CHOLESTEROL TREATMENT MADE EASY
Lipid levels can be lowered with lifestyle changes, medications, or a combination of these approaches. In certain cases, a healthcare provider will recommend a trial of lifestyle changes before recommending a medication.
Lifestyle changes — All patients with high LDL cholesterol should try to make some changes in their day-to-day habits, by reducing total and saturated fat in their diet, losing weight (if overweight or obese), performing aerobic exercise, and eating a diet rich in fruits and vegetables.The benefits of such lifestyle modifications usually become evident within 6 to 12 months.
However, the success of lipid lowering with lifestyle modification varies widely, and healthcare providers sometimes choose to begin drug therapy before this time period is over.
Medications — There are many medications available to help lower elevated levels of LDL cholesterol and triglycerides, but only a few for increasing HDL cholesterol. Each category of medication targets a specific lipid and varies in how it works, how effective it is, and how much it costs. Your healthcare provider will recommend a medication or combination of medications based on blood lipid levels and other individual factors.
Statins — Statins are among the most powerful drugs for lowering LDL cholesterol and are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death. Statins include lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. These medications decrease the body's production of cholesterol and can reduce LDL levels by as much as 20 to 60 percent.
In addition, statins can lower triglycerides and slightly raise HDL cholesterol levels. Statins may prevent heart attacks and strokes in more ways than just lowering cholesterol levels. For instance, statins seem to help keep buildups in blood vessels (known as plaques) from rupturing. Plaque rupture is an important event that can lead to a heart attack.
It is important to closely follow the dosing instructions for when to take statins; some are more effective when taken before bedtime while others should be taken with a meal. In addition, some foods, such as grapefruit or grapefruit juice, can increase the risk of side effects of statins. Most manufacturers recommend that people who take lovastatin, simvastatin, or atorvastatin consume no more than one-half of a grapefruit or 8 ounces of grapefruit juice per day.
Ezetimibe — Ezetimibe (brand name: Zetia) impairs the body's ability to absorb cholesterol from food as well as cholesterol that the body produces internally. It lowers LDL cholesterol levels when used alone. It has relatively few side effects when used alone.
Bile acid sequestrants — The bile acid sequestrants include cholestyramine, colestipol, and colesevelam . These medications bind to bile acids in the intestine, reducing the amount of cholesterol absorbed from foods. Bile acid sequestrants may be recommended to treat mild to moderately elevated LDL cholesterol levels. However, side effects can be bad, and may include nausea, bloating, cramping, and liver injury. Taking psyllium (a fiber supplement, such as Metamucil) can sometimes reduce the dose required and the side effects.
Bile acid sequestrants can interact with some medications, including as digoxin (brand name: Lanoxin) and warfarin (brand name: Coumadin), and with the absorption of fat-soluble vitamins (including vitamins A, D, K, and E). Taking these medications at different times of day can solve these problems in some cases.
Nicotinic acid (Niacin) — Nicotinic acid is a vitamin that is available in immediate-release, sustained-release, and extended-release formulations. Nicotinic acid may be recommended for people with elevated cholesterol levels and some types of familial hyperlipidemia.
Side effects — Nicotinic acid has several possible side effects, including flushing (when the face or body turns red and becomes warm), itching, nausea, and numbness and tingling. This medication can also injure the liver; patients who use it require regular monitoring of liver function.
Taking nicotinic acid with food and taking aspirin (325 to 650 mg) 30 minutes before can decrease the side effects. Side effects often improve after 7 to 10 days.
The immediate-release formulation is more likely to produce side effects, but is also more effective at lowering cholesterol levels and less likely to injure the liver than certain sustained-release formulations. The sustained-release and extended-release formulations have fewer side effects and are usually taken at night with a meal or snack.
Nicotinic acid can produce other side effects in some people. For example, it can blunt the body’s reaction to insulin, which can increase blood sugar levels in diabetics. It can increase uric acid levels in people with gout and is not recommended for this group. Nicotinic acid can also produce low blood pressure in people taking vasodilator medications such as nitroglycerin, and it can sometimes worsen angina pectoris (chest pain).
Fibrates — Fibrate medications (gemfibrozil, fenofibrate and fenofibric acid) can lower triglyceride levels and raise HDL cholesterol levels. Fibrates may be recommended for people with elevated triglyceride and cholesterol levels. Fibrates have been associated with muscle toxicity (causing muscle pain or weakness), especially when used by people with kidney insufficiency or when used in combination with a statin medication. Fenofibrate/fenofibric acid (brand names: Tricor, Triglide, Trilipex) are less likely to interact with statins than gemfibrozil, and are safer in people who must use both medications.
NUTRITIONAL SUPPLEMENTS
Soy protein — Soy protein contains isoflavones, which mimic the action of estrogen. A diet high in soy protein can slightly lower levels of total cholesterol, LDL cholesterol, and triglycerides, and raise levels of HDL cholesterol. However, normal protein should not be replaced with soy protein or isoflavone supplements in an effort to lower cholesterol levels. Soy foods and food products (eg, tofu, soy butter, edamame, some soy burgers, etc.) are likely to have beneficial effects on lipids and cardiovascular health because they are low in saturated fats and high in unsaturated fats.
Plant stanols and sterols — Plant stanols and sterols may act by blocking the absorption of cholesterol in the intestine. They are naturally found in some fruits, vegetables, vegetable oils, nuts, seeds, and legumes. They are also available in commercially prepared products such as margarine (Promise Active™ and Benecol), orange juice (Minute Maid Premium Heart Wise), rice milk (Rice Dream Heart Wise™), as well as dietary supplements (Benecol SoftGels and Cholest-Off). There is some evidence that these supplements might actually increase risk.
STICKING WITH TREATMENT
The treatment of high cholesterol and/or triglycerides is a lifelong process. Although medications can rapidly lower your levels, it often takes 6 to 12 months before the effects of lifestyle modifications are noticeable. Once you have an effective treatment plan and you begin to see results, it is important to stick with the plan. Stopping treatment usually allows lipid levels to rise again. Most people who stop treatment do so because of side effects. However, there are a wide variety of medications available today, which should make it possible for most people to find an option that works for them. Talk with us if a specific medication is not working; we can recommend alternatives that are compatible with your lifestyle and beliefs. TO GET MORE INFORMATION call or sms 0653358123
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