Manage Your Cholesterol

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2016-02-20T20:37:00.001-08:00

20160213

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Cholesterol medications: Consider the options

2010-01-05T07:57:00.000-08:00

By Mayo Clinic staff

A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you may need to take cholesterol medications. Cholesterol medications may help:

Decrease your low-density lipoprotein (LDL), the "bad" cholesterol that increases the risk of heart disease
Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
Increase your high-density lipoprotein (HDL), the "good" cholesterol that offers protection from heart disease

Your doctor may suggest a single drug or a combination of cholesterol medications. Here's an overview of benefits, cautions and possible side effects for common classes of cholesterol medications.

Brand and generic drug names	Drug class	Benefits	Cautions and possible side effects
Altoprev (lovastatin) Crestor (rosuvastatin) Lescol (fluvastatin) Lipitor (atorvastatin) Mevacor (lovastatin) Pravachol (pravastatin) Zocor (simvastatin)	Statins	Decrease LDL and triglycerides, slightly increase HDL	Constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness, possible interaction with grapefruit juice
Colestid (colestipol) Questran (cholestyramine) Welchol (colesevelam)	Bile acid binding resins	Decrease LDL	Constipation, bloating, nausea, gas, may increase triglycerides
Zetia (ezetimibe)	Cholesterol absorption inhibitors	Decrease LDL, slightly decrease triglycerides, slightly increase HDL	Stomach pain, fatigue, muscle soreness
Vytorin (ezetimibe/simvastatin)	Combination cholesterol absorption inhibitor and statin	Decreases LDL and triglycerides, increases HDL	Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness, possible interaction with grapefruit juice
Lofibra (fenofibrate) Lopid (gemfibrozil) TriCor (fenofibrate)	Fibrates	Decrease triglycerides, increase HDL	Nausea, stomach pain, gallstones
Niaspan (prescription niacin) Slo-Niacin (nonprescription niacin)	Niacin (vitamin B-3, nicotinic acid)	Decreases LDL and triglycerides, increases HDL	Facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers
Advicor (niacin/lovastatin)	Combination statin and niacin	Decreases LDL and triglycerides, increases HDL	Facial and neck flushing, dizziness, heart palpitations, shortness of breath, sweating, chills, possible interaction with grapefruit juice

Some cholesterol medications combine a statin and niacin, such as Advicor. No research studies have yet shown that taking these combination drugs lowers cholesterol any more than does taking niacin and a statin separately. However, the combination drug may be more convenient for you because it eliminates the need to take niacin and a statin separately. If you're interested in taking a combination medication, talk to your doctor.

You may have heard that the combination medication of ezetimibe and simvastatin (known collectively as Vytorin) is no more effective than is simvastatin (Zocor) by itself. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.

Most cholesterol medications are well tolerated, but effectiveness varies from person to person. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver. Also remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.

Source: MayoClinic

Concerned About Your Cholesterol? 10 Ways to Lower LDL and Raise HDL

2009-12-15T12:04:00.000-08:00

Learn how to decrease the "bad" type of cholesterol or increase the "good" kind

Your doctor tells you that your level of LDL—the "bad" type of cholesterol—is too high, and, in a double whammy, he says that your level of HDL—the "good" cholesterol—is too low. So, you wonder, is there anything you can do to decrease the bad while increasing the good?

There are steps you can take to accomplish this. It's much easier to push LDL down than to push HDL up, but it's well worth the effort to strive to do both. A November study published in the Postgraduate Medical Journal found that increasing HDL levels in patients who are also aggressively lowering their LDL levels can reduce cardiovascular risk. An HDL level of 60 milligrams per deciliter or higher is believed to help protect against heart disease. Women's risk for heart disease rises significantly at HDL levels below 47 mg/dL; men are at particular risk if their HDL level falls below 37 mg/dL.

For LDL, a reading of 190 mg/dL or higher is considered to be very high, 160 to 189 is considered to be high, and 130 to 159 is considered to be borderline
high. A level of 100 to 129 is considered to be near optimal; less than 100 is considered optimal for most people. But for those who are at very high risk for heart disease or have a history of heart trouble, a reading of less than 70 is preferred.

Depending on your cholesterol levels, successfully reaching your target levels will probably take a combination of medication and lifestyle and dietary changes. Among the changes you'll have to make: Stop smoking, work out, lose weight, and eat well, the PMJ study suggests.

