Overview of Cholesterol Medications

This is Dr. K, your War on Diabetes pharmacist, here to talk to you about something new.  My previous posts have all been about diabetes medications.  Don’t worry, I have more medications to talk about and will come back to them soon.  But today I want to touch on a topic that has been mentioned a few times on the blog – cholesterol.  Many of you are probably taking some form of a cholesterol medication.  In fact, they are one of the first kinds of medications, aside from diabetes medications, that we give to most diabetic patients; unfortunately, many diabetics also have high cholesterol – the two seem to go hand in hand.  Not a great combination when you consider that they can lead to heart disease and clogged arteries, putting you at risk for a heart attack or stroke.

But there is good news – we have some wonderful medications that are very effective in lowering cholesterol and keeping the heart healthy.  And if you are not a big fan of medications (which most of us aren’t!), you are in for some better news!  You see, two of the weapons that you are using in your fight against Diabetes – proper nutrition and exercise – go a long way in helping to keep cholesterol levels in check.  So while you are fighting your War on Diabetes, you are also winning the battle against high cholesterol!  Since I am a pharmacist, however, I figured it would only be right for me to focus on the medication side of high cholesterol, but I know we will return to talking about nutrition and exercise very soon.  So this week I will be giving a short overview of the different types, or classes, of cholesterol medications that are available.

Bile Acid Sequestrants

This is a class of medications that has been around since the 1970s, but is not used very much today (at least not for cholesterol).  The drugs in this category are cholestyramine, colestipol, and Welchol.  Bile acid sequestrants work to help lower bad cholesterol (LDL).  The way they do this is by binding up bile acids in the gut so that they cannot be reabsorbed into the body.  What does that do?  Well, bile acids are needed in the body to help with digestion.  When bile acid sequestrants stop these acids from being reabsorbed, the body needs to make bile acids another way.  Bile acids are made from cholesterol, so in order to make more bile acid, cholesterol must be used.  This will help to lower cholesterol levels in the body.

Niacin

Niacin is a B vitamin that helps to lower bad cholesterol (LDL) and triglycerides, but its main effect is in raising good cholesterol (HDL).  It helps your body convert cholesterol into energy.  Niacin is also important in digestion, the nervous system, and it keeps your hair, skin, and eyes healthy.  Some foods contain niacin and it is also found in multivitamins (under the name vitamin B3).  It is currently the best drug for raising good cholesterol levels.

HMG-CoA Inhibitors (“Statins”)

These are the drugs that you are probably most familiar with – the “statins.”  Pravastatin, lovastatin, simvastatin, Crestor, and Lipitor (atorvastatin) are all in this category.  These are the big guys, the main medications we use for lowering bad cholesterol levels.  Statins slow down the process of the liver making cholesterol.  This also causes the liver to take up and digest cholesterol from the bloodstream.  As we will talk about later, we don’t want high levels of cholesterol in the blood because it causes damage (just like glucose!).

But these aren’t the only reasons why statins are some of our favorite drugs.  They also have so many more benefits than just lowering cholesterol.  Statins can decrease the risk of heart attack or stroke by about 50%, decrease the rate of hospitalization and death in patients with heart disease, decrease blood vessel inflammation, are beneficial in the immune system and bones, make plaques in arteries more stable, work as antioxidants, and may reduce the risk of getting esophageal cancer.  And there are possibly many more benefits that we have not discovered yet.

Fibrates

Fibrates are medications that are used to lower triglycerides and increase good cholesterol (HDL).  Gemfibrozil and fenofibrate are the drugs in this class.  Fibrates help the body break down fats in the blood, reduce the amount of triglycerides and cholesterol that the body makes, and help the body get rid of triglycerides more easily.

Cholesterol Absorption Inhibitors

Zetia is the only cholesterol absorption inhibitor that is currently available in the US.  It works in the small intestine and stops the body from absorbing cholesterol from the food that you eat.  It works mostly to lower bad cholesterol levels (LDL).

Omega-3 Fatty Acid Supplements (Fish Oil)

Omega-3 is a fatty acid that can be found in certain fish, flax seeds, and walnuts.  It works to lower triglycerides, but it can raise bad cholesterol levels (LDL), which is why it should only be taken if you are already on a statin.  This is one of the more common mistakes I see patients making in my pharmacy – a patient hears that they should take fish oil to keep from having high cholesterol, or to treat their current high cholesterol.  Fish oil should not be used to treat “bad” cholesterol (LDL) because it can make it worse.  Fish oil is only good for taking care of high triglycerides.  We usually don’t give medications to treat high trigylcerides (unless they are extremely high) because treating “bad” cholesterol (LDL) is the most pressing issue and triglycerides will decrease when LDL decreases.  So please, don’t make the mistake in thinking that fish oil will make your cholesterol all better, because it could make it worse.  I know I will be coming back and addressing this in a full post later.

Those are the different classes of cholesterol medications currently available.  In the upcoming posts I will be covering the medications in each class in more depth.

As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions.  However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs.  Remember to always check with your medical provider and pharmacist before stopping or starting any new medications.  My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health.  Please consult with your doctor and pharmacist about anything regarding your health.

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3 comments on “Overview of Cholesterol Medications
  1. beetleypete says:

    I was very pleased to see this clear and succinct explanation. However, I have personally had very bad side-effects after taking Simvastatin for almost five years, and now, despite having high cholesterol (7.2), I have been taken off all statins by my doctor.
    It is very important to have checks on the blood for muscle wastage caused by statins, as it may affect you, and end up being more dangerous than the high cholesterol. Luckily, many are not affected at all, and are able to enjoy the full benefits of cholesterol-reducing drugs.
    Thanks for a good post Dr K, and to Phil for posting it too. Regards from England, Pete.

    • Dr. K says:

      Thanks for your reply, Pete.

      Yes, you are very right in saying that it is so important for regular lab tests when you are on a statin – in fact it is something that I tell every patient of mine when they first start taking one. I’ll be discussing it further in my posts on the individual statins. We want to make sure the liver and muscles stay safe while taking care of the cholesterol. It really is a risk versus benefit battle. For physicians, we realize that heart disease is the leading cause of death in the United States, even ahead of cancer and diabetes, so we have to make sure to keep control on cholesterol. Not to mention the fact that diabetics have a higher risk of heart disease because of their diabetes. That cholesterol number might not seem that big of a deal at the time, but there is a direct relationship between high cholesterol and heart disease, and statins have been shown to decrease the risk of a heart attack by about 54%. Honestly, statins are some of the most tolerated medications out there. Yes, we have some who have problems with the liver and muscle while on statins and we take them off for a time, but most patients are actually able to restart the same statin at a later time without having the same problems with their liver and muscles. Fortunately cholesterol can be controlled through diet and exercise, which I will discuss in a later post, but if numbers are high at all we need to be controlling them through some type of medication until the patient can do it on their own.

      Thanks so much for your comments!
      Dr. K

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