When should someone start taking cholesterol medication?
It's a simple question with a different answer for each and every person, which means that nobody but you and your doctor can figure it out.
The general guidelines for cholesterol medication are to try a diet and lifestyle change for six months first. If, at the end of six months on a low cholesterol diet, your blood cholesterol levels haven't come down to normal, then most doctors will put you on cholesterol medication.
If your cholesterol levels are too high, they may start the cholesterol medication immediately along with the low-cholesterol diet and exercise program.
Whether started immediately or only after six months, all cholesterol medication should be re-evaluated from time to time to see if it's both necessary and still effective.
"Why not start medication right away?" is the normal logical question.
People are naturally concerned with their health, and some would rather take medication than change their normal and comfortable lifestyle. Others just want to get their cholesterol down to "safe" levels as fast as possible.
It's important to remember that every cholesterol drug can be dangerous.
Each and every cholesterol medication in the world can have unpleasant, dangerous or even lethal side effects.
Prescription cholesterol medications are only available through doctors because prescription drugs are more dangerous and need to be taken under a doctor's supervision in order to be reasonably safe.
Prescription cholesterol drugs always represent a risk. Doctors don't generally like taking risks unless there's a really good reason.
Trying to manage a chronic and long-term problem like high cholesterol with diet and lifestyle first makes sense.
The less prescription cholesterol medication you have to take, the less chance there is for a serious side effect to hit.
In addition, there are no cholesterol medications in the world that can be effective if you're still eating a high-cholesterol diet or failing to exercise, so the lifestyle changes are inevitable.
Cholesterol medication comes in quite a few different classes, each one affecting cholesterol levels in a different way.
Some cholesterol medications are fairly well known and documented, while others do their cholesterol lowering work through methods we still don't entirely understand.
The most powerful cholesterol medication class is the "statin" class, officially designated as the HMG-CoA reductase inhibitors. This class includes such commonly prescribed medications as atorvastatin (Lipitor) and pravastatin (Pravachol). These medications are often considered the first line of medication to be used against high cholesterol levels because of their effectiveness and relatively low incidence of side effects.
Statins function as cholesterol medication through two pathways simultaneously. All of the statins imitate HMG-CoA reductase, the first enzyme involved with cholesterol synthesis. By imitating this enzyme in the liver, they reduce the amount of cholesterol that can be synthesized. In addition, by inhibiting this enzyme, more LDL receptors are produced to bind LDL and VLDL cholesterol in the blood and bring them into the liver for elimination.
Statins usually lower LDL cholesterol in fairly short order. Most people start seeing an effect within one week of treatment, and the maximum cholesterol-lowering effect is often seen at four to six weeks after beginning the medication. Cholesterol and liver function tests are important to assess both the safety of a given statin and whether it's effective enough for you.
Other classes of cholesterol medications tend not to be as effective, but these can pair up to create excellent combination therapy. Bile acid sequestrants represent a class of cholesterol medications that fit this description perfectly. These cholesterol medications work by binding bile in the intestinal tract, forcing the body to excrete it.
Bile is produced by the gall bladder from cholesterol and dumped into the intestinal tract in order to help digest food. It's usually reabsorbed by the body at the end of the small intestine. However, if it's caught up in a bile acid sequestrant, it continues on out of the body with bowel movements and the gall bladder is forced to synthesize more bile, thus burning through more cholesterol. In addition, bile is one of the intestinal compounds responsible for fat absorption from the diet. If the bile gets bound up instead of being reabsorbed by the body, less fat and cholesterol comes into the bloodstream from the diet.
Other classes of cholesterol medication work in ways we don't fully comprehend. For example, we know that fibrates work by stimulating a type of receptor found in multiple kinds of tissue, including muscle and liver tissue, that results in lower LDL and increased HDL cholesterol levels, but we don't entirely understand the connection as of yet.
Cholesterol medications often carry some truly unpleasant side effects, many having to do with liver function. The liver is where the vast majority of cholesterol is synthesized, so the liver is where the vast majority of cholesterol medications do their work. Given the high level of activity, liver side effects come as no real surprise.
The most common severe side effect from cholesterol medications is called rhabdomyolysis. Statins and fibrates can both cause muscular tissue to start disintegrating in extremely rare cases. This muscular degeneration eventually produces so many toxins that the kidneys get overloaded and death results. When used alone, neither statins nor fibrates cause this side effect very often, but the chances of developing it go up when statins and fibrates are used in combination.
Fibrates and bile acid sequestrants both increase your chances of developing gallstones because they increase the amount of cholesterol present in bile. Bile acid sequestrants can also cause digestive blockages or other digestive problems. In addition, they can interfere with the body's absorption of fat-soluble vitamins such as Vitamin K, Vitamin D, Vitamin A and Vitamin E. If the levels of these vitamins in your body gets too low, very dangerous side effects can result. Therefore, your doctor might recommend special vitamin supplements if you're going to take bile acid sequestrants for any length of time.
Of course, every drug can cause common side effects like headache, diarrhea, nausea, constipation and so on. These side effects often disappate after taking the medication for a while, but in the event that they go so far as to interfere with your daily life, feel free to ask your doctor to change medications. All of the cholesterol medication classes have multiple members, and each one causes different side effects. Even if your experience with one is absolutely miserable, a related drug may cause you no problems at all.
Cholesterol medications offer an important tool to modern people fighting high cholesterol levels.
Many people suffer from high cholesterol produced by their genetics and family history. This sort of cholesterol cannot be controlled simply through diet and exercise with today's mostly sedentary lifestyle, as it's flatly impossible to get as much daily exercise as our ancestors did.
However, cholesterol medication is not a "magic bullet".
Any cholesterol medication is meant to be used in conjunction with a low-cholesterol diet and a decent exercise program, not as an excuse to eat whatever you like in large quantity while failing to raise your heart rate above a slow march beat.
In addition, it may take some experimentation to find the combination of cholesterol medication, diet and exercise that works for you, so be prepared to re-evaluate your strategy at least once or twice a year.
In addition, cholesterol medication cannot compensate for other cholesterol-raising problems such as smoking, alcohol abuse or poorly managed diabetes.
You must manage contributing health conditions as much as possible before turning to cholesterol medication, including metabolic disorders and substance addictions. In particular, remember that addictions are just as much of a chronic health problem as diabetes, and don't be afraid to ask for your doctor's help in managing them.
With a little work and your doctor's assistance, you should be able to manage your cholesterol levels over the long term.
A well balanced cholesterol profile mostly translates into a long and happy life free of cardiovascular problems, so use every tool at your disposal to create your cholesterol management strategy, including cholesterol medications.
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The 2006 Physician's Desk Reference
Main Research and write by Loni Ice, Editing by Donald Urquhart