Cholesterol Medication
When we look at treating high cholesterol, we need to know whether we are treating high LDL cholesterol, low HDL cholesterol, high triglycerides or some combination of the three.
We have both lifestyle choices, and drug choices available to us.
Before treating dyslipidemia it is important to know not only what our lipid levels are but what levels we are aiming for and why. The levels we aim for will be dependent on the risk factors we have for getting cardiovascular disease. Charts are available to assess these risks. Being a male over 45 or female over 55, having high total cholesterol readings > 200 mg/dl, HDL reading < 40 mg/dl, high LDL reading >130 mg/dl, high systolic blood pressure > 130 mmHG (blood pressure reading when the heart contracts), blood pressure of 140/90 or higher or on blood pressure medications, being a smoker, having diabetes or having a family history of premature coronary heart disease are all risk factors for getting cardiovascular disease.2 An electronic 10 year risk calculator is available online from the National Institute of Health here, as well as score charts to calculate your risk according to the Framingham 10 year Coronary Heart Disease Risk Score Here.
When LDL cholesterol is higher than our goal it is always important to initiate lifestyle changes. Depending on our risk factors and level of success with life style changes our physician may or may not recommend drug therapy in addition to these life style changes.
Lifestyle Recommendations
Diet low in saturated fats, high fiber, fruit, vegetables, nuts and whole grains, and low fat dairy products
- Increased physical activity
- Weight loss
- No smoking
- Low alcohol consumption
For help with a heart healthy diet go to the American Health Association and look at An Eating Plan for Healthy Americans Here.
Medication Choices
A number of medications are available to treat high cholesterol. Your physician will make the best selection for your treatment based on your LDL, HDL and triglyceride readings, your risk factors, other disease states and the cost of the various medications. Sometimes your physician may need to use a combination of medications to reach your cholesterol and triglyceride goals.
Classes of medications available are:
Cholesterol Absorption Inhibitor
- Ezetimibe
* - Well tolerated
Fibrates
- Fenofibrate
- Gemfibrozil
* - Side effects: nausea, abdominal pain, gas, muscle pain; perform routine blood tests
HMG CoA Reductase Inhibitors
- Atorvastatin
- Fluvastatin
- Lovastatin
- Pravastatin
- Rosuvastatin
- Simvastatin
* - Side effects: mild upper GI disturbance, muscle pain, sleep disturbance; perform routine blood tests
Niacin (Nicotinic Acid)
* - Side effects: hot flushes, itching, dry skin, GI disturbance; perform routine blood tests
Resins
- Cholestyramine
- Colestipol
* - Side effects: constipation, bloating, abdominal fullness, gas; perform routine blood tests; take other medications 1-4 hrs before these ones