If you're up to the task, here are 10 ways to lower your LDL and raise your HDL:

1. Taking a statin can lower LDL by 10 percent (at the lowest dose) to 55 percent (at the highest dose), says Robert H. Eckel, professor of medicine at the University of Colorado-Denver and past president of the American Heart Association. A small percentage of people who take statins experience severe myopathy, which is muscle discomfort or weakness. (Consider 7 reasons statin users shouldn't dismiss muscle pain.) Statins also bump up HDL, typically by 5 to 10 percent (that's only 2 to 4 mg/dL, not enough to make much of a difference). Other types of cholesterol-lowering medications are sometimes prescribed in combination with statins.

2. A cholesterol absorption inhibitor would be a likely next step for those who can't take statins because of side effects, Eckel says. There is only one such drug—ezetimibe (Zetia). A 2003 study in the journal Pharmacotherapy found that when given alone or in combination with other cholesterol-lowering medications, ezetimibe reduced LDL by 15 to 20 percent and raised HDL, but, as with a statin, not by much—2.5 to 5 percent.

3. Bile acid sequestrants can decrease LDL by about 10 to 20 percent, according to the National Heart, Lung, and Blood Institute. When combined with a statin, these medications can lower LDL by more than 40 percent. Medications in this class—cholestyramine, colestipol, and colesevelam—come in pill or powder form. The powder must be mixed with water or juice before being taken. These drugs offer an added benefit for diabetics: Recent research has shown they help to lower blood glucose levels.

4. Nicotinic acid, also known as niacin, is a water-soluble B vitamin that lowers LDL by 10 to 20 percent and is the only drug that can have a real impact on HDL, says Eckel. According to the NHLBI, it can lift HDL levels by 15 to 35 percent. A study published this month in Current Medical Research and Opinion says that niacin and fibrates (explained below) are underutilized—either alone or in combination with statins—to treat low HDL and high triglycerides (a kind of fat in the blood). Because most people who take niacin experience flushing of the skin and a warm feeling, particularly on the face, neck, and ears, up to half of those taking the medication choose to stop it, according to the Mayo Clinic.

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Manage Your Cholesterol

2009-11-09T18:32:00.001-08:00

Knowing the facts about cholesterol can reduce your risk for a heart attack or stroke. But understanding what cholesterol is and how it affects your health are only the beginning.

To keep your cholesterol under control:

* schedule a screening
* eat foods low in cholesterol and saturated fat and free of trans fat
* maintain a healthy weight
* be physically active
* follow your healthcare professional's advice

What is Cholesterol?

2009-11-09T18:26:00.001-08:00

Cholesterol is a form of fat that is carried through the body in two kinds of bundles, or lipoproteins. It’s important to have healthy levels of both.

Low-density lipoproteins (LDL), or “bad” cholesterol, can lead to a buildup of cholesterol in the arteries. In general, the lower your LDL the better. Reaching your LDL target is the most effective way to protect your heart and blood vessels.

High-density lipoproteins (HDL), or “good” cholesterol, helps remove cholesterol from your body. In general, the higher your HDL the better.

What are Triglycerides?
Triglycerides are another kind of blood fat that raises your chances for a heart attack or stroke if your levels are too high.

What Should My Targets Be?
Talk to your doctor about how often you should have your cholesterol checked and what numbers you should aim for. For most people, here are the LDL, HDL, and triglycerides numbers to aim for:

* LDL Cholesterol: Less than 100 mg/dL
* HDL Cholesterol: Greater than 60 mg/dL
* Triglycerides: Less than 150 mg/dL

What Can I Do to Improve My Numbers?
It’s a good idea to have your cholesterol checked every 5 years, or more often if there’s a problem. Here are some steps you can take to improve your cholesterol:

* If you smoke, quit
* Lose weight if needed
* Exercise most days of the week (brisk walking for 30 minutes/day is a good goal)
* Eat a low-fat, low-cholesterol diet with plenty of fresh veggies, whole grains, and fruit
* Increase monounsaturated fats in your diet. Monounsaturated fats include canola oil, avocado oil, or olive oil
* Your doctor may also prescribe cholesterol-lowering medicine

Cholesterol is also affected by blood pressure and blood glucose. If your blood glucose and blood pressure are high, your cholesterol numbers may be off as well. All of these are risk factors for diabetes and heart disease, and the more risk factors you have, the higher your risk. Talk to your doctor about whether you may be at higher risk for diabetes and heart disease. Then take steps to lower your risk so you can live a longer, healthier life.