Cholesterol lowering treatment: Statins: Are these cholesterol-lowering drugs right for you?

14.06.202111.07.2023 by alexxlab

Содержание

Cholesterol Medications | American Heart Association

Help to control your cholesterol levels

For some people, lifestyle changes, such as a healthier diet and more exercise, may prevent or treat unhealthy cholesterol levels. For others with high cholesterol, medication may also be needed.

Work with your doctor to develop a treatment plan that’s right for you. If medication is required, be sure to take it as prescribed. The potential benefit to your health is worth making these medications part of your normal routine.

Types of cholesterol-lowering drugs

Various medications can lower blood cholesterol levels.

Statins are recommended for most patients and have been directly associated with a reduction in the risk of heart attack or stroke. Statins continue to provide the most effective lipid-lowering treatment in most cases.

Guidelines recommend that people in any of these groups talk to their doctor about the risks and benefits of statin therapy:

Adults with a history of cardiovascular disease, including stroke, caused by atherosclerosis
Those with LDL-C level of greater than 190 mg/dL
Adults 40-75 years with diabetes
Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 5% to 19. 9% 10-year risk of developing cardiovascular disease from atherosclerosis and risk-enhancing factors
Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 20% or greater 10-year risk of developing cardiovascular disease from atherosclerosis

Some people who don’t fall into these categories may also benefit from statin therapy.

It’s important to talk to your healthcare professional about your 10-year or lifetime risk. They will assess your risk factors to determine your level of risk and work with you to choose the best treatment.

View an interactive slideshow to see how cholesterol drugs work.

Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. We’ve included generic names as well as major trade names to help you identify what you may be taking. Please understand that the American Heart Association is not recommending or endorsing any specific products. If your prescription medication isn’t on this list, your doctor and pharmacist are your best sources of information. It’s important to discuss all the drugs you take with your doctor and to understand their desired effects and possible side effects. Never stop taking a medication or change your dosage (or frequency) without first consulting your doctor.
Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your doctor about any potential risks.

Statins

This class of drugs, also known as HMG CoA reductase inhibitors, works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.

Talk to your doctor about the possible side effects before starting statins. Most side effects are mild and go away as your body adjusts. Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests. Women who are pregnant or people who have active or chronic liver disease should not take statins.

Statins available in the U.S. include:

Atorvastatin (Lipitor®)
Fluvastatin (Lescol®)
Lovastatin (Mevacor®, Altoprev™)
Pravastatin (Pravachol®)
Rosuvastatin Calcium (Crestor®)
Simvastatin (Zocor®)

If statins don’t help you enough, or if you develop side effects, your doctor may recommend different medications.

Statins are also found in the combination medications Caduet® (atorvastatin + amlodipine) and Vytorin™ (simvastatin + ezetimibe).

If you have CVD and are already taking the highest tolerated statin and your LDL-C is still 70 or above, one or more of the following medicines may be prescribed. They all can be taken in combination with a statin.

Ezetimibe (cholesterol absorption inhibitors)

Prevents cholesterol from being absorbed in the intestine. It’s the most commonly used non-statin agent.

Bile Acid Sequestrants

Also called bile acid-binding agents, cause the intestine to get rid of more cholesterol.

Those available in the U.S. include:

Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®, Locholest® Light)
Colestipol (Colestid®)
Colesevelam Hcl (WelChol®)

PCSK9 inhibitors

PCSK9 inhibitors are powerful LDL-lowering drugs. They bind to and inactivate a protein on cells found in the liver to lower LDL (bad) cholesterol. Some names are alirocumab and evolocumab.

Adenosine triphosphate-citrate lyase (ACL) inhibitors*

ACL inhibitors work in the liver to block the production of cholesterol. They are used in combination with lifestyle changes and statins to further decrease LDL cholesterol in adults with familial heterozygous hypercholesterolemia and patients with heart disease that need to further lower their LDL.

Bempedoic acid (Nexletol)
Bempedoic acid and ezetimibe (Nexlizet)

*Adenosine triphosphate-citrate lyase (ACL) inhibitors are not in the current Guideline on the Management of Blood Cholesterol, as they were FDA approved in 2020. For more information on ACL inhibitors visit the National Library of Medicine(link opens in new window).

The following triglyceride-lowering drugs have mild LDL-lowering action, but data doesn’t support their use as an add on to statins.

