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What Does Cholesterol Medicine Do

Putting Guidelines Into Practice

High Cholesterol – Do I Need To Take Medication?

Will these guidelines change how your doctor checks and treats your cholesterol? Yes and no. Many physicians are already focusing on the balance of benefits and risks when making decisions about treatment. I, for one, am already prescribing statins to patients of mine at high risk of heart disease even when their cholesterol levels are close to normal. What will be new for me is making sure my patients are on an effective dose and no longer focusing on how low their LDL drops.

These new guidelines, while meant for doctors, contain a lot that each of us can do. Here are some examples.

  • Go beyond the numbers. When talking with your doctor, instead of focusing on your cholesterol number, ask about your risk for developing cardiovascular risk. That appears to be a better guide as to whether you should be on a statin. Your doctor should have tools to help you estimate that. The new AHA/ACC guidelines recommend replacing the Framingham Risk Score with a new way to estimate risk.
  • Remember the other stuff. These new guidelines are quick to remind us that there is more to lowering cardiovascular risk than just taking a statin. We need to remain focused on living healthy as welleating right, getting exercise, not smoking, and maintaining a healthy weight.
  • About the Author

    Reena L. Pande, MD, Instructor in Medicine, Harvard Medical School

    Dangers Of Statin Drugs: What You Havent Been Told About Popular Cholesterol

    Hypercholesterolemia is the health issue of the 21st century. It is actually an invented disease, a problem that emerged when health professionals learned how to measure cholesterol levels in the blood. High cholesterol exhibits no outward signsunlike other conditions of the blood, such as diabetes or anemia, diseases that manifest telltale symptoms like thirst or weaknesshypercholesterolemia requires the services of a physician to detect its presence. Many people who feel perfectly healthy suffer from high cholesterolin fact, feeling good is actually a symptom of high cholesterol!

    Doctors who treat this new disease must first convince their patients that they are sick and need to take one or more expensive drugs for the rest of their lives, drugs that require regular checkups and blood tests. But such doctors do not work in a vacuumtheir efforts to convert healthy people into patients are bolstered by the full weight of the US government, the media and the medical establishment, agencies that have worked in concert to disseminate the cholesterol dogma and convince the population that high cholesterol is the forerunner of heart disease and possibly other diseases as well.

    The drugs that doctors use to treat the new disease are called statinssold under a variety of names including Lipitor , Zocor , Mevacor and Pravachol .

    How Long Will I Need Cholesterol Medication

    Typically, people who take cholesterol medication need it for the rest of their lives, and youre more likely to need it as you get older. However, children and teens can have high cholesterol, too. Lifestyle changes can often prevent the need for medication or work with medication to lower your risk of coronary artery disease.

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    How Should I Take Lipitor

    Take Lipitor exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

    Lipitor is usually taken once a day, with or without food. Take the medicine at the same time each day.

    Do not break an Lipitor tablet before taking it, unless your doctor has told you to.

    You may need to stop using this medicine for a short time if you have:

    • uncontrolled seizures

    • a severe infection or illness or

    • surgery or a medical emergency.

    It may take up to 2 weeks before your cholesterol levels improve, and you may need frequent blood test. Even if you have no symptoms, tests can help your doctor determine if Lipitor is effective.

    Lipitor is only part of a complete treatment program that may also include diet, exercise, and weight control. Follow your doctor’s instructions very closely.

    Store at room temperature away from moisture, heat, and light.

    A Guide To Cholesterol Medication

    Cholesterol Drugs DO NOT Prevent Heart Attack and Stroke But Can Cause ...

    Cholesterol medications help lower total cholesterol within the body. Cholesterol is a natural waxy, fat-like substance that is carried through the bloodstream to different organs and tissues. Although cholesterol is essential for human health, too much bad cholesterol or not enough good cholesterol can put you at risk for coronary heart disease, heart attack, or stroke. This is because LDL can build up in the arteries, causing the artery to limit blood flow. HDL is important because it clears the build-up of such damaging cholesterol.

    Doctors used to advise us to avoid foods that are high in cholesterol, which include animal products, such as milk, eggs, and meat. They now say that eating foods high in cholesterol does not cause a persons cholesterol levels to increase. However, red meat and whole milk are not healthy for other reasons. On the other hand, eating fresh fruits and vegetables, nuts, and whole grains can help us reduce our cholesterol levels and has been shown to help prevent heart disease and cancer.

    High levels of triglycerides, a type of fat in your blood produced from unused calories, can also increase your risk of heart disease.

    Cholesterol-lowering medications work by blocking the substance your body needs to make cholesterol. Medications may also reduce triglycerides and help your body reabsorb cholesterol that has built up as plaque on your artery walls. This prevents further blockage in your blood vessels and potential heart attacks.

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    Statins And How Statins Work

    Doctors also prescribe, usually if lifestyle changes are falling short, drugs like statins. 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.

    Why Arent Lifestyle Modifications Enough To Adequately Lower Cholesterol In Some People

    Some people have a very strong family history of high cholesterol, known as familial hypercholesterolemia. Lifestyle modifications may not be enough to lower their cholesterol levels.

    Additionally, some people need to lower their cholesterol levels because they are at high risk for future cardiovascular events. They should take cholesterol-lowering medications and not rely on lifestyle modifications alone.

