who have an underlying health condition. Many side effects go away as your body adapts to the medication.

The most common side effect of statins is muscle and joint aches and pains. The medication can also cause nausea and vomiting.

More serious side effects include liver and kidney damage, an increase in blood sugar, and neurological side effects. In some people, statins can cause a breakdown in muscle cells and lead to permanent muscle damage.

Acc/aha Guideline On The Treatment Of Blood Cholesterol

Non-Statin Therapies for LDL-C Lowering How to Rationally Use Them

For the first time, in 2013, the American College of Cardiology and American Heart Association released lipid guidelines that strayed away from treating lipid values. Instead, they recommend primary or secondary prevention treatment based on the presence of a prior CV event or risk factor alongside lifestyle interventions . The primary goal of the 2013 guidelines was to identify and effectively manage the risk of atherosclerotic cardiovascular disease .

While the 2013 guidelines greatly influenced medical practice, they included minimal guidance on the use of available non-statin therapies . The ACC/AHA panel recommended that clinicians consider adding an Food and Drug Administration -approved non-statin medication in the following high-risk patients :

Individuals who have a less-than-anticipated response to statins.

Individuals who are unable to tolerate a less-than-recommended intensity of a statin.

Individuals who are completely statin intolerant.

When selecting a non-statin therapy, the panel recommended that clinicians initiate a drug that has shown ASCVD risk reduction benefits that outweigh the potential for adverse effects and drug-drug interactions . At the time this guideline was published, none of the available non-statin demonstrated significant ASCVD benefits.

You May Like: Does Butter Cause High Cholesterol

Rosuvastatin And Atorvastatin Are The Best At Lowering Ldl Cholesterol

Heres the evidence backing this:

A 6-week clinical trial compared rosuvastatin against atorvastatin, pravastatin, and simvastatin and found that it lowered total cholesterol significantly more than all others, and lowered triglycerides significantly more than simvastatin and pravastatin.
A 54-week clinical trial compared atorvastatin with fluvastatin, lovastatin, and simvastatin and found that atorvastatin was better at lowering LDL cholesterol than the other medications.
A systematic review of 75 clinical trials found that rosuvastatin and atorvastatin were the only statins that lowered LDL cholesterol by more than 40% .