Bay Area Medical Information (BAMI.us)
Medications to Lower Cholesterol
In general, physicians often start out therapy with a single drug, but if that fails to improve blood test results, the dosage may be increased, or another drug may be added.  Once the goal set by you and your health care provider is achieved, drug therapy must continue indefinitely to maintain these results. Also it will be recommended to monitor your blood cholesterol and liver function every four to six months. All types of cholesterol-lowering drugs — with the possible exception of cholesterol absorption inhibitors — can cause liver function abnormalities. Your doctor will order a blood test periodically to check your liver function.  No single drug works well for everyone, thus the specific drug your doctor recommends depends on a number of factors.  The following abnormal blood test results will play a role in your physician's selection of medications:
  • High LDL cholesterol (bad cholesterol): 
    • Statins (Lipitor, Lescol, Mevacor, Altoprev, Pravachol, Crestor and Zocor)
    • Cholesterol Absorption Inhibitor (Zetia) Lowers LDL, apolipoprotein B, and reduces elevated sitosterol and campesterol in hereditary sitosterolemia. Zetia is often given in combination with a statin.  Vytorin is a brand name of a combination drug that is a statin plus Zetia (23)
    • Bile Acid Sequestrants (Welchol) lowers LDL
       
  • Low HDL (good cholesterol):
    • Niacin is the most effective treatment currently available to increase low levels of HDL. (see below for more about niacin)
    • Statin therapy (Lipitor, Lescol, Mevacor, Altoprev, Pravachol, Crestor and Zocor) alone or in combination with niacin raises levels of HDL (see below for more about statins)
       
  • High triglycerides:
    • Fibrates (Tricor, Lopid) are often used to lower triglycerides
    • Niacin also lowers triglycerides
    • Statins to a lesser extent, lowers triglycerides
    • Omega-3 fatty acids lower triglyceride. Some people who have elevated triglycerides may need 2 to 4 grams of Omega-3 fatty acids, EPA and DHA, per day provided as a supplement. Even 1 gram/day dose may be more than can readily be achieved through diet alone. These people should consult their physician to discuss taking supplements to reduce heart disease risk. Patients taking more than 3 grams of omega-3 fatty acids from supplements should do so only under a physician’s care. The FDA has noted that high intakes could cause excessive bleeding in some people.
Statin drugs
Statin drugs (Lipitor, Lescol, Mevacor, Altoprev, Pravachol, Crestor and Zocor) are the most effective treatment for lowering LDL. Statin therapy  also raises levels of HDL and improves LDL. Statins are also thought to lower inflammation and CRP levels.  Evidence shows that medications, particularly statins can reduce the risk for heart attack, stroke, and death in some people who have known coronary artery disease or diabetes.  These drugs not only prevent new plaques from forming, but also may help repair damaged blood vessels and reduce the risk of life-threatening blood clots.  Further benefits of statin therapy have recently been studied, and researchers have observed a cancer-preventive benefit of statin therapy on esophageal, liver, pancreatic and breast cancers.  These drugs have not yet been fully studied or approved for cancer prevention. Note: Grapefruit juice interacts with some statins which increases the risk of side effects.  Statins, as well as most cholesterol-lowering drugs can cause liver function abnormalities which must by monitored by periodic blood tests. 
Niacin
Niacin, prescription-strength, extended-release form, (Niaspan) also helps reduce LDL (bad cholesterol) and triglycerides, and improves HDL as well.  Statins & niacin lower CRP levels, possibly by reducing inflammation.  Niacin is often used in conjunction with statin therapy. Advicor is the brand name of a combination of a statin plus niacin.  Niacin is a B vitamin and is available without a prescription, but dietary-supplement niacin must not be substituted for the niacin that your doctor prescribes because the supplement can cause significant liver injury.   Prescription-strength, extended-release niacin raises levels of HDL (good cholesterol) and also helps reduce LDL (bad cholesterol) and triglycerides.  Statins & niacin lower inflammation and CRP levels as well.  One of the oldest cholesterol-lowering drugs, niacin is the most effective treatment currently available to increase low levels of HDL.    A recent study (Nov 2004) found that adding prescription-strength, extended-release niacin to a statin medication slows the progression of atherosclerosis better than statin therapy alone.(21) 
  • The presence of other medical problems may affect the use of niacin. Make sure you tell your doctor if you have any other medical problems, especially: bleeding problems, glaucoma, gout, liver disease, history of jaundice, low blood pressure,  stomach ulcer, or kidney problems—Niacin (extended-release tablets) may make these conditions worse. 
  • Niaspan (prescription-strength niacin) should be taken at bedtime after a low-fat snack or with Metamucil stirred up in water.  This helps reduce the facial flushing, which is a harmless, but annoying side effect. To further help decrease flushing, ask your doctor if you can take aspirin or ibuprofen (e.g., Advil, Motrin) 30 minutes before taking the Niaspan and avoid drinking alcohol or hot drinks around the time you take your Niaspan.   Do not stop the medication without consulting with your doctor.  If you stop taking this medication for any period of time, contact your doctor prior to restarting it.
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