Cholesterol Lowering Drugs

Drug therapy can be considered for patients who - in spite of normal activity and the proper diet for weight loss - need to lower their blood cholesterol levels inevitably through further treatment.

In men less than 35 years of age and premenopausal women with LDL cholesterol levels of 190 to 219 mg/dL, drug therapy should be delayed except in high-risk patients such as those with diabetes.

In coronary heart disease patients with LDL cholesterol levels of 100 to 129 mg/dL, the physician should exercise clinical judgment in deciding whether to begin drug treatment.

In some cases, a physician may decide that using cholesterol-lowering drugs at lower LDL cholesterol levels is justified. On the other hand, drug therapy may not be appropriate for some patients who meet the above criteria. This may be true for elderly patients.

Drugs for elevated LDL cholesterol are -HMG CoA reductase inhibitors, e.g., atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. Statin drugs are very effective for lowering LDL cholesterol levels and have few immediate short-term side effects.

Patients, who are pregnant, have active or chronic liver disease, or who are allergic to statins shouldn't use statin drugs.

The most common side effects are gastrointestinal, including constipation and abdominal pain and cramps. These symptoms are usually mild to severe and generally subside as therapy continues.

Bile acid sequestrants are the other class of drugs used to reduce cholesterol levels- colesevelam, cholestyramine and colestipol - and nicotinic acid (niacin). These have been shown to reduce the risk for coronary heart disease in controlled clinical trials. Both classes of drugs appear to be free of serious side effects. Both have considerable side effects and the patient needs to educate about its manifestation. Nicotinic acid is preferred in patients with triglyceride levels that exceed 250 mg/dL because bile acid sequestrants tend to raise triglyceride levels.