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Cholesterol - drug treatment

Alternate Names

Hyperlipidemia - drug treatment

Definition

Your body needs cholesterol to work properly. But cholesterol levels that are too high can be life threatening.

When you have extra cholesterol in your blood, it builds up inside the walls of your heart’s arteries (blood vessels). This buildup is called plaque. It narrows your arteries and reduces, or even stops, the blood flow. This can cause a heart attack, stroke, or other serious heart disease.

See also: Cholesterol and lifestyle

Your Cholesterol Numbers

Total cholesterol is the amount of all of the fats in your blood. These fats are called lipids. Several different types of lipids make up your total cholesterol.

High cholesterol, especially "bad" cholesterol (LDL), can clog your arteries, which may reduce blood flow to your heart. This can lead to heart disease, stroke, or heart attack. Cholesterol is measured in milligrams per deciliter (mg/dL).

  • If you have heart disease or diabetes, your LDL cholesterol should stay below 100 mg/dL.
  • If you are at risk for heart disease (even if you do not yet have any heart problems), your LDL cholesterol should be lower than 130 mg/dL.
  • Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 - 190 mg/dL.

Your HDL cholesterol is called "good" cholesterol. You want your HDL cholesterol to be high.

  • For men, it should be above 40 mg/dL.
  • For women, it should be above 50 mg/dl.
  • Exercise helps raise your HDL cholesterol.

Your doctor may want you to take medicine for your cholesterol. This will depend on your age and whether or not you smoke, are overweight, have high blood pressure, or have diabetes.

Once you start taking cholesterol medicine, you will probably take it for the rest of your life. Sometimes, if you change your lifestyle and lose a lot of weight (and keep it off), you can stop taking cholesterol medicine. But you will always need to be aware that you still have a cholesterol problem.

Taking Your Cholesterol Medicine

Some cholesterol medicines work best when you take them at bedtime. For others, the time of day doesn’t matter. You should take some of these medicines with food. You should take your medicine at the same time every day. This makes it easier to remember to take it. It also makes you less likely to confuse different pills you may be taking.

Remember to take your medicine as directed. Some helpful aids are using a special pill box labeled with the time of day, setting alarms, or putting a reminder note in a place you are sure to see it. Keep in mind that being "on a pill" doesn’t mean anything if you forget to take it.

Make sure you tell your doctor about all other medicines you are taking, including over-the-counter medicines, vitamins, and herbal supplements. They may change the way your cholesterol drug works. Ask your doctor if you should avoid any particular foods or drinks.

Understand the side effects of your medicine. If you have any side effects, call your doctor.

Ask your doctor what you should do if you miss a dose of medicine. Keep all appointments with your doctor. Regular blood tests will tell your doctor how the drug is working. Plan ahead for refills and travel so that you do not run out.

Keep these and all other medicines stored in a cool, dry place where children cannot get to them.

Medicines for Cholesterol

There are several kinds of drugs to help lower blood cholesterol levels. They work in different ways. Some help lower LDL (bad) cholesterol, some help lower triglycerides, and others help raise HDL (good) cholesterol.

Your doctor will prescribe the best medicine for you. Sometimes you may need to take more than one cholesterol-lowering drug.

Statins are one kind of drug that lower cholesterol. They are:

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Lovastatin (Mevacor)
  • Pravastatin (Pravachol)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)

Resins are another kind of drug that lowers cholesterol. They are:

  • Colesevelam
  • Cholestyramine
  • Colestipol

Fibrates are a third kind of drug that lowers cholesterol. They are:

  • Fenofibrate (Antara, Lofibra, Tricor, or Triglide)
  • Gemfibrozil

Nicotinic acid (niacin) also helps lower cholesterol. (People with diabetes should NOT take this drug.)

Ask Your Doctor

When your doctor prescribes medicine to lower your cholesterol, ask:

  • How much should I take?
  • How often should I take it?
  • What time of day should I take it?
  • How should I take it? (With food, with water?)
  • What other drugs cannot be taken at the same time?
  • What are the possible side effects?
  • How often should I get my blood retested?
  • Should I also be taking aspirin?
  • Should I be taking any special vitamins or using fish oil or other over-the-counter remedies?
  • Should I avoid certain foods when I am taking this medicine?

When to Call the Doctor

Call your doctor if you:

  • Have muscle or tendon aches or weakness
  • Have stomach pain, cramps, or gas
  • Feel sick to your stomach, or you are vomiting
  • Have headaches
  • Have diarrhea
  • Feel more tired than usual
  • Feel dizzy
  • Have flush (your skin is warm and turning red)
  • Are unable to sleep

References

American Heart Association. Cholesterol lowering drugs. 2007 July 16. Accessed November 18, 2008.

Gaziano M, Manson JE, Ridker PM. Primary and secondary prevention of coronary heart disease. In: Libby P, Bonow RO, Mann DL, Braunwald E, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. Saunders; 2007;chap 45.

Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Nov 27;166(21):2307-13.


Review Date: 12/31/2008
Reviewed By: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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