Cholesterol (cont.)
What are the statin drugs?
The statins are the most widely used, and also the most powerful medications
for lowering LDL cholesterol. Numerous large, randomized, double-blind,
placebo-controlled, , clinical trials (controlled trials) have shown that
statins reduce heart attacks (and strokes) and improve survival. Statins are
well tolerated with low side effect rates when used long term. Statins not only
lower blood LDL cholesterol levels, they also modestly increase HDL cholesterol
levels and modestly decrease triglyceride levels. The statins that are now on
pharmacy shelves in the U.S. (putting the generic name first followed by the
brand name in parentheses) are:
Studies have consistently shown that lowering LDL cholesterol with diet and
statins reduces the risk of a second heart attack. The prevention of recurrent
heart attacks in patients who have already suffered a heart attack is called
secondary prevention.
Studies have also demonstrated that reducing LDL cholesterol with lifestyle
changes and statins reduces the risk of having the first heart attack.
Prevention of heart attacks in those who have never had a heart attack is called
primary prevention.
Studies have also confirmed that reducing LDL cholesterol benefits both men
and women, and the elderly. For more, please read our article on
Statins.
How do doctors select statin drugs?
Which statin to use is an individualized decision. There are several
considerations in choosing a statin:
- In patients who need intense LDL
cholesterol-lowering, it is more appropriate to use one of the more potent
statins, such as atorvastatin (Lipitor) or rosuvastatin (Crestor). Sometimes a
statin may need to be combined with another medication such as cholestyramine
(Questran), ezetimibe (Zetia) or nicotinic acid, in order to achieve the LDL
cholesterol goals.
- In patients with chronic liver disease who need
statin treatment, it is important to completely abstain from alcohol and use
either pravastatin (Pravachol) or rosuvastatin (Crestor) in low doses.
(Pravastatin and rosuvastatin are safer to use in patients with liver disease.)
If LDL cholesterol goals cannot be attained with low doses of either of these
two statins, cholestyramine (Questran) or ezetimibe (Zetia) can be added.
- In patients who develop muscle aches or muscle damage
with a statin, it may be appropriate to try another statin, such as
pravastatin (Pravachol), that probably has less of a muscle toxic effect than
the other statins. In patients who are at risk of developing muscle injury
(for example a patient who is already taking gemfibrozil), pravastatin
(Pravachol) would also be a suitable statin to use.
- Atorvastatin (Lipitor) and fluvastatin
(Lescol) do not require dose adjustments in patients with kidney diseases.
Next: What is nicotinic acid? »
- Statins - Read about statins, cholesterol lowering medications like Levacor, Zocor, Pravachol, Lipitor, Crestor, and more. Side effects, drug interactions, and patient information is also provided.
- Homocysteine - Read about the test for homocysteine levels in the blood. High levesl of homocysteine include increased risk of heart attacks, strokes, blood clots, and Alzheimer's disease.
- Diabetes - Learn about type 1 and 2 diabetes (Diabetes Mellitus) symptoms including increased urination, thirst, weight loss, fatigue, nausea, vomiting, skin infections, and blurred vision. Causes and diagnosis information is provided in the information.
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