Choice of cholesterol-lowering drugs

Article Abstract:

High blood levels of cholesterol have long been associated with an increased risk of coronary artery disease. New studies suggest that lowering cholesterol levels not only lowers mortality, but can actually reverse the underlying development of atherosclerotic lesions. Patients are usually advised to try to lower cholesterol levels by altering diet and losing weight, before resorting to drug treatment. Eight types of drugs currently used to lower cholesterol levels are reviewed in this article; the effects of such drugs usually are reversed when they are discontinued. The bile acid-binding resins cholestyramine and colestipol act by increasing fecal excretion of bile acids, which are derived from cholesterol. These drugs lower blood levels of LDL (low-density lipoprotein) cholesterol, the major transport form of cholesterol, which is associated with risk of coronary artery disease. In one seven-year study, mortality was not lowered by treatment with these drugs, but in another, atherosclerotic lesions progressed less often in resin-treated patients. Constipation, pain, and bloating are common side effects of these drugs. Niacin lowers blood levels of LDL cholesterol and increases HDL (high density lipoprotein) cholesterol (higher levels of HDL are associated with a lower risk of coronary artery disease). Several long-term studies have shown that niacin decreases mortality and the incidence of heart attack, and increases regression of atherosclerotic plaques. Niacin can cause flushing, itching, digestive distress, and other systemic effects, some of which can be modulated with dosage adjustment. Lovastatin affects the body's production of cholesterol and is more effective than other drugs in lowering LDL cholesterol levels. Coronary lesions have regressed with this drug, but as long-term effects are not well-established and some severe muscle, kidney, and liver complications have occurred, the use of this drug should be selective. Gemfibrozil lowers blood fat levels, increases HDL cholesterol, and is associated with a decrease in heart attacks, but may increase formation of gallstones. Probucol, clofibrate, neomycin, and fish oil are other agents with variable effects on blood cholesterol levels, but are generally not the drugs initially chosen to treat elevated cholesterol. (Consumer Summary produced by Reliance Medical Information, Inc.)

Coronary heart disease

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Choice of cholesterol-lowering drugs

Article Abstract:

A wide variety of drugs are used to treat patients with elevated cholesterol levels. Reducing blood cholesterol can prevent or slow the development and progression of atherosclerosis. Patients with elevated cholesterol levels are usually advised to reduce their dietary fat and to lose weight. Some patients may require additional treatment with cholesterol-lowering drugs. Cholesterol is carried in the blood in low-density lipoproteins (LDL). Cholestyramine and colestipol are two drugs that reduce blood levels of LDL cholesterol. Niacin reduces total cholesterol and LDL cholesterol, and HMG-CoA reductase inhibitors reduce cholesterol synthesis. Other cholesterol-lowering drugs include gemfibrozil, clofibrate and probucol. Fish oil may also reduce blood levels of LDL cholesterol.

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Choice of lipid-lowering drugs

Article Abstract:

A variety of drugs are now available to lower the risk of coronary heart disease by reducing the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL levels can be reduced 20-60% with a class of drugs called statins, such as atorvastatin, fluvastatin, and simvastatin. These drugs lower the blood cholesterol level and decrease the risk of heart attack and stroke, and are recommended first for hypercholesteremia. Bile acid-binding resins, such as cholestyramine, and niacin, fibric acid derivatives, fish oil, and hormone replacement therapy may also effectively reduce blood levels of unhealthy cholesterols.

Estrogen, Estrogens, Fish oils

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