Should we know exactly about cholesterol-lowering drugs (Antihyperlipidemic Drugs)?

Have you ever seen a blood test report that says "your cholesterol is a little high"? Or has your doctor ever told you to "start taking medication to control your cholesterol"? This is a very familiar experience for many people in our country. So today I am going to talk simply and politely about these cholesterol-lowering medications, or in medical terms, ``Antihyperlipidemic'' drugs.

Why do we need this cholesterol medication?

First, let's understand this. Cholesterol is something our bodies need in some amount. It helps build our cells and produce hormones. Our liver produces the cholesterol we need. But the problem starts with the foods we eat and the lifestyle we live in, which can lead to extra cholesterol in our bodies.

There are several main reasons why cholesterol levels generally increase:

• Our food and drink: Saturated fat found in animal foods (meat, butter, cheese, milk) and deep-fried foods (especially things like palm oil) increase cholesterol levels.
• Lack of exercise: When the body is inactive, the extra calories we consume are stored as fat.
• Genetic causes: Some people may have high cholesterol levels due to genetic influences passed down through generations.

When cholesterol levels in the blood increase, it starts to build up on the walls of our blood vessels. This is called ``Atherosclerosis''. It's like dirt building up inside a water pipe. Over time, these deposits cause the blood vessels to become narrow and obstruct the flow of blood. This is what paves the way for serious diseases like heart attacks and strokes.

Commonly used cholesterol-lowering medications

There are several types of medications used to lower cholesterol. Not all medications are the same. Your doctor will choose the most appropriate medication for you based on your cholesterol level, other medical conditions, and your risk factors. Let's take a brief look at each of these medications.

1. Statins - the most commonly used type

This is the most widely used and most effective class of cholesterol-lowering drugs in the world. You may have heard of the brand names `Lipitor®`, `Crestor®`, `Zocor®`. These all belong to the `Statins` class of drugs.

• How does it work?: Simply put, our liver is like a factory that makes cholesterol. This factory has a key enzyme called `(HMG CoA reductase)` that is used to make cholesterol. `Statins` block this enzyme. Then the production of cholesterol by the liver decreases.
• Additional benefits: Statins have other good properties.
• Improves the function of the inner wall of blood vessels.
• Reduces swelling and damage to blood vessels.
• Reduces the risk of blood clots.
• It reduces the risk of plaques (fatty deposits) in blood vessels breaking down and causing damage.

Because of these additional benefits, statins are a very important drug for reducing the risk of heart disease.

2. Fibrates (Fibric acid derivatives or Fibrates)

This type of medication mainly targets the reduction of another type of fat called triglycerides in the blood. The extra calories we eat are stored in the body as `Triglycerides`. `Tricor®`, `Lopid®` are examples of this type of medication. While these reduce the bad cholesterol `(LDL)`, they also help to increase the good cholesterol `(HDL)` to some extent. However, these medications are not suitable for people with severe kidney or liver disease.

3. Other medications

There are several other types of medications. These are usually given to people who do not respond to statins or in other special cases.

• PCSK9 inhibitors: These are injectable drugs that very effectively lower bad cholesterol (LDL). They are usually given to people who are at high risk of heart disease and whose cholesterol cannot be controlled with other medications.
• Bile acid sequestrants: These medications work in the intestines. They bind to the bile produced by the liver to help digest food, reducing the body's absorption of cholesterol.
• Selective cholesterol absorption inhibitors (Ezetimibe): As the name suggests, these work by blocking the absorption of cholesterol from the intestines into the body. They are often given in combination with statins.
• Nicotinic acid (Niacin): This is a type of B vitamin. It helps lower bad cholesterol (LDL) and triglycerides and increase good cholesterol (HDL). However, it is not suitable for people with gout or severe liver disease.
• Omega-3 fatty acids: Also called "fish oils." They are mainly used to lower triglyceride levels. Some of them are available over the counter, but you should not use them without consulting your doctor , as they can interact with other medications.

What are the side effects of this medication?

Like any medicine, cholesterol-lowering medications can cause side effects in some people. The important thing is that not everyone gets these side effects. And most of them are not serious. But if you experience any discomfort, it is imperative to inform your doctor about it.

In the table below, we will look at the common side effects that can occur with major medications.

Things we should pay attention to while taking medicine

To get the most out of cholesterol medication, there are a few things we need to do on our part. It's not a good idea to forget everything else just because you took the pill.

• Change your lifestyle: This is the most important thing.
• Eat heart-healthy foods: Reduce your intake of oil, coconut milk, sugar, and flour as much as possible. Include vegetables, fruits, legumes, nuts, and fish in your diet.
• Exercise: Make it a habit to walk, run, or bike for at least 30 minutes a day.
• Take your medicine on time: Take the prescribed dose at the prescribed time as prescribed by your doctor. Don't miss a single day.
• Do not reduce the dosage of your medication: Do not reduce the dosage of your medication, whether you are thinking "save money" or "it will feel better today." You will get the full benefit only if you take the full dose.
• Get new medicine before it runs out: Don't wait until you run out of medicine, get new medicine strips before you do.
• What to do if you forget to take a dose: If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your next dose at the usual time. Never take two doses at once to make up for a missed dose.
• Tell your doctor about other medications: Tell your doctor about any other medications, vitamins, or Ayurvedic remedies you are taking, as some medications can interact with each other.

A word about "natural" things too

Some people try to lower their cholesterol with "natural" things rather than taking medication. For example, they use a supplement called `red yeast rice`. This actually contains a chemical similar to that found in some `statins`.

But remember, "natural" doesn't mean "safe." Supplements like these aren't tested as rigorously as medications. They can also interact dangerously with other medications you're taking. So, if you're thinking about using something like this, be sure to talk to your doctor about it and only make decisions based on their advice.