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Lowering Cholesterol When Diet and Exercise Aren't Enough

What do you do when your diet and exercise aren't enough to lower your cholesterol? Statin drugs (Atorvastatin-Lipitor, Pravastatin-Pravachol, Simvistatin-Zocor, Fluvastatin- Lescol XL, Lovastatin-Mevacor and Rosuvastatin-Crestor) are considered the first options for lowering cholesterol. That's because they have a proven track record of reducing heart attacks and blows and extending life. You can no longer watch the nightly news without watching the commercial of this drug. Statins work by inhibiting the HMG CoA reductase enzyme needed to produce bad cholesterol. This blockbuster drug is the most commonly used drug to treat high (bad) LDL cholesterol. However, LDL cholesterol levels are not always a problem in insulin resistance. Insulin resistance causes the quality of LDL to turn into a small type of dense substance. Statins have little effect on lowering triglycerides and increasing HDL cholesterol levels. Statins help improve the quality of LDL from harmful, small dense to less harmful types. Statins have "antioxidant" properties that reduce inflammation and blood clots. Statins dramatically reduce the risk of cardiovascular disease and even reverse it. This is why statins are prescribed more and more commonly and higher than ever.

The most common side effects are muscle problems that can spread from mild to severe and can result in severe muscle damage. Any pain or muscle weakness should be reported to your doctor. A test called CPK or CK can be done to determine if the drug is causing muscle damage. Because statins have incredible health benefits, most doctors now recommend that you continue to take them if they only cause mild muscle pain. Liver inflammation is a rare side effect. Your doctor should periodically monitor liver tests.

Also known as "fibric acid derivative" or "fibril," it is effective in lowering cholesterol. Fibrates are the perfect choice for overweight people as they lower triglycerides and LDL cholesterol while increasing HDL cholesterol. Side effects are not uncommon, but muscle or liver problems can occur.

Also known as nicotinic acid or vitamin B3, Niacin, in high doses simultaneously treats multiple lipid disorders by lowering triglycerides and LDL cholesterol while increasing HDL cholesterol. Niacin is sometimes found as an over-the-counter supplement, but it is extremely difficult to take as the dose needed (usually 1000-2000 mg per day) almost always causes a side effect or reduced skin or redness. To reduce side effects begin with low doses and gradually increase the dose for several months. Drying can also be reduced by taking aspirin and drinking a full glass of water an hour before taking niacin. The formulation of niacin slow release prescriptions known as Niaspan is easier to obtain due to its lesser side effects, but there is still a great deal of scrubbing with this product.

One concern with niacin is that it can exacerbate insulin and may increase blood sugar levels. For most people, the benefits outweigh the risks and niacin can benefit the entire health and wellness plan. Although niacin is available without a prescription, it can only be taken under medical supervision.

Lovaza is an approved formulation of omega 3 fatty acids approved for the treatment of high levels of triglycerides. This substance, found naturally in cold water fish, also improves insulin resistance. Prescription formulation is better than counter preparation because it is stronger and more pure.

Acidic acidquestion or "bile acid resin," lowering LDL cholesterol by pulling it out of the digestive juices, allows it to pass through the stool. Bile acid resins can increase triglyceride levels. The most common side effect is constipation. Proper fiber supplementation and hydration helps.

Ezetimibe lowers LDL cholesterol by blocking the absorption of cholesterol from the intestines. Ezetimibe does not do much triglyceride or HDL cholesterol. Side effects are rare but may have stomach aches or diarrhea. Do you remember this ad for Vytorin, which is a drug that treats high cholesterol? The ad featured an interesting character paired with food plates of the same color and design as an ensemble cast. The benefit, the ad explained, is to treat cholesterol by treating genetics and food. The drug makers claim that two drugs are better than one. An important study called ENHANCE, which questions the benefits of ezetimibe, one of the components of Vytorin, is a big surprise to doctors and patients. In this study, the combination of ezetimibe and simvastatin (sold as Vytorin) was compared with simvastatin alone. It turns out that cholesterol formation in the arteries does not differ between the two treatments, although the combination drug is stronger in lowering cholesterol. Researchers are trying to understand this decision and what they mean. We do not know if ezetimibe actually reduces heart attacks or saves lives. On the other hand, simvastatin and other statin drugs are well proven.

A 2008 ezetimibe study published in the New England Journal of Medicine suggests that it may increase the risk for many types of cancer including prostate, colon, and skin cancer. Cancer death is more common in patients taking ezetimibe. We do not know whether the cancer is actually developing ezetemibe or something else. One theory is that ezetemibe increases the risk because it not only inhibits cholesterol absorption but also inhibits the absorption of other cancer prevention substances.

Most experts including the American College of Cardiology recommend that statin drugs be the best first approach to fight cholesterol and use other drugs such as niacin, fibrates, colesevelam, cholestyramine and omega-3 fatty acids as the next line of defense. Ezetimibe should be reserved as a last resort.

The point is that most experts recommend using tried and true drugs to lower cholesterol. Drugs that are not proven are just ... not proven.


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