How does niacin affect cholesterol levels. What are the potential benefits and risks of using niacin for cholesterol management. How should niacin be taken properly to maximize its effects on cholesterol.

Understanding Niacin’s Role in Cholesterol Management

Niacin, also known as vitamin B3 or nicotinic acid, has long been recognized for its potential to improve cholesterol levels. This powerful compound can help protect against heart disease, heart attacks, and strokes by influencing lipid profiles. However, recent research has cast doubt on its efficacy as an add-on therapy to statins, the gold standard in cholesterol management.

Traditionally, healthcare providers have turned to niacin when dietary improvements alone were insufficient to achieve desired cholesterol levels. Its ability to raise HDL (good) cholesterol while lowering LDL (bad) cholesterol and triglycerides made it an attractive option. But how exactly does niacin work its magic on our lipid profile?

The Mechanism of Action

Niacin’s effects on cholesterol are multifaceted:

• It reduces the production of VLDL (very low-density lipoprotein) in the liver, which in turn lowers LDL levels.
• It increases the production of HDL cholesterol, promoting the removal of excess cholesterol from the bloodstream.
• It inhibits the breakdown of HDL, allowing it to remain in circulation longer.
• It decreases the release of free fatty acids from adipose tissue, reducing triglyceride levels.

Despite these promising mechanisms, the landscape of niacin use in cholesterol management has shifted dramatically in recent years. Why has this change occurred?

The Changing Paradigm: Niacin’s Diminishing Role

Recent studies have challenged the long-held belief in niacin’s supplementary benefits when used alongside statins. Research now suggests that adding niacin to statin therapy does not significantly reduce the risk of cardiovascular events, including heart attacks and strokes, beyond what statins alone can achieve. This revelation has led to a decline in niacin prescriptions and a reevaluation of its place in cholesterol management strategies.

Weighing the Pros and Cons

The decision to use niacin for cholesterol management now requires careful consideration of its potential benefits against its known side effects and risks. While it can still be effective in certain scenarios, particularly for patients with very high cholesterol levels or those intolerant to other medications, its use is no longer as widespread as it once was.

Are there specific situations where niacin might still be recommended? Indeed, some healthcare providers may still prescribe niacin for patients who:

• Have extremely high cholesterol levels that don’t respond adequately to statins alone
• Cannot tolerate statins or other primary cholesterol-lowering medications
• Have a specific need to raise their HDL cholesterol levels significantly

It’s crucial to understand that the decision to use niacin should always be made under the guidance of a healthcare professional, taking into account individual health profiles and risk factors.

Types of Niacin Medications and Their Proper Use

For those prescribed niacin, understanding the different formulations available and how to use them correctly is essential for maximizing benefits while minimizing risks. What are the various forms of niacin medications, and how should they be taken?

Prescription Niacin Formulations

Prescription niacin comes in several forms:

1. Immediate-release niacin: Rapidly absorbed, often causing more intense flushing
2. Extended-release niacin (e.g., Niaspan): Designed to be absorbed more slowly, potentially reducing side effects
3. Sustained-release niacin: Absorbed over an even longer period, but may carry a higher risk of liver problems

These medications may be prescribed alone or in combination with other cholesterol-lowering drugs. Some combination tablets include niacin along with statins or other lipid-lowering agents.

Proper Administration of Niacin

Taking niacin correctly is crucial for both efficacy and safety. How should patients approach their niacin regimen?

• Follow prescribed dosages carefully, typically taking the medication 1 to 3 times daily
• Take extended-release formulations at bedtime with a light, low-fat snack to minimize flushing
• Avoid breaking or chewing tablets, as this can alter the drug’s release profile
• Steer clear of alcohol and hot drinks around the time of taking niacin to reduce flushing
• Store medications in a cool, dry place, out of reach of children

It’s important to note that over-the-counter niacin supplements should not be used as a substitute for prescription niacin in cholesterol management. These supplements can vary widely in quality and potency, and their use for cholesterol control without medical supervision can lead to serious side effects.

Lifestyle Modifications to Complement Niacin Therapy

While niacin can be a powerful tool in managing cholesterol levels, its effectiveness is significantly enhanced when combined with healthy lifestyle choices. What lifestyle modifications should patients consider alongside their niacin regimen?

