Cholesterol-lowering drugs

Hypercholesterolemia must be combated first of all with an appropriate diet associated with moderate but constant physical activity. But, if that’s not enough, resorting to drugs like statins.

Even if we do not have any disorder, blood tests could reveal that our cholesterol exceeds the optimal values.

If there is no heart disease, the first measure to take, as also indicated by the guidelines of the National Cholesterol Education Program, a control of one’s lifestyle. There are three basic rules:

• diet low in saturated fats and cholesterol,
• physical activity,
• weight control.

But, if after six months cholesterolemia has not returned to normal or if other risk factors are present (smoking, age, hypertension, family history of coronary heart disease), it will be necessary to resort to special drugs.

Statins, the most active drugs

Whether it’s old-generation statins or new-generation statins, they’re still the drugs of choice for lowering cholesterol.

Penalized by an alarm (which turned out to be unfounded) launched years ago about their potential serious negative effect, statins have on the contrary established themselves as safe drugs.

Used at the correct dosages and paying attention to the combination with other medicines, they are the most active pharmacological means in lowering cholesterol.

The need and opportunity to start statin therapy depends on your cholesterol level and any other risk factors for cardiovascular disease.

How they work

Statins interfere with endogenous cholesterol production: they block a liver enzyme (HMG-CoA reductase) responsible for cholesterol synthesis in the liver.

It also seems that they also have anti-inflammatory properties, which help stabilize the walls of blood vessels.

In the heart this stabilization is useful because it decreases the chances of rupture of the plaques and, therefore, the risk of heart attack. They could also reduce the risk of thrombus formation.

Precisely for this reason today they are also used before and after bypass surgery or angioplasty, as they are considered fundamental to protect the coronary arteries.

Which and when

The choice of a statin rather than another is made by the doctor after assessing, in addition to cholesterol levels, also other risk factors for cardiovascular diseases, such as:

• family history of hypercholesterolemia or cardiovascular disease,
• sedentary lifestyle,
• hypertension
• diabetes,
• overweight or obesity,
• smoke
• peripheral arterial disease.

Some molecules also have known interactions with other drugs. This will also help your doctor choose the type of statin, or a different medication.

Once you have chosen the most suitable drug, there are no special attentions to be paid.

They are generally taken in the evening towards dinner, but they are still absolutely well tolerated drugs.

The goal of therapy is to have a lowering of total cholesterol below 200 and an increase in good cholesterol (HDL). The dosage of the drug will then be chosen depending on the starting values.

Effects

The most important side effects are found in the muscles: if the patient complains of severe cramps it may be appropriate to suspend statins and look for alternative solutions (fibrates, resins, nicotinic acid).

While if the pain is not too intense you try to maintain the therapy rather than suspend it and have cholesterol skyrocketing.

In the meantime, the cause of the disorder should be investigated and, if it is linked to the drug, you can try to reduce the dose or change statin.

Other side effects, which may disappear with the progress of therapy, are: nausea, diarrhea or constipation.

Unless there are serious liver disease, statins are safe. They are not recommended during pregnancy.

Chronic care

It should be emphasized that, once cholesterol has been brought back to normal, therapy should not be interrupted: without the drug, the cholesterol level would probably increase again.