When we see that your blood cholesterol level is high in the report, the first thing we think of is controlling our diet and exercising, right? That's actually the first thing to do. Reducing saturated fat, completely eliminating trans fat, reducing sugar, and exercising regularly are very important.
However, sometimes these lifestyle changes alone are not enough to lower your LDL cholesterol levels, which is harmful to your body. That's when your doctor may start you on medication to help.
But remember this well, you should never give up the good habits you started (diet control and exercise) just because you started taking medication. You need to continue both of them together.
Now let's look at the types of medications that doctors prescribe to lower bad cholesterol (LDL), how they work, and what we need to be careful about when using these medications.
What are the statins that almost everyone knows?
Simply put, statins are the first type of medication a doctor prescribes to lower cholesterol. They work by controlling the production of cholesterol by your liver. This reduces the level of bad (LDL) cholesterol in your blood. They also help reduce another type of fat called triglycerides and slightly increase the level of "good" (HDL) cholesterol.
Research has shown that using statin drugs significantly reduces the risk of heart disease and stroke.
| Commonly used statins | Side effects to watch out for |
|---|---|
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| Special note: If you are taking statin medications, avoid grapefruit and grapefruit juice, as they can change how the medication is absorbed and how it works in the body. | |
Medicines that work inside the intestines
These mainly function inside your intestinal system.
Bile Acid Resins
These medications work by binding to a substance called "bile" secreted by the liver (which is also made of cholesterol) and preventing it from being reabsorbed into the blood. This means that they indirectly help reduce the amount of cholesterol in the body.
- Examples: Cholestyramine (Prevalite), Colesevelam (WelChol), Colestipol (Colestid)
- Side effects: The most common are constipation, bloating, and stomach discomfort.
Ezetimibe
This is a different type of medication. Ezetimibe (Zetia) works by directly blocking the absorption of cholesterol from your small intestine into your blood. It is often given in combination with a statin drug. This will make the cholesterol-lowering effect even more effective.
- Side effects: Muscle pain, back pain, stomach pain, and diarrhea may occur.
A new class of drugs called PCSK9 Inhibitors
These are relatively new and expensive medications. They are usually used for people whose cholesterol levels have not been controlled by lifestyle changes and statin therapy. They are especially prescribed for people who have a genetic condition that causes high cholesterol (such as Heterozygous Familial Hypercholesterolemia - HeFH) or who already have heart disease and statins alone are not enough.
These are not pills, but come as an injection under the skin every two weeks. They work by blocking a protein called PCSK9, increasing the body's ability to remove LDL cholesterol from the blood.
- Examples: Alirocumab (Praluent), Evolocumab (Repatha)
- Side effects: Because these are new, little is known about long-term side effects. The only reported side effects are itching, swelling, pain, and bruising at the injection site, as well as symptoms such as a runny nose and fever.
Let's learn a little about other types of medicine.
In addition to the main types of medications mentioned above, there are several other types of medications.
Niacin
This is a type of B vitamin. When given as a medicine in high doses, it can lower LDL cholesterol and raise HDL cholesterol. However, studies have not shown that adding niacin to statins further reduces the risk of heart disease. The main side effects are flushing, itching, numbness, and headaches.
Fibrates
These medications mainly work by reducing the production of a type of fat called triglycerides and increasing good (HDL) cholesterol levels.
- Examples: Fenofibrate, Gemfibrozil (Lopid)
ATP Citrate Lyase (ACL) Inhibitors
Bempedoic acid (Nexletol) is a type of drug that also works by blocking the production of cholesterol by the liver.
Omega-3s
Many people think that taking fish oil supplements from pharmacies can reduce the risk of heart disease. But there is no evidence that taking fish oil supplements, like a regular vitamin, does the same. However, high-dose omega-3s prescribed by a doctor can lower triglyceride levels and reduce the risk of heart disease in people at risk.
Therefore, avoid buying fish oil from the pharmacy on your own without consulting a doctor.
Be sure to keep these things in mind when using cholesterol medication!
Once a medication is prescribed, it is important to use it exactly as prescribed, otherwise you will not get the full benefit from it.
- Know why you are taking this medication: Ask your doctor to understand exactly why you have been prescribed this medication and what it will do.
- Take your medicine at the same time every day: Make it a habit to take your medicine every day. Choose the same time of day for it.
- Don't stop taking your medication even if you feel better: Don't stop taking your medication or change the dosage without asking your doctor. Even if you feel better and there's nothing wrong with you, continue taking your medication.
- Get organized: Use a pillbox with the days of the week marked on it. Fill it up at the beginning of the week and you'll never forget to take your medication.
- Keep a medication calendar: Make a mark on your calendar every time you take your medication. If your doctor makes any changes to your medication, write it down there as well.
- Don't reduce the dose to save money: To get the full benefit of the medicine, you need to take the exact dose. If cost is an issue, don't be shy about talking to your doctor. He or she may be able to offer you a different solution.
- Tell your doctor about other medications: Tell your doctor about any vitamins, herbal remedies, or other medications you're taking, as some can interact with cholesterol medications.
- If you forget to take a dose: Take the dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at the scheduled time. Ask your doctor for clarification on this.
- When traveling: Keep your medications with you. If you're going on a long trip, take at least a week's worth of medication and a copy of your prescription.
- Before surgery: Tell your doctor or dentist about the medications you are taking before undergoing anesthesia or having a tooth extraction.
- Be careful with alcohol: Alcohol can increase the side effects of some medications and reduce their effectiveness. So ask your doctor about alcohol and seek advice.
Take-Home Message
- Even if you start taking medication, don't give up on a healthy diet and exercise. These two need to go together.
- Take the medicine exactly as prescribed by the doctor, at the right time, and in the right dosage.
- Never stop taking medication or change the dosage without consulting your doctor.
- If you experience any new side effects (e.g., body aches, skin changes), inform your doctor immediately.
- Tell your doctor about any other medications, vitamins, or Ayurvedic remedies you are taking, as they may interact with cholesterol medications.
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