Dietary Adjustments

A heart-healthy diet is crucial for anyone taking niacin for cholesterol management. Key dietary recommendations include:

• Reducing saturated and trans fat intake
• Increasing consumption of fruits, vegetables, and whole grains
• Incorporating lean proteins and healthy fats, such as those found in fish and nuts
• Limiting sodium and added sugars

Physical Activity

Regular exercise complements the cholesterol-lowering effects of niacin. Patients should aim for:

• At least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week
• Strength training exercises at least twice a week
• Increased daily movement, such as taking stairs instead of elevators or parking farther from destinations

Stress Management

Chronic stress can negatively impact cholesterol levels and overall heart health. Effective stress management techniques include:

• Meditation and mindfulness practices
• Deep breathing exercises
• Yoga or tai chi
• Regular leisure activities and hobbies

Smoking Cessation

For smokers, quitting is one of the most impactful steps towards improving cardiovascular health. Healthcare providers can offer resources and support for smoking cessation, which can significantly enhance the benefits of niacin therapy.

Potential Risks and Side Effects of Niacin Therapy

While niacin can be effective in managing cholesterol levels, it’s not without potential risks and side effects. Understanding these is crucial for patients and healthcare providers alike. What are the most common and serious side effects associated with niacin use?

Common Side Effects

Many patients experience mild side effects when taking niacin, especially when first starting the medication or adjusting dosages. These may include:

• Flushing and redness of the face and neck
• Itching or tingling sensations
• Headache
• Upset stomach or nausea
• Diarrhea
• Skin rash

While these side effects are generally not serious, they can be bothersome. Many patients find that these symptoms improve over time as their body adjusts to the medication.

Serious Side Effects and Risks

Though less common, niacin can sometimes cause more serious side effects that require immediate medical attention. These may include:

• Liver damage or changes in liver enzyme levels
• Severe muscle pain, tenderness, or weakness (which could indicate rhabdomyolysis)
• Irregular heartbeat or significant changes in blood pressure
• Severe skin reactions
• Vision changes or loss
• Glucose intolerance or worsening of diabetes control
• Gout flares

Healthcare providers typically monitor patients closely for these potential complications through regular check-ups and blood tests. It’s crucial for patients to report any unusual symptoms promptly to their healthcare provider.

Monitoring and Follow-up for Niacin Therapy

Proper monitoring is essential for ensuring the safety and efficacy of niacin therapy. How should healthcare providers and patients approach the monitoring process?

Regular Blood Tests

Patients on niacin therapy typically undergo regular blood tests to assess:

• Lipid profile changes to evaluate the medication’s effectiveness
• Liver function tests to monitor for potential liver damage
• Blood glucose levels, particularly in patients with or at risk for diabetes
• Uric acid levels to assess the risk of gout

The frequency of these tests may vary depending on the individual patient’s health status and response to the medication.

Clinical Evaluations

Regular check-ups allow healthcare providers to:

• Assess overall response to the medication
• Monitor for side effects and adjust dosages if necessary
• Evaluate the need for continued therapy or potential changes to the treatment plan
• Provide guidance on lifestyle modifications and complementary therapies

These evaluations also offer an opportunity for patients to discuss any concerns or questions they may have about their treatment.

Special Considerations and Contraindications

While niacin can be an effective tool in cholesterol management, it’s not suitable for everyone. What are some special considerations and contraindications for niacin therapy?

Pregnancy and Breastfeeding

The safety of niacin during pregnancy and breastfeeding is not well-established. Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the potential risks and benefits with their healthcare provider before starting or continuing niacin therapy.

Liver Disease

Patients with a history of liver disease or abnormal liver function tests may not be suitable candidates for niacin therapy due to the risk of liver damage. Close monitoring is essential if niacin is prescribed in these cases.

Diabetes

Niacin can affect blood sugar control, potentially worsening glucose tolerance or increasing insulin resistance. Patients with diabetes require careful monitoring and may need adjustments to their diabetes management plan when taking niacin.

Gout

Niacin can increase uric acid levels, potentially triggering gout flares in susceptible individuals. Patients with a history of gout should be closely monitored and may require preventive measures.

Peptic Ulcer Disease

Niacin may exacerbate symptoms in patients with active peptic ulcer disease. Alternative cholesterol-lowering strategies may be preferable for these individuals.

Drug Interactions

Niacin can interact with various medications, including:

• Other cholesterol-lowering drugs, potentially increasing the risk of side effects
• Blood thinners, which may require dose adjustments
• Certain blood pressure medications
• Diabetes medications, as niacin can affect blood sugar levels

It’s crucial for patients to inform their healthcare provider about all medications, supplements, and herbal products they are taking to avoid potential interactions.

The Future of Niacin in Cholesterol Management

As the landscape of cardiovascular disease prevention continues to evolve, what does the future hold for niacin in cholesterol management? While its role has diminished in recent years, ongoing research may yet reveal new applications or benefits for this versatile compound.

