Reducing Cardiovascular Disease Risk with Cholesterol Medication

If you are at risk for heart disease or stroke, your doctor may recommend a cholesterol lowering medication for you along with a heart healthy diet and exercise. Selection of the right medication regimen for you will depend upon a variety of factors including age, sex, medical history, current medications, cholesterol levels, and lifestyle factors.  Statin medications are preferred for most patients, but variety of other cholesterol lowering medications are also available that may be used alone or in combination with statins to address individual needs. The benefits and cholesterol lowering effects vary for each class of medication.  

Statins

Statins are one of the most commonly prescribed classes of cholesterol lowering medications. They work by reducing the amount of cholesterol produced by the liver. Elevated cholesterol levels can lead to narrowing and hardening of your arteries, reducing blood flow. By reducing the amount of cholesterol circulating in your blood, statins reduce the risk of heart attack and stroke. These agents are very effective at lowering your “bad” cholesterol (LDL). They also lower triglycerides, a type of fat from the food that we eat, and increase your “good” cholesterol (HDL). In addition to lowering cholesterol levels, statins have other beneficial effects in the body that help to reduce the risk of heart attack and stroke. They help the walls of your arteries to work better, reduce the amount of inflammation in your arteries, and prevent blood clots from forming. They also make plaque, a buildup of cholesterol and other substances in the walls of arteries, less likely to rupture. Statins, when appropriate, are the preferred cholesterol lowering drug class for reducing the risk of cardiovascular events.

Currently available statin medications include: 

• Atorvastatin (Lipitor) 
• Fluvastatin, Fluvastatin extended-release (Lescol XL) 
• Lovastatin, Lovastatin extended-release (Altoprev) 
• Pitavastatin (Livalo, Zypitamag) 
• Pravastatin (Pravachol) 
• Rosuvastatin (Crestor) 
• Simvastatin (Zocor)

Who may benefit from statin medication?

Statins may benefit patients who have a history of cardiovascular disease (CVD) or are at an increased risk of developing CVD, even if they have healthy cholesterol levels. Guidelines recommend that statin medications be considered for patients in the following groups. 

• Those with very high LDL cholesterol levels (190 mg/dL or greater) 
• Adults with a history of cardiovascular disease, such as heart attack, stroke, or peripheral artery disease 
• Individuals with diabetes who are 40 – 75 years of age 
• Adults with an elevated 10-year risk of cardiovascular disease – Your doctor may use a special calculator that considers your age, sex, race, smoking status, and other factors to determine your 10-year risk.  

What side effects can be experienced with statin therapy?

Side effects of statin medications may include muscle and joint aches, headaches, diarrhea, and nausea.  If you are experiencing intolerable side effects with statin therapy, several strategies may be considered, including modifying your statin dose or switching to an alternative statin. Talk to your doctor or pharmacist if you are experiencing intolerable side effects. 

What other cholesterol lower medications are available?

Cholesterol Absorption Inhibitor

Ezetimibe (Zetia) is the only cholesterol absorption inhibitor currently available. It works by reducing the amount of cholesterol absorbed from the food that you eat. It’s effective at lowering LDL cholesterol. It is recommended in combination with statins for patients with cardiovascular disease who do not achieve their cholesterol goals on a statin alone. It can also be considered as an alternative for some patients who are unable to tolerate statins. 

Bile Acid Sequestrants

These agents primarily lower LDL cholesterol. Like ezetimibe, these agents may also be combined with statins in patients with CVD if cholesterol goals are not achieved with statin alone. Currently available bile acid sequestrants are colesevelam (Welchol), cholestyramine (Questran), and colestipol (Colestid). 

Fibrates

This drug class is only mildly effective in lowering LDL cholesterol, but is very effective at lowering triglycerides. Thus, it is usually reserved for treating elevated triglyceride levels. Fibrates include gemfibrozil (Lopid) and fenofibrate (Tricor, Trilipix, others). 

Niacin

Niacin is a B vitamin that is effective in lowering triglycerides and increasing HDL cholesterol. Niacin comes in several formulations and is available via prescription and as an over-the-counter (OTC) supplement. Because the formulation and amount of niacin in OTC supplements can vary greatly, don’t take a niacin supplement without first talking to your doctor or pharmacist. Niacin can cause liver damage and other side effects when taking in high doses. 

Omega-3-Fatty Acids (Fish Oils)

These agents are very effective in lowering triglycerides and are often used to treat severe elevations in triglyceride levels (500 mg/dl or higher). Like statins, omega-3 -fatty-acids have beneficial effects beyond cholesterol lowering that help to reduce the risk of cardiovascular disease. They also reduce the amount of inflammation in your arteries, prevent blood clots from forming, and make plaque in the arteries more stable and less likely to rupture. Prescription omega-3-fatty acids include Lovaza and Vascepa. Numerous fish oil formulations are available OTC. The OTC products contain less omega-3-fatty acids than the prescription products. If using OTC fish oil supplements, talk to your doctor or pharmacist to help you select the OTC product that’s right for you.  

PCKS9 Inhibitors 

These are injectable agents that are used for lowering LDL cholesterol. This class is often reserved for patients who have genetic conditions that cause very high LDL cholesterol levels.  PCKS9 Inhibitors include Praluent and Repatha.

Cholesterol lowering medications in combination with a heart healthy diet and exercise can help to reduce your risk of heart disease and stroke. Talk to your doctor about whether cholesterol lowering therapy may be appropriate for you. 

If you are looking for a pharmacist who will work with you  to help meet your healthcare needs, visit www.catalysthealthrx.com, call (214) 291-5087, or ask your doctor how to get set up.