If you wind up needing medication, think about how fortunate we are today to have these generally safe and highly effective drugs available to us. Not too long ago all cardiologists could do for their patients was hold their hands, watching them succumb to a disease they couldn’t control. Today we have the means at our disposal to shut off the rampage of atherogenesis, the formation of plaque. That said, lifestyle changes are still the mainstay of the Plan. While all drugs have potential side effects, healthy lifestyle changes are never toxic. Also, whereas drugs target a single disease or risk factor (like high cholesterol), habits like getting more exercise, lowering your stress levels, and eating a heart-healthy diet provide a vast array of health benefits no pharmaceutical product could ever match. In the next chapter we’ll walk you through the Plan week by week for 12 weeks. You should follow the Plan regardless of what drug you’re taking. By getting good...
The American pharmaceutical industry spent more than $30 billion in 2001 researching and developing new drugs. Not surprisingly, companies tend to focus much of their research in areas that promise the biggest sales potential, such as diabetes, heart disease, and cancer. And with an estimated 36 million Americans walking around with cholesterol levels high enough to qualify them for medication, along with the success of the statin drugs, it’s not surprising drug companies are anxious to bring new cholesterol medications to market. Here, then, is a snapshot of what’s in the works: CETP inhibitors. During the 1990s researchers discovered a protein called cholesterol ester transfer protein (CETP), responsible for the transfer of fats between lipoproteins. People with high blood levels of CETP generally have low levels of HDL. The finding sent pharmaceutical scientists scrambling to find a drug that would reduce or inhibit the production of CETP. Although several such drugs are in...
First the proviso: Aspirin won’t lower your cholesterol. But its effects on blood clotting and inflammation are so significant that anyone with known heart disease, diabetes, or two or more risk factors for heart disease (and no problems taking aspirin) should talk to their doctor about taking a daily baby aspirin. Aspirin acts like WD-40 on blood platelets, making them less likely to stick to plaque in blood vessels. It also reduces the inflammation that is a hallmark of heart disease and a part of the process that leads to the buildup of plaque. Numerous studies have found that aspirin reduced the nsk of another heart attack, stroke, or premature death in people with heart disease, and it also reduced the risk of heart attacks in healthy people. One analysis of four large studies conducted on people with no history of heart disease found a daily aspirin reduced the nsk of a nonfatal heart attack 32 percent. Side effects: Aspirin’s very strength is also its greatest weakness...
This class of drug, in use for more than 40 years with no major problems, acts like super glue, binding with bile acids in the intestines so that the acids are removed with the stool. Bile acids (which help your body digest fatty foods) are made from cholesterol in the liver. Ordinarily, as they pass through the intestines they are reabsorbed into the bloodstream and carried back to the liver. This “recycles” the cholesterol component as well. But bile acid sequestrants interrupt this pathway, causing the bile acids to exit the body. This causes a loss of cholesterol as well. In response, the liver removes more LDL from the bloodstream. And—voila—your blood cholesterol levels drop. The most common drugs include cholestyramine, sold under the brand names Questran, Prevalite, and LoCholest, and colestipol (Colestid). These drugs generally lower LDL about 15 to 30 percent with relatively low doses while increasing HDL slightly (up to 5 percent). They may be prescribed with a statin if you...
Fibric acid derivatives, or fibrates, affect the actions of key enzymes in the liver, enabling the liver to absorb more fatty acids, thus reducing production of triglycerides. These drugs also work well at increasing production of HDL. Although they can also lower LDL levels, they’re not considered first-line treatments for high LDL or total cholesterol. Overall, they tend to lower LDL levels between 10 and 15 percent, increase HDL levels between 5 and 20 percent, and lower triglycerides between 20 and 50 percent. Fibrates are often prescribed in conjunction with other cholesterollowering drugs, but they shouldn’t be taken with statins. They may be particularly helpful for people with insulin resistance syndrome, in which HDL tends to be low, LDL normal, and triglycerides high, Brands include Atromid-S (clofibrate), Lopid (gemfibrozil), and Tricor (fenofibrate). Side effects: Fibrates have few side effects and most people can take them with no problem, The most common problems...
Niacin (nicotinic acid) is one of the oldest cholesterol-lowering drugs. A member of the B vitamin family, it’s found in fruits, vegetables, meats. and grains, as well as in most multivitamins. At doses up to 35 milligrams per day, niacin is considered a supplement, but if you’re taking it at doses high enough to lower your cholesterol— more than 100 times the recommended daily intake of 16 milligrams for men and 14 milligrams for women—vyou need to be taking it under the supervision of your doctor (even though it’s sold over the counter). Niacin works by reducing the production and release of LDL from the liver, lowering LDL 15 to 20 percent, It also reduces the release of free fatty acids stored in fat cells, which eventually become Sound too good to be true? Well, there is a drawback to niacin that turns some people off: It can cause flushing and redness—an intense blush. This occurs because niacin relaxes blood vessels, enabling more blood flow. The blushing usually...
Two organs primarily control cholesterol levels in your blood: the liver, which produces cholesterol and bile acids (used to digest fats), and the intestine, which absorbs cholesterol both from food and from the bile, While statins primarily lower cholesterol by preventing its production in the liver, a new class of drug called cholesterol absorption inhibitors lowers cholesterol by preventing it from being absorbed in the intestine, The first approved drug in this class, Zetia (ezetimibe), hit American markets in 2002. By itself, Zetia reduced cholesterol about 18 percent in studies, When the drug was paired with statin drugs, cholesterol levels dropped 25 percent more than with statins alone. That’s important, since on average only 60 percent. of people who take statins get their cholesterol levels as jow as they should. In one study just 19 percent of people taking statins alone reached their cholesterol goal; adding Zetia increased that figure to 72 percent. “Taking 10...
his class of drug, which also goes by the tongue-twisting name HMG-CoA reductase inhibitors, has revolutionized the treatment of high cholesterol more than any other medication. In use for more than a decade, the drugs are sold under the brand names Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin), Additionally, an extended-release form of lovastatin, called Altocor, was approved in 2002. It needs to be taken only once a day; most statins must be taken more often. To prevent confusion, we’re going to stick to the brand names throughout this chapter. Statins work by partially blocking an enzyme called HMG-CoA, which controls how quickly your body produces cholesterol. (Remember that your body makes about three or four times more cholesterol than you eat.) By blocking this enzyme, statins put the brakes on cholesterol production. They also increase your body’s ability to remove LDL frorn your bloodstream:...
As we talked about in this Chapter , your levels of cholesterol, combined with your other risk factors for heart disease, determine your need for medication. Your doctor will ikely recommend prescription medication if your LDL level remains between 160 and 189 after three months on the Live It Doum Plan and if you have none of the following risk factors: A history of coronary heart disease (CHD), diabetes, or hypertension, or a family history of premature CHD. Smoking. An HDL level below 40 milligrams per deciliter, If you don’t have any of these risk factors and your LDL level is more than 190, your doctor will likely recommend that you start on medication at the same time that you begin following the Plan. But it’s worth noting that the use of medication doesn’t have to mean a permanent commitment. If you improve your diet and increase your activity level, in the process you may reduce vour cholesterol enough to get off the medication and stay off it. If you do have any of the...