Targeted Therapy

Future research may focus on identifying specific subgroups of patients who derive the greatest benefit from niacin therapy. This could lead to more personalized treatment approaches, where niacin is prescribed based on individual genetic profiles or specific lipid abnormalities.

Novel Formulations

Efforts to develop new niacin formulations that minimize side effects while maximizing cholesterol-lowering benefits are ongoing. These may include:

• Improved extended-release formulations with reduced flushing
• Combination drugs that pair niacin with other lipid-lowering agents or compounds that mitigate side effects
• Targeted delivery systems that enhance niacin’s effects on specific tissues or metabolic pathways

Exploring Additional Benefits

While niacin’s role in primary cardiovascular prevention has been questioned, researchers continue to explore its potential benefits in other areas, such as:

• Secondary prevention in patients with established cardiovascular disease
• Management of specific lipid disorders, such as hypertriglyceridemia
• Potential neuroprotective effects in conditions like Alzheimer’s disease
• Metabolic health beyond lipid profiles, including potential anti-inflammatory effects

As our understanding of niacin’s complex effects on human metabolism grows, new therapeutic applications may emerge, potentially revitalizing its use in clinical practice.

Integration with Emerging Therapies

The future of cholesterol management is likely to involve a more integrated approach, combining multiple therapies to achieve optimal cardiovascular health. Niacin may find a place within these comprehensive strategies, perhaps in combination with newer classes of lipid-lowering drugs or as part of lifestyle intervention programs.

While the role of niacin in routine cholesterol management has diminished, it remains an important tool in the pharmacological arsenal against dyslipidemia. Its unique ability to influence multiple aspects of the lipid profile ensures that it will continue to be a subject of interest and research in the field of cardiovascular health.

As we look to the future, the key to maximizing niacin’s potential lies in refining our understanding of its mechanisms, improving its formulations, and identifying the patients who stand to benefit most from its use. By doing so, we can ensure that this time-tested compound continues to play a valuable role in the ongoing fight against cardiovascular disease.

Niacin for cholesterol Information | Mount Sinai

Antilipemic agent; Vitamin B3; Nicotinic acid; Niaspan; Niacor; Hyperlipidemia – niacin; Hardening of the arteries – niacin; Cholesterol – niacin; Hypercholesterolemia – niacin; Dyslipidemia – niacin

How Niacin Helps

Improving your cholesterol levels can help protect you from:

• Heart disease
• Heart attack
• Stroke

Your health care provider will work with you to lower your cholesterol by improving your diet. If this is not successful, medicines to lower cholesterol may be the next step. Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.

Research now suggests that niacin does not add to the benefit of a statin alone for reducing the risk of cardiovascular events, including heart attacks and stroke.

In addition, niacin can cause unpleasant and potentially dangerous side effects. Therefore, its use has been declining. However, some people may be prescribed niacin in addition to other drugs if they have very high cholesterol or if they do not tolerate other medicines.

Which Niacin Medicine is Right for you?

There are different brands of niacin medicines. Most of these also come in a less expensive, generic form.

Niacin may be prescribed along with other medicines, such as a statin, to help lower cholesterol. Combination tablets that include nicotinic acid plus other medicines are also available.

Niacin is also sold over-the-counter (OTC) as a supplement. You should not take OTC niacin to help lower cholesterol. Doing so could have serious side effects.

How to Take Niacin

Take your medicine as directed. The medicine comes in tablet form. Do not break or chew tablets before taking the medicine. Do not stop taking your medicine without talking with your provider first.

You take niacin 1 to 3 times per day. It comes in different doses, depending on how much you need.

Read the label on the pill bottle carefully. Some brands should be taken at bedtime with a light, low-fat snack; others you will take with dinner. Avoid alcohol and hot drinks while taking niacin to reduce flushing.

Store all of your medicines in a cool, dry place. Keep them where children cannot get to them.

You should follow a healthy diet while taking niacin. This includes eating less fat in your diet. Other ways you can help your heart include:

• Getting regular exercise
• Managing stress
• Quitting smoking

Know Your Risks

Before you start taking niacin, tell your provider if you:

• Are pregnant, plan to become pregnant, or are breastfeeding
• Have allergies
• Are taking other medicines
• Drink a lot of alcohol
• Have diabetes, kidney disease, peptic ulcer, or gout

Talk to your provider about all of your medicines, herbs, or supplements. Certain medicines may interact with niacin.

