Cholesterol-Lowering Drugs: What You Need to Know

WebMD Live Events Transcript

When you're trying to lower your cholesterol, you know that eating right is the first step. But what is the role of drugs in your fight to lower cholesterol levels? We asked Michael Chesner, MD, when he joined us on Nov. 3, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

This event was brought to you by Reliant Pharmaceuticals. Reliant Pharmaceuticals is the manufacturer of Lescol XL, a drug approved to reduce total elevated cholesterol.

I don't want to take medicine for my cholesterol. It was 245 and my doc still wants me on it. I go walking every day and watch what I eat. What else can I do?

There are many ways to lower cholesterol without resorting to medications. I should add, however, that in a majority of cases elevated cholesterol can be treated both safely and effectively with appropriate medications by a health care provider. I too have many patients who are uncomfortable with the concept of taking medications and am therefore forced to help them find alternative treatments for lowering cholesterol. Several methods exist to assist with that:

  • Dietary management is an important method of lowering cholesterol, reducing saturated fat in the diet, cutting back on dairy products, red meats, certain oils, such as palm and coconut, are helpful adjuncts to lowering cholesterol.
  • Exercise has also been shown to be beneficial at lowering cholesterol levels as well as raising the level of HDL, which we know to be the good cholesterol in the bloodstream.
  • Some patients treat themselves with a product from a health food store known as red yeast rice and feel they are taking a more healthful treatment for their cholesterol. What they don't realize, however, is that this is in fact similar to the statin class of cholesterol-lowering drugs and is therefore subject to the same potential side effects as that particular class of drug, without the benefit of FDA monitoring.
  • Metamucil, one to three times daily, has been shown in a study published several years ago in the Journal of the American Medical Association , to reduce total cholesterol by approximately 17%. Some patients are more comfortable with this agent than with medications.

I should repeat, however, that in a majority of cases, patients do benefit from one of the available medications for lowering cholesterol and that they can be used safely and effectively.

"Most cholesterol-lowering medications are better able to decrease LDL and at present the options for raising HDL are somewhat more limited."

This questioner mentioned a level of "245," but that's a combined number, I'm guessing. Can you go into more detail about the different types of cholesterol? Not all cholesterol is bad, right?

There are different substances in the bloodstream that make up the total cholesterol level. In general, the LDL cholesterol is the more dangerous and the more important number to lower, while the HDL is the good cholesterol, which we want to be as high as possible.

A little mnemonic device I teach my patients to help them remember is: the HDL is happy when it's high, while the LDL we want to be low, for the letter L. That helps patients remember the difference between them.

It is interesting to note that most cholesterol-lowering medications are better able to decrease LDL and at present the options for raising HDL are somewhat more limited. I expect over the next five years more medications to be available to raise the HDL, which would be as beneficial if not more beneficial, than lowering LDL, as our present medications are best able to do.

Should I be worried about taking Crestor based on the recent warnings about its safety?

Statins fit into that class known as HMG CO-A inductase inhibitors. These drugs are the class most often used today for cholesterol reduction. In fact, they make up the largest dollar value of medications prescribed in the United States today. Currently in the United States over 17 million people are currently using statins, and another 15 to 20 million should be on them, based on their risks and current cholesterol levels.

They are, by and large, safe and highly effective at lowering total cholesterol and LDL cholesterol. They also lower triglycerides and modestly raise HDL, the good cholesterol, in many patients. They have been used since the 1980s and have been shown to prevent heart attacks, strokes, and death in millions of people, based on numerous well-published studies. As a class, they are by and large very well tolerated, and have been associated with few, but very well publicized, side effects in a small minority of patients.

For those who are unaware of which drugs are in this class, they include Privation, Lipitor, Zocor, Lescol, Mevacor, and Crestor. There had been one other member of the class, known as Baycol, which was removed from the market in the year 2001 due to a higher than expected frequency of cases of muscle breakdown that had been noted with Baycol.

Crestor is a very powerful statin that has been shown to reduce LDL cholesterol better than any of the other statins currently available when compared milligram for milligram. However, at higher dosages, it has been shown to have a slightly higher than expected amount of muscle inflammation associated with it, and therefore patients at higher dosages, such as Crestor 40 milligrams per day, should be followed closely with regard to measurement of their CPK levels.

In general the side effects of the statin class are noted in 1% or less of patients and can include:

  • Nausea
  • GI upset
  • Malaise
  • Fever
  • Elevation of liver tests
  • Muscle aches or muscle cramps

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