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Friday, September 10, 2010
Cholesterol
Click here to go directly to Drug Review High cholesterol is a major contributor to heart disease, the number one cause of death in both adult men and adult women in the United States. High cholesterol contributes to the development of heart disease by forming plaques in the arteries that lead to the heart. Impeded blood flow to the heart can leave the heart "starved" for oxygen, thus causing angina (chest pain) and possibly even a heart attack. LDL's (low-density lipoproteins) are responsible for "holding" cholesterol in the blood, thus increasing the risk of developing fatty build-ups on the walls of blood vessels. HDL's (high-density lipoproteins) are responsible for transporting cholesterol to various tissues like the liver, where cholesterol is eliminated and prevented from adhering to the walls of blood vessels. As a result, LDL cholesterol is commonly referred to as "bad" cholesterol since it contributes to arterial obstruction, and HDL cholesterol is sometimes called "good" cholesterol because it actually reduces the risk of developing fatty arterial build-ups. Other fats, called triglycerides, are also carried in the blood by lipoproteins. Their contribution to heart disease is unknown, although they are thought to be unfavorable. Measurements of triglyceride levels usually reflect the levels of VLDL's (very-low-density lipoproteins). High levels of VLDL's may contribute to the development of heart disease.
The Need for ImprovementIt is estimated that 50% of american adults have elevated blood cholesterol levels which can lead to the development of heart disease. In recent years, average total cholesterol levels have dropped but are still too high. According to the Food and Drug Administration, about 29% of American adults could reduce their cholesterol levels to a safe range by simple dietary adjustments, and about 7% of Americans could accomplish a safe cholesterol range through dietary adjustments and drug therapy. Improvement is possible since accurate methods for diagnoses and risk factor assessment exist, and since very effective treatment options are also available.
Risk Factors Associated With High CholesterolA large number of risk factors have been identified that may lead to high cholesterol. These risk factors include:
In addition to risk factors that contribute to high cholesterol (which increase the risk of developing heart disease), there are a number of risk factors that directly contribute to the development of heart disease like cigarette smoking and high blood pressure. It is important to note that if any of these risk factors exist in conjunction with high cholesterol, the risk of developing heart disease may be dramatically increased. Sometimes even one change in daily routine may eliminate more than one risk factor, which can greatly improve an individual's chance of avoiding cholesterol-related complications. For instance, weight loss can reduce blood cholesterol levels, while also lowering blood pressure and diminishing the risk of developing type 2 diabetes.
Diagnoses of High CholesterolThe first step in determining if your cholesterol levels need to be controlled is to see a doctor. A small sample of blood is taken from a finger stick, from which the total cholesterol level is measured. In addition, a lipoprotein analysis may be done to determine the levels of LDL and HDL cholesterol. A lipoprotein analysis is recommended for anyone who: has heart disease, shows significant risk for developing heart disease, or who is considering drug treatment for high cholesterol. Home testing kits are available, but are not recommended. It is better to have cholesterol measured by a doctor so that the data may be properly interpreted. The National Cholesterol Education Program (NCEP) has devised criteria that help determine the extent to which an individual needs to control their cholesterol levels. As of August 1999, the following criteria have been established for people who do not have heart disease:
For people with heart disease, LDL levels above 100 mg/dL are considered high. It is also important to note that HDL levels below 35 mg/dL are considered too low and may increase the risk of developing heart disease.
Non-Drug TherapiesWhen someone without heart disease is diagnosed with elevated cholesterol, the first line of treatment is usually a six month program of diet, exercise, and weight loss commonly referred to as a "step 1" diet. The majority of people respond very well to this first line of therapy. It has been shown that for every 1% reduction in dietary saturated fat, a comparable 1% drop in LDL levels can be expected. When the initial "step 1" diet proves ineffective, a change to the "step 2" diet is often recommended. "Step 2" diets can be very demanding and sometimes require the assistance of a registered dietician. A "step 2" diet requires that saturated fat intake not exceed 7% of calories, and that total daily cholesterol not to exceed 200 mg. When non-drug therapy proves unuseful drug use may be needed. Only a select number of people should begin drug-therapy without ever attempting changes in diet or exercise. Often, people with heart failure or with hereditary problems (i.e. familial hypercholesterolemia) may require drug therapy as an initial form of treatment. Regardless, all people attempting to control their blood cholesterol levels should make significant lifestyle changes. Drugs used to control cholesterol are intended to be used in conjunction with dietary and exercise changes.
Drug TherapiesAccording to the NCEP, about 9 million Americans take cholesterol-lowering drugs. The most promising drugs appear to be the "statins". They are a relatively new class of drugs that are extremely effective in reducing total cholesterol, and have very favorable side effect profiles. The statins reviewed in this article are Lescol (Fluvastatin), Lipitor (Atorvastatin), Pravachol (Pravastatin), and Zocor (Simvastatin). On average, all statins have similar side effect profiles. Although many people observe a different frequency of side effects with different statins. The main difference between the statins lies in their ability to reduce cholesterol. Some may be more effective for more severe cases, while other statins may prove more useful for people requiring smaller reductions in total cholesterol. It is important to note that of the statins reviewed in the scope of this article, only Zocor and Pravachol have been studied in long-term trials. Even though the safety of long-term use of statins has not been adequately studied, many doctors are hopeful that their prolonged use is safe. It is important to address the issue of long-term statin use since they usually require a lifetime commitment. It has been shown that when medication is stopped, cholesterol returns to higher levels. Sometimes dosing can be reduced, but rarely can drug therapy be stopped altogether. Other drug therapy options include: Resins, Nicotinic acid, Fibric acid derivatives, and Aspirin. Resins include Questran (Cholestyramine) and Colestid (Colestipol), and are a much older class of drugs compared to the statins. They work by decreasing the recycling of bile acids, thus causing the liver to absorb cholesterol from the blood to resynthesize lost bile acids. Resins are effective at reducing LDL levels for people who don't respond well to dietary changes alone. Nicotinic acid, otherwise known as Niacor (Niacin), has been shown to be effective at reducing LDL levels, increasing HDL levels, and at lowering blood triglyceride levels. One disadvantage of Niacor is that it requires use at about 100 times the recommended daily allowance, thus it has a much greater potential for toxicity. Fibric acid derivatives like Lopid (Gemfibrozil) are most effective at lowering triglyceride levels and raising HDL levels. Other drugs like statins are more effective at reducing LDL levels. In addition, people with high cholesterol, who are also at high risk for developing a blood clot (often due to atherosclerosis), are frequently prescribed Aspirin. It has been shown that Aspirin provides significant protection against heart attack, and as a result, is often prescribed to people with heart disease. Aspirin carries a significant risk of developing gastrointestinal toxicity with prolonged use. Click here to learn more about the uses and the risks associated with Aspirin. We hope this review has provided you with enough information to help you become informed about high cholesterol.
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