Regular blood tests will help you and your provider:

• See how well the medicine is working
• Monitor for side effects, such as liver problems

Possible Side Effects

Mild side effects may include:

• Flushing and red face or neck
• Diarrhea
• Headache
• Upset stomach
• Skin rash

Though rare, more serious side effects are possible. Your provider will monitor you for signs. Talk with your provider about these possible risks:

• Liver damage and changes to liver enzymes
• Severe muscle pain, tenderness, and weakness
• Heartbeat and rhythm changes
• Changes in blood pressure
• Severe flushing, skin rash, and skin changes
• Glucose intolerance
• Gout
• Vision loss or changes

When to Call the Doctor

You should call your provider if you notice:

• Side effects that are bothering you
• Fainting
• Dizziness
• Fast or irregular heartbeat
• Yellow skin or eyes (jaundice)
• Muscle pain and weakness
• Other new symptoms

American Heart Association website. Cholesterol medications. www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications. Updated November 11, 2020. Accessed May 3, 2022.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In:  Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3234-3237. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.

Guyton JR, McGovern ME, Carlson LA. Niacin (nicotinic acid). In: Ballantyne CM, ed. Clinical Lipidology: A Companion to Braunwald’s Heart Disease. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 24.

Lavigne PM, Karas RH. The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013;61(4):440-446. PMID: 23265337 pubmed.ncbi.nlm.nih.gov/23265337/.

Mani P, Rohatgi A. Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct? Curr Atheroscler Rep. 2015,17(8):43. PMID: 26048725 pubmed.ncbi.nlm.nih.gov/26048725/.

Semenkovich CF, Goldberg IJ. Disorders of lipid metabolism. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 41.

Last reviewed on: 2/23/2022

Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Statin and niacin treatment reduces risk of heart attack by 70 percent, can reverse arterial buildup

Archive

November 13, 2000

NEW ORLEANS (Nov. 13) — Treatment with a combination of statin and niacin can slash the risk of hospitalization for chest pain or a heart attack by 70 percent among patients who are likely to suffer heart attacks and/or death from cardiovascular problems, according to a study presented here by researchers at the University of Washington School of Medicine.

The treatment combines two already well-known ways of improving cardiac health: the use of a statin drug to lower levels of the “bad” cholesterol, LDL, and the use of niacin to boost levels of the “good” cholesterol, HDL.

The study found that use of this combined treatment, in people with low levels of good cholesterol and average levels of bad cholesterol, could even remove plaque buildup in the arteries. Cardiovascular disease is the No. 1 killer in the Western Hemisphere.

At the start of the study and again after three years of treatment, doctors performed angiograms of the patients’ arteries. The angiograms showed that in most of the patients who received the combination treatment, plaque buildup had actually decreased.

“This is the first demonstration of a striking clinical benefit from combination drug therapy for a common type of coronary disease patient,” said Dr. B. Greg Brown, a cardiologist and UW professor of medicine.

Researchers are finishing up their analysis of the study data, and plan to submit their report this winter for publication. Brown is the study’s lead author. The results were presented in New Orleans on Nov. 13 at the Scientific Sessions of the American Heart Association.

“This interesting study is a good demonstration of the enormous value of cholesterol management in patients with coronary disease,” said Dr. Claude Lenfant, director of the National Heart, Lung, and Blood Institute, which funded the study.

The same study found that a mixture of antioxidant vitamins had no effect on cardiovascular outcomes. Scientists are not sure why this is so, since there has been laboratory evidence that suggests antioxidants should be helpful.

“More research and larger studies are needed to confirm the lack of effectiveness of antioxidant vitamins on risk for coronary events,” Lenfant said.

Brown was involved in the first studies in the late 1980s that showed that a kind of statin, lovastatin, could reduce the occurrence of major cardiovascular events by about 25 to 35 percent. Giving statins to people with cardiovascular disease is now common.

“What you expect with statins is a slowing of the disease progression, but not a stopping. Arteries continue to get narrower, but not as fast,” Brown said. “But when niacin is combined with a statin, the artery blocking actually improves, on average.”

Brown and colleagues surmised that combining simvastatin with niacin might prevent even more heart attacks and such cardiac events. The goal would be to reduce plaque buildup. That’s important because the cholesterol-rich plaque is what can clog artery walls and lead to fatal complications.

Cholesterol: The statin lowers blood levels of LDL, which is called the “bad” cholesterol because it is more likely to clog ateries. Niacin, or Vitamin B3, is the best agent known to raise blood levels of HDL, which helps dissolve cholesterol deposits from the artery walls.

The 160 patients involved in the study had low levels of good HDL cholesterol (a level of 35 or less). At least four out of every 10 people with coronary artery disease fit this profile. But the study results may have implications for other people with coronary diseases. They would have even higher levels of HDL – and having higher levels of the good cholesterol should only help them, Brown said.

Some patients in this study received simvastatin and niacin, while others received antioxidants. A third group received three treatments while a fourth, control, group received placebos. All patients received exercise training and dietary counseling.