Fibrates

Fibrates are especially good for lowering triglyceride (blood fat) levels and have a mild LDL-lowering action.

Fibrates available in the U.S. include:

Gemfibrozil (Lopid®)
Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)
Clofibrate (Atromid-S)

Niacin (nicotinic acid)

Niacin is a B vitamin that limits the production of blood fats in the liver. Take this only if your doctor has prescribed it. It lowers triglycerides and has mild LDL-lowering action.

Niacin side effects may include flushing, itching and upset stomach. Your liver functions may be closely monitored because niacin can cause toxicity. Nonprescription immediate-release forms of niacin usually have the most side effects, especially at higher doses. Niacin is used cautiously in diabetic patients because it can raise blood sugar levels.

Niacin comes in prescription form and as a dietary supplement. Dietary supplement niacin must not be used as a substitute for prescription niacin because of potentially serious side effects. Dietary supplement niacin is not regulated by the Food and Drug Administration and may contain widely variable amounts of niacin – from none to much more than the label states. The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy.

Omega-3 Fatty Acid Ethyl Esters

These are derived from fish oils that are chemically changed and purified. They’re used in tandem with dietary changes, to help people with high triglyceride levels.

Omega-3 Fatty Acid Ethyl Esters available in the U.S. include:

Lovaza®
Vascepa™
Epanova®
Omtryg®

Marine-Derived Omega-3 Polyunsaturated Fatty Acids (PUFA)

Commonly referred to as omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high blood triglyceride levels. They help decrease triglyceride secretion and clear triglycerides. The amount of marine-derived omega-3 PUFAs needed to significantly lower triglyceride (2 to 4 g) is hard to get from a daily diet alone, so supplementing with capsules may be needed.

Use these supplements only under a doctor’s direction and care, because large doses may cause serious side effects. These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics. Negative interactions with other medications, herbal preparations and nutritional supplements are also possible. People with allergies to fish, shellfish or both may have a severe adverse reaction to using these supplements.

Written by American Heart Association editorial staff and reviewed by science and medicine advisors. See our editorial policies and staff.

Last Reviewed: Nov 11, 2020

Cholesterol-Lowering Medicines | cdc.gov

If you have high low-density lipoprotein (LDL) cholesterol, your health care team may prescribe medicine in addition to lifestyle changes to manage your LDL cholesterol level.

What are the types of medicines that treat high cholesterol?

Several types of medicines help lower LDL cholesterol. The chart below describes each type and how it works.

Cholesterol Lowering Medications
Type of Cholesterol-Lowering Medicine	How It Works
Statins	Statin drugs lower LDL cholesterol by slowing down the liver’s production of cholesterol. They also increase the liver’s ability to remove LDL cholesterol that is already in the blood.¹
Bile acid sequestrants	Bile acid sequestrants help remove cholesterol from the bloodstream by removing bile acids. The body needs bile acids and makes them by breaking down LDL cholesterol.
Niacin, or nicotinic acid	Niacin is a B vitamin that can improve all lipoprotein levels. Nicotinic acid raises high-density lipoprotein (HDL) cholesterol levels while lowering total cholesterol, LDL cholesterol, and triglyceride levels.²
Fibrates	Fibrates lower triglycerides through several complex mechanisms including reducing triglyceride production in the liver. They may also increase removal of LDL particles and increase apoA-I and apoA-II in the liver which may contribute to increase in HDL cholesterol levels.¹
Injectable medicines	Medicines called PCSK9 inhibitors lower cholesterol-increasing LDL receptors. This results in a decrease in LDL cholesterol circulating in the bloodstream.² These medicines are used in people who have familial hypercholesterolemia (FH), a genetic condition that causes very high levels of LDL cholesterol and people with clinical ASCVD who require lower LDL cholesterol levels.³

All drugs may have side effects, so talk with your health care team, including your pharmacist, on a regular basis. Once your cholesterol levels have improved, your health care team will monitor them to ensure they stay in a healthy range.

Who needs cholesterol-lowering medicine?

Your treatment plan for high cholesterol will depend on your current cholesterol levels and your overall risk of heart disease and stroke.

Your health care team may prescribe medicine if:³

You have already had a heart attack or stroke or have peripheral arterial disease.
Your LDL cholesterol level is 190 mg/dL or higher.
You are 40–75 years old and have diabetes and an LDL cholesterol level of 70 mg/dL or higher.
You are 40–75 years old and have a high risk of developing heart disease or stroke and an LDL cholesterol level of 70 mg/dL or higher.

