5 comments

  • There are a few different cholesterol lowering agents that work by different mechanisms. The issues surrounding the medicinal control of cholesterol and serum triglyceride are exceedingly complex. Frankly, this stuff gives me a headache to think about and I’m glad I don’t do internal medicine for a living!

    It helps to know a few things about cholesterol in the body first. For example, there are two basic ways in which cholesterol comes to be inside the body. One is by way of dietary intake, and the other is through the liver’s synthetic function. Also, it is valuable to understand how cholesterol gets out of the body. One way is that cholesterol is the starting material for a number of biochemical processes like making hormones (this is why they’re called "STERoids" – they’re made from, and are similarly shaped molecules to choleSTERol!!) Another way that cholesterol leaves the body is by secretion into the bile system and then exiting the body by way of the intestine. However, bile is actually re-used. Bile is reabsorbed in the intestine with the food molecules and the re-used bile is then filtered out of the blood and put back into the liver and then the bile system.

    There are two basic strategies by which medication can decrease cholesterol that I am aware of. The older method involves increasing the rate of cholesterol elimination. A class of medication known as "cholesterol binding resins" exists, and includes drugs like "cholestyramine" and "cholestipol". These agents are indigestible and they stay inside the intestine without absorbing into the body. They pass through and are eliminated. However, along the way, they chemically bind the bile that would otherwise be reabsorbed into the blood. The bile is rich in cholesterol. Because the bile is normally reabsorbed with about 95% efficiency, this chemical binding represents a huge loss of systemic cholesterol, and the body responds by turning more cholesterol into bile. The cholesterol level is lowered. Other drug strategies exist which do the same thing, like a combination of the vitamin "niacin" and the antibiotic "neomycin". Together, these medications can seriously lower bile reabsorption and lower systemic cholesterol. Neomycin is very upsetting to the intestine and causes nausa. Therefore, this is not a commonly used strategy.

    The second strategy, developed over the last 15 years, is to inhibit the manufacture of cholesterol in the liver. Every biochemical that is made within the body requires multiple steps in its production. Typically, one step in the process is the "key" which is responsive to blood levels. When blood levels go low, the key step is turned up, and when blood levels get high, the key step is turned down. It’s like the gas and brake on a car.

    The key step in cholesterol manufacture involves an enzyme called "HMG-CoA Reductase". A class of medications called "HMG-CoA Reductase Inhibitors" exists which blocks the regulated step of cholesterol manufacture. This is the class of medication that everyone calls STATINS. They carry chemical names like "lovastatin", "atorvastatin", "pravastatin"… etc.

    It turns out that the benefits of the statins are multiple. Not only do they lower cholesterol, but they generally affect the levels of the various kinds of serum lipids in a favorable way. In addition, they are directly associated with improvements in vascular diseases and heart attack, which is the real end point that everyone is interested in (it wouldn’t do to lower cholesterol unless lowering cholesterol made you more healthy!). We even have information now that if you put someone on a statin before they undergo surgery, they’ll be less likely to have certain kinds of complications after the operation!

    The most important first step in lowering cholesterol, however, has ALWAYS BEEN and CONTINUES TO BE lifestyle related. The benefit of administering medication to reduce cholesterol, for example, would be minimal, if the patient was also 100 pounds overweight and an uncontrolled diabetic. Sensible food choices (not crazy diets) and sensible amounts of exercise are the most important first step to cholesterol lowering. Doctors have observed that in some patients, even a 10% reduction in excess body weight is associated with remarkable improvements in things like lipid profile and diabetic control. The makers of oatmeal and cheerios are quick to point out that the fiber contained in their products has a cholesterol lowering characteristic. I assume that it is because they tend to bind bile almost like the cholesterol binding resins, but I don’t know this for sure.

    My personal recommendation for anyone battling mild to moderate hypercholesterol or hyperlipidemia is to start with a program of eliminating snacks and eating sensible sized meals … do not "diet"! (dieting is usually a little bit crazy and nobody can do it over the long haul). Increase exercise. Start with going to the gym and doing a half hour 4 times a week on a simple cardio machine. Learn to sweat profusely and be comfortable with it. People usually drop about 10 pounds doing this alone and can hold it off. Recheck labs in about 4 to 6 months and if the lipid profile still looks bad, start medication.

    I hope that answers your question.

  • honey nut cherrios

  • science teacher

    Statins

    Good diet helps too.

  • keepsondancing

    Cholesterol reducing medicines are called statins. Google STATINS to find an array of articles. Some merely explain how statins work. But you will also find quite a few articles expressing concerns about these drugs.

    I was afraid of the side effects of these meds so tried to reduce my cholesterol by diet alone. Over a 90-day period, dietary changes had little effect. Next I tried weight loss and started walking 2 miles/day, every day. Bingo! I lowered my cholesterol by one point for every pound I lost…a total of 60 points!

  • gangadharan_nair

    Hypolipiaemic agents-Fibric acid derivatives.
    Gemfibrozil.
    Bezafibrate.
    Miscellaneous preparations

    Statins (HMGCoA reductase inhibitors)
    Lovastatin.
    Simvastatin.
    Atorvasatin.
    Pravastatin sodium.
    Rosuvastatin.

    Nicotinic acid group
    Nicotinic acid.

    Omega-3 fatty acids
    Eicsapentaenoic acid / Docosahexaenoic acids.
    Omega-3 fatty acids + Vit.E

    Others
    Gugulipid
    Policosanol
    Ezetimibe.
    Miscellaneous preparations.