The results for those receiving statin and niacin were startlingly different than the others. The average level of HDL increased from 31 to 38, while the average LDL dropped from 125 to 76 — that is considered an extremely good level of the bad cholesterol. Angiograms showed that most of these people had no additional plaque buildup over the years. In many of them, the amount of plaque actually decreased.

“What we saw was a reversal of the disease,” Brown said. “The patients’ arteries, on average, had stopped narrowing and begun to improve.”

The study involved use of niacin at moderately high and carefully supervised levels. Brown said that people should only take niacin under a doctor’s supervision, because in some patients, the doctor may wish to monitor the patient’s liver. Rarely, the unsupervised use of niacin can cause severe liver problems, including liver failure.

The study had included antioxidants because there has been considerable evidence that they should help protect against the basic mechanisms for cholesterol buildup. The antioxidants involved in this study include Vitamins C, E, beta carotene and selenium.

Others involved in the study include UW researchers Dr. John Albers, Dr. Xue-Qiao Zhao, Dr. Alan Chait, Dr. Lloyd Fisher, Alice Dowdy, Dr. Marian Cheung, Josiah Morse, Leny Serafini and Ellen Huss-Frechette, as well as Debbie DeAngelis and Dr. Jiri Frohlich of the University of British Columbia, Vancouver, B.C.

NOTE: Images relevant to this story may be downloaded from http://depts.washington.edu/hsnews/LAD_regression.html

lipid lowering

Content

• 1 Lipid-lowering drugs
  • 1.1 The role of lipids in the body
  • 1.2 The problem of high lipid levels
  • 1.3 Lipid-lowering drugs : basic information
  • 1.4 Diet and exercise as the main methods of dealing with elevated levels lipids
  • 1.5 Major groups of lipid-lowering drugs
  • 1.6 Statins: mechanism of action and uses
  • 1.7 Fibrates: mechanism of action and uses
  • 1. 8 Niacin: mechanism of action and uses
  • 1.9 Ezetimibe: mechanism of action and uses
  • 1.10 Combination drugs: features and uses
  • 1.11 Related videos:
  • 1.12 Q&A:
    • • 1.12.0.1 Which drugs reduce the level of lipids in the body?
      • 1.12.0.2 How long do lipid-lowering medications usually take to lower lipid levels?
      • 1.12.0.3 What are the possible side effects of lipid-lowering drugs?

Lipid-lowering drugs are medicines that help lower the level of LDL (low-density lipoprotein), also known as “bad” cholesterol, in the body. They may be prescribed by a doctor for patients with high cholesterol levels or a risk of cardiovascular disease. Lipid-lowering drugs can be of various types, including statins, fibrates, nicotinic acid, and cholesterol absorption inhibitors. They can be effective in lowering cholesterol levels and improving overall health. But before you start taking lipid-lowering drugs, you should consult your doctor, as they can cause side effects and interact with other drugs.

Are you looking for an effective solution to control lipid levels in the body? Lipid-lowering drugs – this is what you need!

Lipids such as cholesterol and triglycerides can accumulate in the body and cause many diseases, including atherosclerosis, cardiovascular disease, and even stroke. Lipid-lowering drugs help lower blood lipid levels and prevent the development of these dangerous consequences.

With our lipid-lowering drugs, you can control the level of lipids in the body and prevent many diseases. Do not risk your health – choose a reliable solution, choose our lipid-lowering drugs!

The role of lipids in the body

Lipids play an important role in the body, performing various functions. They are the main source of energy, supplying the body with the required number of calories. In addition, lipids serve as reserve values ​​that can be used in the absence of other energy sources.

The main lipid-related disease is atherosclerosis, caused by the accumulation of cholesterol in the walls of blood vessels. In this regard, the control of lipid levels in the body is an important component of maintaining health and preventing cardiovascular disease.

Lowering the level of lipids in the body can be achieved with lipid-lowering drugs. These drugs affect the levels of cholesterol and other lipids in the blood, helping to reduce the risk of developing cardiovascular disease.

Lipid-lowering drugs can be of different types – statins, fibrates, nicotinic acid and others. They work in different ways, but their goal is the same – to reduce the level of lipids in the body and improve the overall health of a person.

If you have high lipid levels or are at risk for developing cardiovascular disease, talk to your doctor about the possibility of using lipid-lowering drugs. They can be an important tool in the fight for your health.

High lipid problem

High lipid levels in the body is a serious problem that can lead to various diseases, including atherosclerosis, coronary heart disease and stroke. Lipids such as cholesterol and triglycerides are important components of cell membranes and play a role in various biological processes. However, excess lipids can cause negative health effects.

