Otc Supplements For The Management Of High Cholesterol
Emily M. Ambizas, PharmD, MPH, CGPAssociate Clinical ProfessorCollege of Pharmacy & Health SciencesQueens, New YorkClinical Specialist, Rite Aid PharmacyWhitestone, New York
US Pharm. 2017 42:8-11.
Cardiovascular disease remains the leading cause of mortality and morbidity in the United States, with coronary artery disease being the number-one cause of death.1 Dyslipidemia is a major contributor to the development of CAD and other forms of atherosclerosis individuals with high total cholesterol levels have about twice the risk for heart disease. Approximately 100 million adults in the U.S. have total cholesterol levels > 200 mg/dL , and almost 74 million have high levels of low-density lipoprotein cholesterol .2,3 Adults aged > 20 years should have their cholesterol measured at least once every 5 years.2
Choose Fish In Water Not Oil
Fish is a heart healthy food, but read the label carefully when you buy canned fish. Doctors recommend that you watch your intake of fat when you have high triglycerides, especially saturated and trans fats. It is a better idea to buy canned fish that is packed in water. You will get all the benefits of omega-3 fatty acids in fish without the downside of additional fats that may contribute to high triglyceride levels. The American Heart Association recommends that people eat at least 2 servings of fatty fish per week. Fatty fish that are high in omega-3 fatty acids include salmon, herring, trout, mackerel, sardines, and albacore tuna.
Why Do Doctors Focus On My Ldl Cholesterol
Some cholesterol is necessary for normal cell and body function. But too much cholesterol can lead to atherosclerosis , which results in heart disease, heart attack, and stroke.
There are two types of cholesterol: high-density lipoprotein and low-density lipoprotein . The amount of each that circulates in your blood is added together to form your total cholesterol number. Thus, focus on total cholesterol can be confusing as it may be elevated due to high HDL cholesterol.
When your LDL cholesterol is above 130 it is considered borderline, while above 160 is considered high. Ideally, we would all have an LDL under 100 , but not everyone needs medications above this level.
We focus on the bad cholesterol because it is one of the main culprits responsible for blocking and hardening the arteries. A blocked artery can lead to a heart attack or stroke. Statin therapy helps control the bad cholesterol of patients who are at high risk for heart disease, stroke, and other serious cardiovascular events. In general, the lower your LDL levels, the better off you will be.
Theres a lot of science around how HDL cholesterol affects your risk for heart disease. But its the function how well it works that may be more important thanhow high its level is.
Also Check: How To Increase Hdl Cholesterol With Food
Increase Your Physical Activity
Physical activity increases levels of HDL cholesterol the good cholesterol that removes LDL cholesterol from the blood. Vigorous aerobic exercise is best.
If you havent been exercising much lately, gradually build up to the recommended amount of physical activity:
- People aged 18-64 years should do 30 to 60 minutes of moderate-intensity physical activity on most days of the week.
- People aged 65 years and over should aim for a total of 30 minutes of moderate physical activity on most days .
Moderate-intensity exercise is a level that increases your heart rate and breathing but allows you to keep talking. Vigorous intensity exercise makes your heart rate higher and makes you breathe more heavily.
Resistance training and muscle-toning exercises can increase HDL cholesterol. Aim to do this twice a week.
What Are Normal Cholesterol Numbers
Everyone aged 20 years and older should have his or her cholesterol levels checked at least once every 5 years. The blood test should be taken after fasting for 9 to 12 hours.
You should aim for a total cholesterol level of < 200 mg/dL. Levels of 240 mg/dL or above are considered high. For LDL, lower levels are better, and the goal should be below 130 mg/dL, with < 100 mg/dL being optimal. For HDL, higher numbers are better. An HDL level < 40 mg/dL is a major risk factor for developing heart disease. You want to aim for levels of 60 mg/dL or better to help lower this risk.
Read Also: What Is The Best Alcohol To Drink To Lower Cholesterol
Drugs That Work In Your Intestines
What they are: Your doctor may call these âbile acid resinâ drugs or âbile acid sequestrants.â The work inside your intestines. They attach to bile from the liver and keep it from being absorbed back into your blood. Bile is made largely from cholesterol, so these drugs whittle down the body’s supply of cholesterol.
Examples include:
A different type of drug, ezetimibe , lowers âbadâ LDL cholesterol by blocking cholesterol absorption in your small intestine. Studies have found that in people who have had a heart attack, it can make a small cut in the risk of heart âevents,â such as another heart attack, when you also take a statin.
Side effects: For bile acid drugs, the most common side effects are constipation, gas, and upset stomach. For ezetimibe, the most common ones include muscle or back pain, diarrhea, and abdominal pain.