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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.

    How Do Doctors Decide Who Is Prescribed A Statin

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    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.

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    Can Statins Damage My Liver

    Liver damage from taking statins is extremely uncommon. We used to test patients for liver damage throughout the course of statin treatment, but because of the rarity of that potential side effect, the Food and Drug Administration determined that regular monitoring of liver function tests is unnecessary for patients taking statins. Now, we check a patients liver enzymes before we begin statin therapy to ensure the liver is healthy before treatment begins, and we dont put anyone through unnecessary testing during treatment, unless symptoms arise.

    Interestingly, there is a statin study examining people who already had abnormal liver function tests and fatty liver. Roughly half of the participants took a statin medication, and the other half took a placebo. The people who took statins actually had improvements in their liver function compared to the placebo group and had a lower risk of cardiovascular events. People who have blood sugar issues, have insulin resistance, and are obese or have other risks for heart disease often have fatty liver and abnormal liver function tests. The study suggests that these people may need statins the most.

    How Does My Health Care Provider Decide Which Cholesterol Medicine I Should Take

    When deciding which medicine you should take and which dose you need, your health care provider will consider:

    • Your cholesterol levels
    • Your risk for heart disease and stroke
    • Your age
    • Any other health problems you have
    • Possible side effects of the medicines. Higher doses are more likely to cause side effects, especially over time.

    Medicines can help control your cholesterol, but they don’t cure it. You need to keep taking your medicines and get regular cholesterol checks to make sure that you cholesterol levels are in a healthy range.

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    When Is Medication Typically Required To Manage High Cholesterol

    Medication is typically recommended when:

    • your cholesterol levels are high enough to increase your risk for cardiovascular disease
    • you have an LDL level greater than 190 milligrams per deciliter
    • you have diabetes or are otherwise considered high risk for cardiovascular disease, and you have an LDL level greater than 70 mg/dL

    A doctor will calculate your cardiovascular disease risk score to show your risk for developing a heart attack or stroke over 10 years. If the score is greater than 5 percent, theyll recommend a medication.

    You can calculate your cardiovascular disease risk score online using the American College of Cardiologys risk estimator.

    Having a triglyceride level greater than 200 mg/dL also puts a person at higher risk for cardiovascular disease. A triglyceride level of greater than 885 mg/dL will prompt a doctor to prescribe a medication, because you would be at an additional increased risk for pancreatitis.

    What Are Side Effects Of Statins

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    Common side effects include

    • Statins when taken together with itraconazole , erythromycin , protease inhibitors, nefazodone , cyclosporine , diltiazem , verapamil , and grapefruit juice could cause an interaction that blocks the enzymes in the liver that eliminate statins from the body.
    • This causes an increased level of statins that could result in an increased risk of myopathies and rhabdomyolysis.
  • Bile acid sequestrants prevent the absorption of statins into the body by binding to them in the intestine. It is recommended that statins be ingested one hour before or four hours after cholestyramine or colestipol .
  • Statins , when taken with warfarin , may cause an increased risk of bleeding. Atorvastatin and pravastatin do not have a clinically significant effect when given warfarin .
  • An increased risk of rhabdomyolysis or liver failure can occur when statins are taken with niacin , or fibric acids .
  • St Johnâs Wort decreases the levels of lovastatin and simvastatin and could possibly reduce the efficacy of the specified statins.
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    You Can’t Ignore Your Diet

    Your LDL may drop once you start taking the medication, but these aren’t magic pills. You still may need to lose weight, eat a low-fat diet, and exercise.

    “Medication doesn’t take the place of a healthy lifestyle,” Dr. Gotto says. “Just because you take a statin doesn’t mean you can forget about diet and exercise. The medication is much more effective, even at lower doses, if you follow a healthy lifestyle,” he adds.

    Changing your diet and exercising more can lower your cholesterol by 4% to 13%. Statins lower cholesterol by 20% to 45%, depending on the type.

    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.

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    What Statins Dont Do

    Its also important to keep in mind that statins address just one risk factor for heart disease high cholesterol levels. There are many other risk factors that statins do not touch, like high blood sugar, insulin resistance, belly fat, high blood pressure, and high triglycerides .

    To attack all these risk factors, your best bet is a healthy lifestyle like Pritikin, points out Dr. Danine Fruge, Medical Director at Pritikin.

    Side Effects Of Statins

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    Many people who take statins experience no or very few side effects.

    Others experience some troublesome, but usually minor, side effects, such as diarrhoea, a headache or feeling sick.

    Your doctor should discuss the risks and benefits of taking statins if they’re offered to you.

    The risks of any side effects also have to be balanced against the benefits of preventing serious problems.

    A review of scientific studies into the effectiveness of statins found around 1 in every 50 people who take the medicine for 5 years will avoid a serious event, such as a heart attack or stroke, as a result.

    Find out more about the side effects of statins.

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    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:

    • Lipitor
    • Vytorin

    How Do Statins Work

    Statins get in the way when your liver is trying to make cholesterol. Like a good basketball player who doesnt let an opponent get the ball, statins dont let your liver have an enzyme it needs to create cholesterol. Your body makes 75% of your cholesterol, so helping it make less can make a big difference. The rest of your bodys cholesterol is from what youre eating.

    Statins also help your liver get rid of more cholesterol.

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