Lipid-lowering drugs are widely used to lower lipid levels in the body. They can be of different types, for example, statins, fibrates, nicotinic acid and others. Each drug has its own characteristics and mechanism of action, but they are all aimed at lowering lipid levels and improving the general condition of the body.

However, before you start taking lipid-lowering drugs, you should consult your doctor, as the choice of drug and dosage should be individual. In addition, it is important to remember that taking drugs should be accompanied by proper nutrition, physical activity and a healthy lifestyle in general.

Lipid-lowering drugs: basic information

Lipid-lowering drugs are pharmacological drugs designed to reduce lipid levels in the body. Lipids are one of the main components of the body and perform a number of important functions, however, their excessive accumulation can contribute to the development of cardiovascular diseases and other pathologies.

Lipid-lowering drugs are divided into several groups, each of which has its own effect on the level of lipids in the body. Statins are one of the most commonly used groups of drugs, they reduce the synthesis of cholesterol in the liver and contribute to its removal from the body. Fibrates are another group of drugs that increase body fat utilization and lower triglyceride levels. Resins bind bile acids and their salts, which leads to an increase in their excretion from the body.

The use of lipid-lowering drugs helps to reduce the level of lipids in the blood, improve the general condition of the patient, and prevent the development of heart and vascular diseases. However, before taking these drugs, you should consult your doctor, as they have their own contraindications and side effects.

Diet and exercise as the main methods of dealing with elevated lipid levels

Elevated lipid levels in the body is a serious problem that can lead to various diseases of the cardiovascular system. To control and lower blood lipid levels, a holistic approach involving diet and exercise is required.

In addition to proper nutrition, physical activity is an integral part of the fight against elevated lipid levels. Regular exercise helps improve metabolism, burn excess calories, and raise your “good” cholesterol. It is recommended to engage in physical activity such as running, swimming, cycling or exercising in the gym for 30 minutes a day.

In addition to general advice on diet and physical activity, there are also specific lipid-lowering drugs that can help lower the body’s lipid levels. However, before using them, it is necessary to consult a doctor in order to choose the most suitable drug and determine the correct dosage.

The main groups of lipid-lowering drugs

Lipid-lowering drugs are drugs that help reduce lipid levels in the body. They are used to prevent and treat hyperlipidemia, a condition in which blood lipid levels are elevated.

There are several main groups of lipid-lowering drugs:

1. Statins are one of the most common groups of lipid-lowering drugs. They lower blood cholesterol levels by inhibiting the activity of the enzyme responsible for its synthesis. Statins also help increase high-density (good) cholesterol levels and lower low-density (bad) cholesterol levels.
2. Fibrates are drugs that activate the enzymes responsible for the breakdown and removal of lipids from the body. They help lower triglycerides and increase high-density cholesterol levels.
3. Niacin is a substance that regulates lipid metabolism in the body. Niacin helps lower cholesterol and triglycerides, as well as increase high-density cholesterol.
4. Cholagogues are drugs that help lower cholesterol levels by increasing its excretion along with bile.

Each group of lipid-lowering drugs has its own characteristics and is used depending on the individual characteristics of the patient and the goals of treatment. Before you start taking lipid-lowering drugs, it is recommended to consult a doctor.

Statins: mechanism of action and uses

statins are a class of drugs that are used to lower blood lipids. They effectively lower cholesterol and triglycerides, which helps prevent the development of cardiovascular diseases.

The mechanism of action of statins is based on the suppression of the activity of the enzyme hepatic 3-hydroxy-3-methylglutaryl-coenzyme A-reductase (HMG-CoA-reductase), which is involved in the synthesis of cholesterol in the liver. Due to this, statins reduce cholesterol synthesis and increase the number of receptors on the surface of liver cells, which leads to increased uptake of low-density lipoprotein (LDL) from the blood and a decrease in their concentration in the bloodstream.

It is important to note that when taking statins, it is necessary to follow the doctor’s recommendations and periodically monitor the level of lipids in the blood. In some cases, side effects may develop, such as muscle weakness, pain or fatigue, so it is necessary to see a doctor and undergo regular examinations.

Fibrates: mechanism of action and uses

Fibrates are one of a group of lipid-lowering drugs designed to lower lipid levels in the body. They are used as an additional therapy for hyperlipidemia, as well as metabolic syndrome.

The mechanism of action of fibrates is based on the activation of nuclear receptors such as PPAR-alpha. This mechanism allows you to increase the synthesis of low-density lipoprotein (LDL), as well as increase the breakdown of triglycerides in the liver. As a result, the level of LDL and triglycerides decreases, which contributes to the normalization of the lipid profile in the blood.