Talk with your health care team about how you can lower your risk for heart disease.

More information

CDC and Million Hearts^®

About High Cholesterol
The Scoop on Statins: What Do You Need to Know?

Other organizations

U.S. Food and Drug Administration (FDA): Controlling Cholesterol with Statins
American Heart Association (AHA): Cholesterol Medications
National Heart, Lung, and Blood Institute (NHLBI): Blood Cholesterol

References

Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-45.
Staels B, Dallongeville J, Auwerx J, Schoonjans K, Leitersdorf E, Fruchart JC. Mechanism of action of fibrates on lipid and lipoprotein metabolism. Circulation. 1998 Nov 10;98(19):2088-93.
Roth EM, Davidson MH. PCSK9 Inhibitors: Mechanism of Action, Efficacy, and Safety. Rev Cardiovasc Med. 2018;19(S1):S31-S46.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082–e1143.

Lowering cholesterol: 17 tips to avoid heart disease

Simple steps to lower your cholesterol
Does your doctor say you have high cholesterol? Then you know that you need to change your diet and lifestyle to reduce your cholesterol and your risk of heart disease. Even if your doctor prescribes drugs to lower your cholesterol levels, you still need to make dietary changes and be more active for cardiovascular health. Our simple tips will help keep your cholesterol levels in order.
Cholesterol, good and bad
Our body needs a small amount of cholesterol to function properly. But we can get a lot of saturated fat and cholesterol from food. Both increase LDL (bad) cholesterol. LDL cholesterol can cause plaque buildup in the arteries, leading to heart disease. HDL (good) cholesterol, on the other hand, helps clear bad cholesterol from your blood. We need to lower LDL cholesterol and increase HDL cholesterol, let’s start with nutrition.
Control of the amount of food. No more than a palm at a time.
Most people eat twice the amount of food at a time than is recommended for health. This can lead to weight gain and high blood cholesterol. Here’s an easy way to control how much you eat: Use your palm. One serving of meat or fish is about as much as you can fit in the palm of your hand. One serving of fresh fruit is about the size of your fist. And one serving of cooked vegetables, rice, or pasta should fit on both palms of the hands clasped together.
More Healthy Foods
Put more fruits and vegetables on your plate, five to nine servings a day (see previous tip), to lower “bad” LDL cholesterol. The antioxidants contained in these products will also benefit. By eating more fruits and vegetables, there is less room for fatty foods. It will also help lower blood pressure and maintain a healthy weight. Foods fortified with plant steroids, some common margarines, yogurts, and others, also help lower “bad” LDL cholesterol levels.
Sea food is good for heart health
A menu for heart health should include fish at least twice a week. Why? Fish are low in saturated fats. And a large amount of useful omega-3 polyunsaturated fatty acids. Omega-3 fatty acids help lower triglycerides, a certain type of fat in the blood. Omega-3s also help lower cholesterol levels and slow down the buildup of plaque in the arteries. Choose oily fish like salmon, tuna, trout, and sardines.
Start your day with whole grains
A bowl of oatmeal or whole grain porridge will last you all day. The fiber and carbohydrate complex in whole grains will help you feel fuller for longer. you will be less tempted to overeat at lunchtime. They also help reduce bad LDL cholesterol and can be an important part of your weight loss strategy. Other examples of whole grains include brown rice, popcorn, barley, wholemeal bread.
Nuts for cardiovascular health
Would you like a snack? A handful of nuts will be a delicious alternative to other foods that help lower blood cholesterol levels. Nuts are high in monounsaturated fats, which lower the levels of “bad” cholesterol while keeping “good” cholesterol in the normal range. tartar removal cost Several studies show that people who eat about 30 grams of nuts a day have a reduced risk of heart disease. Nuts are high in fat and calories, so try not to eat more than 30 grams of nuts per day.
Unsaturated fats are good for the heart
We need some fat in our diet – about 25 to 35 percent of our daily calories. But the type of fat is key. Unsaturated fats – found in rapeseed, olive and sunflower oils, help lower “bad” cholesterol and increase “good” cholesterol. Saturated fats found in palm oil and trans fats found in animal products raise the level of “bad” cholesterol. Even good fats are high in calories, so don’t overdo them.
More beans, less potatoes
