Medications for Cholesterol: What You Should Know
High cholesterol is a significant risk factor for heart disease and stroke, two of the top killers globally. Although dietary changes such as eating a healthy diet and exercising regularly are necessary, drugs are also often required to get cholesterol under control in many people. If you've been put on cholesterol-lowering medication—or are about to be—here's what you should know about how these drugs work, what to anticipate, and how to take them safely and effectively.
Why Cholesterol is Important
Cholesterol is a waxy material in your blood. Your body requires a little cholesterol for building cells and hormones, but excess "bad" cholesterol (LDL) can accumulate in the walls of your arteries, causing blockage, heart attack, and stroke. However, "good" cholesterol (HDL) assists in taking excess cholesterol out of your blood. Drugs are typically prescribed when diet and exercise are not sufficient to manage cholesterol levels—particularly if you also have other risk factors such as diabetes, high blood pressure, or a family history of heart disease.
Statins: First Line of Defense
Common statins are:
- Atorvastatin (Lipitor)
- Simvastatin (Zocor)
- Rosuvastatin (Crestor)
Statins are effective and well-tested in preventing heart attacks and strokes. They are tolerated by most people, but side effects can be muscle pain, changes in liver enzymes, and in a few cases, memory loss. Blood tests to check for liver function and cholesterol levels are typically taken regularly.
Ezetimibe: Reducing Cholesterol Absorption
Ezetimibe (Zetia) lowers the amount of cholesterol absorbed from the foods you consume. It is usually prescribed in addition to a statin if LDL levels remain too high or if a person cannot tolerate increased statin doses. It is less likely to have side effects than statins and can be used as an add-on therapy.
PCSK9 Inhibitors: For High-Risk Patients
PCSK9 inhibitors are a newer generation of medications that reduce LDL cholesterol dramatically by assisting your liver to take out more of it from the bloodstream. These are injectable drugs usually employed in individuals with familial high cholesterol or those at extremely high cardiovascular risk and unable to achieve their target with other drugs.
Examples are:
- Alirocumab (Praluent)
- Evolocumab (Repatha)
They work well but may be expensive and are usually reserved for particular situations.
Bile Acid Sequestrants and Fibrates
These older drugs are used less frequently now but can still be of value in certain patients. Bile acid sequestrants are active in the gastrointestinal tract where they bind to bile to remove cholesterol, whereas fibrates are stronger triglyceride reducers and mild HDL elevators.
Omega-3 Fatty Acids and Niacin
Prescription omega-3 fatty acids may reduce high triglycerides, whereas niacin (vitamin B3) may raise HDL and reduce LDL and triglycerides. Niacin, however, is used less frequently these days because it may have unwanted side effects and limited improvement compared to other medications.
Takeaway: Be Your Doctor's Partner
Cholesterol medications are strong preventive agents against heart disease, but their effects are most beneficial when coupled with lifestyle modifications. Always adhere to the prescription, maintain regular check-ups, and consult your doctor regarding any side effects. With the correct treatment regimen, you can safeguard your heart and lead a healthier, longer life.
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