Fibrates also have an antioxidant effect, helping to reduce oxidative stress in the body. This is important because elevated lipid levels can lead to the development of atherosclerosis and cardiovascular disease.

The use of fibrates is recommended in combination with diet, physical activity and other lipid-lowering drugs. Some indications for the use of fibrates include hypertriglyceridemia, accompanied by high levels of triglycerides in the blood.

However, fibrates have their own contraindications and side effects, so you should consult your doctor before using them. You should also remember about individual sensitivity to the drug and the possibility of developing allergic reactions.

In general, fibrates are effective in reducing lipid levels in the body and preventing the development of cardiovascular disease. Their use requires the supervision of a physician and adherence to all dietary and lifestyle recommendations.

Niacin: mechanism of action and uses

Niacin , also known as vitamin B3 or nicotinic acid, is an essential element in maintaining the body’s health. It plays a key role in metabolism and is involved in many biochemical reactions in the body.

Niacin affects lipid levels in the body through its ability to lower blood cholesterol and triglyceride levels. This drug can lower total cholesterol, as well as the level of “bad” low-density lipoprotein (LDL) and triglycerides, as well as increase the level of “good” high-density lipoprotein (HDL).

Niacin is recommended for people with elevated cholesterol or triglyceride levels and those at risk of developing cardiovascular disease. The drug can be used in complex therapy and in addition to diet and physical activity.

Niacin not only has lipid-lowering properties, but also has a positive effect on the general condition of the cardiovascular system. It promotes vasodilation, improves tissue oxygenation and reduces the risk of thrombosis. In addition, this drug can improve liver function and normalize blood glucose levels.

It is important to note that niacin must be taken under the supervision of a physician as it may cause unwanted effects such as skin flushing, itching, headache and gastrointestinal disturbances. A consultation with your doctor will help determine the optimal dose and regimen of administration, and will also take into account the characteristics of your health.

Ezetimibe: mechanism of action and uses

Ezetimibe is a lipid-lowering drug used to lower blood cholesterol levels. The main mechanism of action of this drug is to block the absorption of cholesterol from food in the intestines.

Interacting with several receptors in the intestine, ezetimibe interferes with the absorption of cholesterol and other lipids that are ingested from food. As a result, the level of cholesterol in the blood is reduced, which is especially beneficial for patients with an increased risk of developing cardiovascular diseases.

Ezetimibe is used in combination with other lipid-lowering drugs, such as statins, for maximum effect. Ezetimibe reduces total cholesterol, LDL (bad) cholesterol and apoB (lupoproteins) in the blood, and also increases VLDL (good) cholesterol.

It is important to note that ezetimibe is not a substitute for a healthy lifestyle and proper diet. It should be used in conjunction with lifestyle advice, including reducing saturated fat and cholesterol intake, weight control, and physical activity.

Combination preparations: features and uses

Combination preparations are effective in lowering lipid levels in the body. They combine several active ingredients, which allows you to achieve a more pronounced therapeutic effect.

One of the features of combined preparations is the ability to influence different mechanisms of formation and transport of lipids. This allows you to improve the overall result of treatment and achieve a stable reduction in cholesterol and other lipids in the blood.

The use of combined preparations is especially recommended in cases where monotherapy does not give sufficient effect or, if necessary, to reduce the risk of cardiovascular diseases. Combined drugs allow you to achieve lipid targets, while having a minimum number of side effects.

When choosing a combined preparation, attention should be paid to its composition and compliance with the existing pathology. It is also important to regularly consult with your doctor and follow his recommendations in order to achieve maximum therapeutic effect and maintain the health of the cardiovascular system.

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Q&A:

Which medications lower lipid levels in the body?

There are a large number of lipid-lowering drugs that help lower the level of lipids in the body. Some of these include statins, fibrates, nicotinic acid, fat absorption inhibitors, and others. The specific drug will be prescribed depending on the indications and the patient’s condition.

How long do lipid-lowering medications usually take to lower lipid levels?

Timing of lipid-lowering drugs may vary depending on the indication and the patient’s condition. In most cases, drugs are taken for a long time, sometimes even for life. It is important to follow the recommendations of the doctor and regularly undergo control tests to evaluate the effectiveness of treatment.

What are the possible side effects of lipid-lowering drugs?

Different lipid-lowering drugs may have different side effects. Some common side effects may include nausea, vomiting, diarrhea, headache, muscle pain, increased liver activity, and skin rash. However, not all patients experience these side effects, and they usually disappear after a short period of addiction to the drug.

