Should You Take A Cholesterol-Lowering Drug?
Unfortunately, because of genetics, not everyone with high cholesterol responds to a low-fat diet—though the vast majority do, and the higher the cholesterol level to begin with, usually the greater the response. But many other people simply can’t stick to a low-fat diet. (Likewise, not everyone with a low level of HDL is able to raise HDL through lifestyle changes.) If your cholesterol level remains unchanged after several months of effort at lifestyle changes, your doctor may prescribe a cholesterol-lowering drug, particularly if you have other risk factors and/or symptoms of CAD.
Not long ago, such medications were recommended only for people who could not reduce their cholesterol by any other means and who have significant risk factors for, or symptoms of, heart disease. However, some new studies have suggested that even healthy people with desirable, but not optimal, cholesterol levels can reduce their risk of a heart attack by taking “statin” drugs, the most effective and widely-used medications for lowering cholesterol. These drugs—which include lovastatin (Mevacor), pravastatin (Pravachol), and atorvastatin (Lipitor)—not only improve cholesterol levels (primarily by lowering LDL), but may also have a beneficial effect directly on artery walls themselves. (Some recent studies have suggested that statins may have other health benefits, such as lowering the the risk of stroke in people with heart disease—but more research is needed to confirm this.)
Not A Clear-Cut Decision
No one should elect to take any type of drug to lower cholesterol without first consulting his or her doctor. Some people experience side effects such as muscle pain and/or weakness and liver damage. And no one knows how safe these drugs are over a lifetime, though they appear to be quite safe. Therefore, the decision to take a drug should be made in light of an overall evaluation of a person’s risk for heart disease.
You will need advice from your doctor, and you will also need a fasting test to obtain a cholesterol profile of your HDL and LDL. Your doctor will also need to check for adverse reactions to any drug you start taking, regulate dosages, and judge the effects of medication on your cholesterol levels.
Some Cholesterol Guidelines
- You probably don’t need a statin drug if your LDL cholesterol is 130 or lower, your HDL is at least 40, and you have good health habits and few, if any, coronary risk factors.
- You may want to discuss statin drugs with your doctor if your LDL is above 130, your HDL is below 40, and you have any other risk factors for heart disease: you smoke, have high blood pressure, are sedentary, overweight, have diabetes, eat a lot of foods high in saturated fat, or are a man over 45 or a woman over 55. Also be sure to ask your doctor about possible interactions between statins and any other medication you are taking.
- You may want to discuss taking low-dose aspirin. Depending on your risk factor profile, a daily low-dose aspirin may be a more appropriate, and much less expensive, measure to reduce your risk of a heart attack. But don’t start taking aspirin without talking to your doctor.
- If you’re a woman at or past menopause, you might consider starting hormone replacement therapy. The hormone estrogen tends to raise HDL. But there are a number of factors to weigh in deciding whether to take hormones, and you’ll need to discuss these with your doctor.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media