Our bodies need carbohydrates, but some are more beneficial than others. Whole grains such as brown rice, whole grain pasta, and legumes contain more fiber and raise blood sugar levels less. They help lower cholesterol and make you feel fuller for longer. Other carbs found in white bread, potatoes, white rice, and pastries raise sugar levels much faster. This leads to faster feelings of hunger, and may increase the risk of overeating.
Get moving
Even 30 minutes of physical activity a day (for vigorous activities like running, 20 minutes three times a week is enough) will help lower your “bad” and increase your “good” cholesterol. The more exercise the better. Physical activity also helps maintain a healthy weight by reducing the chance of developing clogged arteries. There is no need to practice 30 minutes in a row a day, you can divide into classes of 10 minutes during the day.
Walk
If you are not used to exercise and don’t like going to the gym – just go for a walk. It’s easy, useful, and all you need is a good pair of shoes. Activities such as walking reduce the risk of stroke and heart disease, help you lose weight and strengthen your bones. If you decide to go for walks, start with 10 minutes a day, gradually increasing the duration.
Work out without going to the gym
You can improve your heart health without exercising or going to the gym. Any vigorous activity is suitable, such as gardening, dancing, or climbing stairs instead of the elevator. Even housework can be classed as exercise if you’re doing some serious cleaning that gets your heart racing.
Be responsible for your health
If you have high cholesterol, you and your doctor can use several strategies to lower your cholesterol levels. You can improve your diet, lose weight, exercise, and even take pills. There are also other tips you can take on board to make sure you’re on the right track.
What to do if you have to eat out of the house
It’s pretty easy to keep your cholesterol under control if you cook at home. But what if you have to eat out? Restaurant food can be loaded with saturated fat, calories, and sodium. Even healthy food can be brought in large portions. Check out these tips:
Choose foods that are baked, steamed, or grilled, but not fried in oil.
If you know that the portion is large, order half a serving instead of a whole.
Look out for hidden traps
Reading the labels of the foods you buy carefully is essential to a cardiovascular health diet. Here are some tips:
If it says “whole grains” on the package. Read the label, it must contain whole grain wheat or whole grain flour.
Foods that say they don’t contain cholesterol can still raise cholesterol levels. Saturated fats may be the culprit behind this increase.
Avoid stress
Chronic stress can raise blood pressure. High blood pressure adds to the risk of atherosclerosis, when cholesterol plaques build up in the arteries. Researchers have also shown that for some people, stress directly increases blood cholesterol levels. Relieve stress with relaxation exercises or meditation. Focus on your breathing and take deep breaths. These simple steps can be done anywhere.
When loss means victory
Losing weight is the best thing you can do to combat cardiovascular disease. Obesity increases the risk of high cholesterol, high blood pressure, and type 2 diabetes. This all affects the walls of your arteries, making them more prone to plaque buildup from cholesterol. Losing weight, especially belly fat, which hardens the walls of your arteries, helps raise your “good” cholesterol and lower your “bad” cholesterol.
Follow your doctor’s advice
Managing your cholesterol levels is a lifelong process. A2news.ru advises you to visit a doctor regularly to monitor your health. Follow your doctor’s recommendations for diet, exercise, and medications. Working together, you and your doctor can lower your cholesterol levels and keep your heart healthy.

Video explaining the dangers of cholesterol:

http://www.a2news.ru/

HOW TO LOWER THE LEVEL OF CHOLESTEROL: MEDICATION AND NON-DRUG METHODS

Contents:

According to the Ministry of Health, heart and vascular diseases are the main cause of death in Russia. The higher the cholesterol, the more likely you are to die from heart problems or get complications. To protect yourself, it is important to know the norm indicators and ways to reduce high cholesterol.

Why should you monitor your cholesterol levels?

Controlling your cholesterol is a proven way to protect yourself from serious illness. The double danger is that high cholesterol does not manifest itself for a long time, and symptoms appear only against the background of complications.

The sooner you start monitoring its level, the higher the chance to avoid irreversible consequences:

heart attack;
stroke;
atherosclerosis;
coronary heart disease;
heart failure;
diseases of the central and peripheral vessels.