Is it possible to replace statins with dietary supplements

Atherosclerosis and dyslipidemia

September 17, 2020
edition “ifyoucare”

Often people who are prescribed statins are worried about side effects and intolerance, so they want to take dietary supplements (BAA) instead. But experts believe that natural remedies can only supplement therapy, and not completely replace cholesterol-lowering drugs.

The problem with statins

Almost half of the adults who need to lower their cholesterol do not take any special medications ¹ . This is due to many factors, such as cost, distrust of drugs, and most often fear of possible side effects ^{2, 3} .

Dietary supplements are applied in a complex

BAA are food additives. They contain vitamins, minerals, antioxidants, or other compounds, but are not drugs. Certain foods are known to help lower cholesterol levels. The researchers tested different supplements: red rice, omega-3 fatty acids, spirulina, soy proteins, green tea, lupine, garlic fibers, bergamot and berberine ⁴ , but there is no conclusive evidence of their unequivocal benefit and effectiveness yet.

Natural remedies may be given to patients who cannot tolerate statins, for example due to muscle pain, the most common side effect. Other lipid-lowering drugs, such as ezetimibe and PCSK9 inhibitors, are also an alternative for many. Because treatment options are limited, supplements can help lower cholesterol levels.

It is important to know!

Scientists emphasize that natural remedies cannot completely replace drug therapy with drugs from the statin group – a proven and reliable way to reduce cholesterol levels and the risk of heart disease. Patients should also not substitute any other cholesterol-lowering medications with natural remedies without consulting their doctor. Supplements and dietary changes may only be in addition to the prescribed treatment regimen.

Supplement with garlic extract

Garlic has been used as a traditional medicine for many years. Today, many people use garlic extract supplements as a natural remedy to lower blood pressure and cholesterol levels. Garlic also contains the amino acid cysteine, which produces allicin, a substance that lowers total cholesterol. However, clinical studies have shown conflicting results ⁵ .

Garlic has been shown to regulate triglycerides and total cholesterol, but has no effect on low-density lipoprotein (LDL) and high-density lipoprotein (HDL) ⁶ . This effect was observed only if a person consumed garlic for at least two months. This suggests that the benefit of garlic in lowering cholesterol is short-lived, and after six months, the effect of consumption disappears.

Niacin (Vitamin B3)

It is one of the most effective agents for increasing “good” cholesterol levels: it can increase high-density lipoprotein levels by almost 20% ⁷ . Niacin also reduces low-density lipoprotein, or bad cholesterol, by 18% and triglycerides by 36% ⁷ . The effect is dose dependent, usually 1 to 4 grams per day is required ⁷ .

But niacin can cause side effects such as hot flashes, hyperglycemia, increased uric acid levels ⁷ . A hepatotoxic effect is not excluded ⁷ . Hot flashes caused by niacin are difficult to tolerate by patients and are a major barrier to the use of this drug ⁷ .

Omega-3 fatty acids and fish oil

Omega-3 fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The most studied forms of omega-3 fatty acids are eicosapentaenoic acid and docosahexaenoic acid. They can lower serum triglycerides by up to 50%, but docosahexaenoic acid can raise both “good” and “bad” cholesterol levels ⁸ .

Omega-3s are generally well tolerated. The most common side effects are indigestion, diarrhea and heartburn ⁸ . Many patients complain of a fishy taste in the mouth, especially when taking high doses of supplements. Another effect that omega-3 causes is a decrease in blood clotting. Therefore, patients taking anticoagulants or antiplatelet agents should use omega-3 fatty acids with caution.

red rice

It is obtained by cultivating the yeast Monascus purpureus (red yeast) on white rice. This fermented product contains a group of monacolins, substances that inhibit cholesterol synthesis. Clinical trials have shown a significant reduction in total cholesterol, low density lipoprotein and triglycerides, an increase in high density lipoprotein ⁹ . But the level of the active substance in different samples of rice is not stable enough to speak of an unequivocal positive effect.

Do not self-medicate! Before you start taking any dietary supplement, be sure to consult your doctor!

References

1. Mercado C, DeSimone AK, Odom E, et al. Prevalence of cholesterol treatment eligibility and medication use among adults—United States, 2005-2012. MMWR Morb Mortal Wkly Rep. 2015;64(47):1305-1311. /Mercado C. et al. Prevalence of high cholesterol treatment adherence and medication use among adults—United States, 2005-2012

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update. circulation. December 17, 2014. http://circ.ahajournals.org/content/early/2014/12/18/CIR.0000000000000152. Accessed January 8, 2017./ Mozaffarian D. et al. Cardiovascular disease and stroke statistics – 2015 update.

3. National Heart, Lung, and Blood Institute. High blood cholesterol: what you need to know. June 2005. www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-html.