Cholesterol Lowering Drugs - Benefits and Risks

Introduction

Increased cholesterol level is a major risk factor for cardiovascular diseases. The cholesterol level can be lowered by changing the lifestyle, like incorporating physical activity and modifying diet. In some cases, like genetic predisposition, the level of cholesterol cannot be lowered and need the help of drugs that reduce the level of bad cholesterol. These drugs, along with diet and physical activity, help in reducing the cholesterol level.

What Are Cholesterol-Lowering Drugs?

Cholesterol is body fat produced by the liver and found in foods like meat, poultry, and whole-fat dairy products. The body needs some amount of cholesterol for organ growth and proper function. The excess cholesterol has to be burnt by the body. Excess cholesterol in the body can blood the blood vessels and block the blood flow resulting in several health conditions.

Having a balanced diet and physical exercises are the first steps in maintaining the level of cholesterol. If the cholesterol levels are high and not regulated, doctors may prescribe medications that help in lowering the cholesterol level.

There are two types of cholesterol- high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

High-density lipoprotein cholesterol is considered good cholesterol, and helps remove unwanted cholesterol from the blood vessels, whereas low-density lipoprotein cholesterol is considered bad cholesterol; it gets attached to the walls of blood vessels and blocks the blood flow. This leads to plaque formation and leads to a condition called atherosclerosis, and blood flow is impeded. Eventually increases the risk of heart disease, stroke, and heart attack.

The level of bad cholesterol has to be reduced, and doctors might prescribe drugs to control the cholesterol level. Cholesterol-lowering medications work by

• Decreasing the low-density lipoprotein.

• Decreasing triglyceride level.

• Increasing the level of high-density lipoprotein cholesterol.

What Are the Various Cholesterol-Lowering Drugs?

1) Statins:

• Atorvastatin.

• Fluvastatin.

• Lovastatin.

• Pitavastatin.

• Pravastatin.

• Rosuvastatin.

• Simvastatin.

2) Cholesterol Absorption Inhibitor:

• Ezetimibe.

3) PCSK9 Inhibitors:

• Alirocumab.

• Evolocumab.

4) Citrate lyase Inhibitors:

• Citrate lyase inhibitors.

• Bempedoic acid.

• Bempedoic acid-ezetimibe.

5) Bile Acid Sequestrants:

• Cholestyramine.

• Colesevelam.

• Colestipol.

6) Combination of Cholesterol Absorption Inhibitor and Statin:

• Ezetimibe-simvastatin.

7) Combination of Calcium Channel Blockers and Statin:

• Amlodipine-atorvastatin.

8) Fibrates:

• Fenofibrate.

• Gemfibrozil.

9) Niacin:

• Prescription niacin.

10) Omega-3 Fatty Acids.

• Prescription versions include Lovaza, Omacor, and Vascepa.

What Are Statins?

Statins are the commonly prescribed cholesterol-lowering agents. Statins lower cholesterol levels by blocking a substance that the body needs to produce cholesterol. It reduces the risk of heart disease, and stroke, and stabilizes plaque, and blood clots.

Cholesterol Guidelines:

The American College of Cardiology and American Heart Association suggested that following groups of people will be benefited from statins.

1) Increased Risk Factors for Cardiovascular Diseases:

People with absent heart or blood vessel diseases but have one or more risk factors. This group includes patients with diabetes, high blood pressure, and high cholesterol. Smoking is also a major risk factor to be considered. Patients with a 10-year risk of heart attack are ten percent or higher.

2) Cardiovascular Diseases:

Patients with existing cardiovascular diseases related to the hardening of arteries. This group includes patients with heart attacks, blockages, stroke, transient ischemic attacks, or prior surgery to replace coronary arteries.

3) High Cholesterol Level:

Patients with high levels of low-density lipoprotein or bad cholesterol. This group includes adults with LDL cholesterol levels of 190 mg/dL or higher.

4) Uncontrolled Diabetes:

Patients with uncontrolled diabetes. This group includes patients of the age group 40 to 75 with diabetes and high levels of LDL cholesterol.

What Are the Benefits of Cholesterol-Lowering Agents?

• Reduces the inflammation and damage of blood vessels.

• Improves the functioning of blood vessel lining.

• Reduces the risk of blood clotting.

• Draw cholesterol out of plaque and stabilize it.

• Decreases the risk of heart attack or stroke.

What Are the Risks Associated With Cholesterol-Lowering Drugs?

Statins

Statins are well tolerated by the majority of the people. Patients need to remain on statin therapy for a long time to keep their cholesterol levels down. The common side effects include

• Headache.

• Nausea.

• Muscle pain and joint pain.

The risk associated with statins include

• Type 2 Diabetes: Statins can increase the level of blood glucose level and lead to type 2 diabetes if the blood sugar levels are already high.

• Muscle Cell Damage: It is a very rare complication where high-dose statins break down the muscle cells, and the protein myoglobin is released into the bloodstream.

• Liver Damage: In some patients, the use of statin can increase liver enzymes.

• Reversible Memory Loss: After using statins, some patients have reported memory loss and thinking problems. But more studies are required to prove these associated risks.

The possible side effects of other cholesterol-lowering drugs include

• Constipation or diarrhea.

• Weight loss.

• Muscle pain.

• Joint pain.

• Stomach upset or bloating.

• Headache.

• Skin issues.

• Fatigue.

• Sore throat.

• Avoided in severe kidney and liver diseases.

• People with gout serial liver disease are advised not to take niacin.

• Drugs with omega-3 fatty acid esters may interfere with other medications and should be avoided in patients with allergies to fish and shellfish. It may also result in a fishy taste.

How to Correctly Take Cholesterol-Lowering Drugs?

• Taking the medications as per the doctor's prescription is important. If not, it can lead to serious outcomes.

• Strictly adhere to the doctor's instructions and do not decrease the dosage without the doctor's advice.

• If the medications have some serious side effects talk to the doctor and do not hesitate to open up.

• Keep the medicines while traveling.

• If missed a dose, take it as soon, when aware of it. If not, skip the dose and continue with the next dose. Do not take up two doses of medicines together.

What Are the Lifestyle Changes to Be Adopted Along With the Medications?

Certain diet and lifestyle changes are required to reduce cholesterol levels. This will also help to reduce the dosage or to stop the medication.

• Reduce the intake of red meat, full-fat dairy products, and fried items.

• Follow a heart-healthy diet.

• Quitting smoking.

• Physical activity for at least 150 minutes per week.

• Reduce alcohol intake.

• Maintain body weight.

Conclusion

The cholesterol-lowering drugs are highly useful in patients who cannot control their cholesterol by other means. These drugs are also given to patients who have heart diseases and also patients with high-risk factors. The benefits outweigh the risk and are widely popular.