There Are No Warning Signs
Typically, there are not really warning signs for people with high cholesterol, said Dr. Kirley, noting there are some relatively uncommon disorders where people can get physical symptoms like lesions on their skin, but those are quite uncommon.
For the most part, the only way you can get insight into your cholesterol levels and how they might play into your risk for heart attack and stroke is to be evaluated by your physician and have your levels tested with a blood test, she added.
Recommended Reading: How Does Saturated Fat Increase Cholesterol
Your Body Naturally Makes Cholesterol
One of the biggest things we see is that people think their cholesterol levels are more tied to what they eat than they really are, said Dr. Kirley, adding that people tend to think if my cholesterol levels are high, that means I should eat less cholesterol.
The amount of cholesterol that you eat, doesn’t actually impact your own cholesterol very much, she noted. And that’s because your body is making cholesterol. It makes cholesterol no matter what. Even if you eat no cholesterol, your body makes cholesterol.
What you eat matters, but it has less impact on cholesterol levels than a lot of people might realize, Dr. Kirley said.
Related Coverage
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.
You May Like: How To Remove Cholesterol Deposits Under The Eyes
Mechanism Accounting For The Statin Induced Lipid Effects
Statins are competitive inhibitors of HMG-CoA reductase, which leads to a decrease in cholesterol synthesis in the liver. This inhibition of hepatic cholesterol synthesis results in a decrease in cholesterol in the endoplasmic reticulum resulting in the movement of sterol regulatory element binding proteins from the endoplasmic reticulum to the golgi where they are cleaved by proteases into active transcription factors . The SREBPs then translocate to the nucleus where they increase the expression of a number of genes including HMG-CoA reductase and, most importantly, the LDL receptor . The increased expression of HMG-CoA reductase restores hepatic cholesterol synthesis towards normal while the increased expression of the LDL receptor results in an increase in the number of LDL receptors on the plasma membrane of hepatocytes leading to the accelerated clearance of apolipoprotein B and E containing lipoproteins . The increased clearance of LDL and VLDL accounts for the reduction in plasma LDL-C and triglyceride levels. In patients with a total absence of LDL receptors statin therapy is not very effective in lowering LDL-C levels.
What Are Some Things That May Contribute To High Cholesterol And Triglycerides
We often associate high cholesterol and triglyceride levels with obesity, stress, lack of exercise, smoking, alcohol consumption, and poor diet. However, there are many things that may contribute to these conditions.
One of the most common causes of high cholesterol and triglycerides is a diet rich in saturated fats. Saturated fat is found in red meat, dairy products, butter, cheese, and eggs. These foods contain large amounts of cholesterol and saturated fat.
Another cause of high cholesterol and triglyceride levels is a diet lacking in fiber. Fiber helps lower cholesterol and triglycerides by removing excess cholesterol and triglycerides from the body.
Other factors that may contribute to high cholesterol and triglyceride include genetics, age, gender, hormones, medications, and lifestyle choices.
To reduce your risk of developing high cholesterol and triglycerides, try making some simple dietary changes. Avoiding processed food and eating more fruits, vegetables, whole grains, beans, nuts, seeds, fish, and poultry may help.
Also, avoid trans fats, which are found in fried foods, baked goods, snack foods, and fast food. Trans fats raise bad cholesterol and decrease good cholesterol . Theyre linked to heart disease, stroke, diabetes, and weight gain.
Read Also: How Does Cholesterol Medication Work
Microscopic Testing Of Feces
Microscopic testing for fats is performed to identify the amount of fat present in feces. Using a microscopic exam, the laboratory professional is able to determine the number and size of fat droplets present in feces, as well as the type of fats present. The types of fats in feces include triglycerides, fatty acids, and fatty acid salts. The presence of fat in the stool is called steatorrhea, a possible sign or symptom of serious malabsorption syndromes and diseases such as celiac sprue and cystic fibrosis. Triglycerides 1-5 Fatty acids 5-15
Recommended Reading: Do Eggs Have Good Cholesterol
When And Why Triglyceride Levels Should Be Treated
Triglyceride levels are only part of the picture of cardiovascular disease risk, and whats normal can depend on your individual health factors. That said, according to the U.S. National Library of Medicine, triglyceride guidelines are defined as:
- Normal: Less than 150 mg/dL
- Borderline high: 150 mg/dL to 199 mg/dL
- High: 200 to 499 mg/dL
- Very high: 500 mg/dL and above
If you are in a category above normal, your doctor will likely recommend lifestyle changes and possibly discuss medications to normalize your levels and reduce your risk of cardiovascular disease. High triglycerides seem to create some increased levels of cardiovascular risk similar to LDL cholesterol, says Andrew Freeman, MD, a cardiologist at National Jewish Health in Denver. Triglycerides can play a role in the development of atherosclerosis, or the buildup of plaque in arteries that restricts blood flow and is associated with coronary heart disease, angina, and peripheral artery disease, says the AHA.
