Your Cholesterol Profile - In Depth (cont.)
What is ezetimide (Zetia)?
Ezetimibe lowers blood cholesterol by blocking the absorption of cholesterol,
including dietary cholesterol, from the intestines. It does not affect, however,
the absorption of triglycerides or fat-soluble vitamins. Ezetimibe was approved
by the FDA in October, 2002.
Ezetimibe can be used alone or together with a
statin drug. Ezetimibe used alone is modestly effective in lowering LDL
cholesterol. At a dose of 10 mg/day it can reduce LDL cholesterol by
approximately 17%. When used with a statin, it can reduce LDL cholesterol level
further than a statin alone. However, there is insufficient scientific data to
determine whether a statin-ezetmibe combination actually further reduces heart
attack or stroke risks. A new combiniation drug, Vytorin, is available and
combines 10 mg of Zetia with 20, 40, or 80 mg of Zocor.
Ezetimibe is probably
most useful in avoiding having to use high doses of a statin to achieve the 2004
NCEP LDL cholesterol targets in certain patients. Using lower doses of a statin
probably reduces the risk of muscle injury. A statin-ezetmibe combination may
also be helpful in treating patients with very high LDL cholesterol who cannot
attain LDL cholesterol targets even with maximal doses of statins. Ezetimibe can
be taken with or without food and at the same time as statin drugs.
Ezetimibe is
well-tolerated. The overall rate of side effects with ezetimibe in clinical
studies was similar to that reported with a placebo (an inactive sugar pill).
Diarrhea, abdominal pain, back pain, joint pain, and sinusitis were the most
commonly reported side effects, occurring in 1 in every 25 to 30 patients.
Is lowering LDL cholesterol enough?
Unfortunately, the prevention and treatment of atherosclerosis are more
complicated than just lowering LDL cholesterol levels. LDL cholesterol reduction
is only half of the battle against atherosclerosis. Individuals who have normal
or only mildly elevated LDL cholesterol levels can still develop atherosclerosis
and heart attacks even in the absence of other risk factors such as cigarette
smoking, high blood pressure, and diabetes mellitus. Additionally, successfully
lowering elevated LDL cholesterol levels cannot always prevent atherosclerosis
and heart attacks. In many clinical trials to lower LDL cholesterol, there were
patients who adhered to their assigned diets, faithfully took their
cholesterol-lowering medications, and successfully lowered their LDL cholesterol
to target levels, yet still suffered progressive atherosclerosis and heart
attacks. It is clear that while lowering LDL cholesterol below NCEP target
levels is an important step, there are other factors involved.
What are the other risk factors for heart attacks?
In addition to low HDL levels, diabetes, hypertension, cigarette smoking, and
a family history of coronary heart disease, the other risk factors are small LDL
particle size, elevated Lp(a) cholesterol, and elevated homocysteine.
Next: What are LDL cholesterol particle size patterns A and B? »
- 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.
- Electrocardiogram (ECG or EKG) - Read about the Electrocardiogram (ECG, EKG) procedure used to reflect underlying heart conditions such as agnina, occurance of a prior heart attack or of an evolving heart attack, and more.
- Heart Attack - Overview on heart attack (myocardial infarction) and heart attack symptoms including jaw pain, headache, shortness of breath, nausea, vomiting, heartburn, sweating, and more.
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