It is completely impossible to get rid of cholesterol, and it is not necessary, because it performs important vital functions in the body. “Good” cholesterol is part of cell membranes, promotes cell repair, synthesizes the substances we need: vitamin D, sex hormones and bile.

Therefore, it is important to monitor your cholesterol levels regularly, and this can be done with a blood test. For starters, you can take a simple analysis that will show total cholesterol. Further, if the results are high, the doctor will refer you to a detailed analysis – a lipid profile. It shows the ratio of “good” and “bad” cholesterol, as well as the amount of triglycerides in the blood. Based on the results, you will be able to start treatment in a timely manner.

Is the norm for everyone the same?

Cholesterol levels vary for certain people. And what is high for some is normal for others. Only a doctor will give the correct interpretation of your tests, since acceptable indicators will vary from person to person and depend on pressure, blood sugar, and the presence of other diseases. Norm indicators may differ depending on:

Age. The older the person, the higher the risk of developing hypercholesterolemia. Therefore, starting from the age of 35, it is necessary to regularly check and monitor cholesterol levels. It is a mistake to think that this problem concerns only the elderly. High cholesterol is diagnosed in young people, and even in children.

Inheritance. The predisposition to high cholesterol can be inherited. Familial hypercholesterolemia is a genetic disorder that affects the liver’s ability to regulate “bad” cholesterol. The disease can manifest itself in childhood and be severe, requiring medication, or in adulthood, in a milder form. If your close relatives have high cholesterol or problems with the heart and blood vessels, then this is a reason to start taking control of your health.

Sex. In middle age, high cholesterol is more often found in men, but during and after menopause, women become prone to this problem as often as men. In addition, cholesterol in women rises during pregnancy – it is necessary for the proper development of the child. The following shows how the scores vary by gender:

Medications to lower cholesterol

If the scores are high, the patient is prescribed special medications to lower “bad” cholesterol. These drugs include statins, vitamin B, omega-3s, bile acid, and fibrates.

Statins are the first line of treatment for high cholesterol. They enhance the processing of “bad” cholesterol and suppress its synthesis, and also contribute to the prevention of atherosclerosis and heart disease.

However, synthetic drugs can have side effects and should only be taken as directed by a physician. An alternative may be non-drug treatment, which we will discuss below.

Non-drug ways to lower cholesterol

Dietary supplements, dietary changes, daily exercise, bad habits, weight management are few that can be called non-drug treatments. Here the desire of the person himself to switch to the right lifestyle and lower cholesterol levels is important. For non-drug treatment, doctors recommend the following:

HEALTHY HEART FORMULA

Give up bad habits. Alcohol abuse and smoking increase the growth of “bad” cholesterol, which settles on the walls of blood vessels. Treatment will be meaningless if you continue to drink and smoke.

Make physical activity a habit. Sport is a faithful assistant on the way to recovery. Active physical activity makes it possible not only to reduce “bad” cholesterol in men and women, but also to increase “good”. Cardio exercises are best suited for this: walking, brisk walking, aerobics, jogging. The main thing is regularity, otherwise no loads will work.

Normalize nutrition. A proper diet involves avoiding trans fats and saturated fats. They are found in fast food, fried foods, meat and dairy products, convenience foods and margarine. This food should be excluded from the diet, as it affects the growth of cholesterol. What foods lower cholesterol?

Fiber is a proven remedy for high cholesterol. Vegetables, fruits, beans, berries, white rice and wheat, oats, barley and nuts contain fiber, vitamins and beneficial elements.
Legumes will help reduce “bad” cholesterol and have a positive effect on digestion. The legume family includes beans, peas, chickpeas and mung beans.
Whole grains remove excess cholesterol and reduce the risk of complications.
Nuts contain a large amount of unsaturated fatty acids and useful elements. The main thing is not to overeat, because they have a lot of calories.
Spices help lower cholesterol. Garlic will have a beneficial effect, due to the high content of natural statins in it. But this method is not suitable for people with digestive problems.

Vitamin and probiotic complexes

As we already know, synthetic drugs are not for everyone, as they have side effects, including sarcopenia. An alternative can be a probiotic complex Lactoflorene® Cholesterol.

The complex includes:

Natural statin – red fermented rice (Monacolin K 10 mg),
Nicotinomide (vitamin of the PP group),
Powerful antioxidant Coenzyme Q10 studied bifidobacteria Bifidobacterium longum BB536.