According to Mayo Clinic, high triglycerides can often be a sign of other conditions that raise your cardiovascular disease risk, such as obesity and metabolic syndrome, which is defined as having at least three out of a group of conditions: excess abdominal fat, high blood pressure, elevated blood sugar, reduced HDL cholesterol, and, of course, high triglycerides. Extremely high triglycerides can lead to pancreatitis, or inflammation of the pancreas.
Recommended Reading: Is Scallops High In Cholesterol
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.
Help For Your Cholesterol When The Statins Won’t Do
If you are one of the many, but also one of the few…
After a routine check-up, your doctor says that you are one of the many, the 100 million Americans with an unhealthy cholesterol level. Since you are already pretty careful about your diet and you walk every day, medication is the next step. Like most physicians, your doctor prescribes one of the statin drugs. It’s a good choice these widely popular drugs can lower LDL cholesterol levels by 20%60%, thus reducing the risk of cardiac events by 24%37%. If that’s not enough reason to start therapy with a statin drug, consider that it appears to reduce the risk of stroke by 24%31% and it may even protect you against osteoporosis and dementia.
|
Table 1: Cholesterol goals for healthy adults |
|
|
60 mg/dL or above |
Optimal |
It’s a long list of side effects, but it shouldn’t stop doctors from turning to a statin first when medication is needed to bring cholesterol into range. Fortunately, most side effects are mild and disappear promptly when the statin is stopped. In some cases, the problems will resolve simply by reducing the dose or switching to another statin, but care is required. Still, all in all, the statins are the safest and best tolerated of all cholesterol-lowering medications.
Don’t Miss: Does Coconut Oil Cause High Cholesterol
Have Your Cholesterol Levels Tested
As for how often a person should have their cholesterol levels tested, for many people, it does not need to be a yearly test, said Dr. Kirley. The guidelines have been evolving about this in terms of what age you need to start getting your cholesterol levels tested and how frequently.
For most adults, its good to have them checked at least once so you have a general idea about where your levels may be and what your risk may be, she added. And then for people who have risk factors like high blood pressure or older age, we may start checking every few years or so.
Dont Rely On Behavioral Changes Alone
People ask a lot about behavioral changes that they can make to impact their cholesterol levels, said Dr. Kirley. This includes changing what they eat and their physical activity levels.
We see that increasing physical activity and eating a generally more healthful diet can be helpful for cholesterol levels, but these changes tend to have a relatively small impact on cholesterol levels, she said. Eating more veggies, eating less saturated fat and getting more physical activity – those are wonderful things for your health and we totally recommend themthey reduce your risk for heart attacks and strokes overall, Dr. Kirley added. But they tend to not change your cholesterol levels very much.
Recommended Reading: Is There Medication For High Triglycerides
How Quickly Can I Lower My Cholesterol
Your cholesterol levels may lower as quickly as a few weeks to a few months, depending on your treatment plan.
If your levels are very high, your healthcare provider may recommend taking medications at the start of your treatment plan. This may help lower your cholesterol levels more quickly. The sooner you can lower your bad cholesterol levels, the sooner you can lower your risk for plaques to form.
You can also lower your cholesterol through lifestyle and diet changes alone, but it may take three to six months to see results. Talk with your healthcare provider to figure out the best treatment plan for you.
Effect Of Statins Therapy On Clinical Outcomes In Specific Patient Groups
PRIMARY PREVENTION
The key issue is âwhich primary prevention patients should be treatedâ and this is still controversial. It should be noted that the higher the baseline risk the greater the absolute reduction in events with statin therapy. For example, in a high-risk patient with a 20% risk of developing a vascular event, a 25% risk reduction will result in a 15% risk of an event . In contrast in a low-risk patient with a 4% risk of developing a vascular event, a 25% risk reduction will result in a 3% risk . Thus, the absolute benefit of statin therapy over the short term will depend on the risk of developing cardiovascular disease.
Additionally, based on the Cholesterol Treatment Trialists results the reduction in cardiovascular events is dependent on the absolute decrease in LDL-C levels. Thus, the effect of statin treatment will be influenced by baseline LDL levels. For example, a 50% decrease in LDL is 80mg/dl if the starting LDL is 160mg/dl and only 40mg/dl if the starting LDL is 80mg/dl. Based on studies showing that a decrease in LDL of 1 mmol/L reduces cardiovascular events by ~20% the relative benefit of statin therapy will be greater in the patient with the starting LDL of 160mg/dl than in the patient with the starting LDL of 80mg/dl . Thus, decisions on treatment need to factor in both relative risk and baseline LDL levels.
ELDERLY
WOMEN
ASIANS
Don’t Miss: Is Cholesterol Good For Your Hair
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: