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If during the next examination in a blood test (lipidogram) an increased level of total or only “bad” cholesterol is detected, it is necessary to discuss this situation with a doctor. Although this is not yet a heart attack or stroke, the state of hypercholesterolemia (elevated plasma cholesterol levels) is an alarming sign. We need to think about reducing and normalizing indicators.
For some people, only lifestyle changes, such as adjusting their own diet and increasing the amount of exercise, will be effective. They can prevent or reduce unhealthy cholesterol levels. For other people who already have extremely high cholesterol levels, medications may also be needed (along with everything else).
Talk to your doctor to develop a treatment plan that’s right for you. If medication is required, be sure to take all of them as prescribed by a specialist. The potential benefits to your health are well worth making these medications part of your daily routine.
In order to normalize the level of cholesterol in the blood plasma, various drugs are used today.
Statins. They are recommended for most patients. They are the only cholesterol-lowering drug class that has been directly associated with a reduced risk of heart attack (heart attack) or stroke. If statins do not help you enough or you develop side effects, your doctor may recommend other medications with a different spectrum of action.
PCSK9 inhibitors. These new drugs bind and inactivate a protein in the liver to lower the concentration of LDL (aka bad cholesterol). They can be taken in combination with statins.
Selective cholesterol absorption inhibitors. This relatively new class of cholesterol-lowering drugs helps prevent absorption of cholesterol within the intestinal lumen. Selective cholesterol absorption inhibitors are most effective at lowering LDL cholesterol. The drugs can additionally have a modest effect on lowering the concentration of triglycerides (another bad fat in the blood) and increasing the amount of the “good” fraction of cholesterol. They are indicated for the treatment of high cholesterol, plus some hereditary lipid disorders.
resins. This class of LDL-lowering drugs may have an alternative name, so-called bile acid sequestrants or bile acid binders. They act in the intestines to increase the excretion of cholesterol. Your body uses cholesterol to make bile, a fluid used in the digestive process. These medicines bind to bile, so they cannot be taken with food. Your liver responds to the decrease in bile levels by producing more bile. The more bile your liver produces, the more cholesterol it uses. This means that less cholesterol remains circulating in the blood.
Fibrates (drugs that are derivatives of fibric acid). They are best at lowering triglyceride levels, plus in some cases adjusting the concentration of good cholesterol. However, they do not affect the level of bad cholesterol very actively.
niacin (it is also vitamin PP or B3, the chemical name is nicotinic acid). This drug works in the liver, affecting the production of fats. Side effects of niacin may include redness, itching, and upset stomach. Your liver functions must be carefully monitored because niacin can cause toxicity. It is used with caution in diabetic patients because it can increase blood sugar levels.
Omega-3 ethyl esters. These medicines are derived from fish oil and then chemically modified and purified. They are used in tandem with dietary changes to help people with very high triglyceride levels (greater than 500 mg/dL) lower their levels. The drugs can cause serious side effects, plus they can interact negatively with other medications, herbal preparations, and nutritional supplements. People with allergies or sensitivities to fish or shellfish may have serious adverse reactions to these medicines. The same precautions apply to people with sensitivity to certain components of the drug.
Fish oil with omega-3 polyunsaturated fatty acids (PUFAs). They are commonly referred to as omega-3 fish oils and are used in high doses to lower plasma triglyceride concentrations. They help reduce the secretion of triglycerides and make them easier to digest. The amount of marine fish-derived omega-3 PUFAs needed to significantly lower triglycerides (2 to 4 grams) is difficult to obtain from a daily diet alone, so capsules may be required.
These supplements should only be taken under the guidance of a physician because large doses can cause serious side effects. These may include increased bleeding, hemorrhagic stroke, and reduced blood sugar control in diabetics. Negative interactions with other drugs, herbal preparations and nutritional supplements are also possible.
Top 5 rating according to KP
The most basic drugs that are used in our country to reduce bad cholesterol are statins and some other groups. Therefore, we will discuss the best cholesterol-lowering pills from this group.
1. Atoris
The drug is available in the form of tablets, sold by prescription. The main active ingredient is atorvastatin. Refers to the drugs of the 3rd generation, effectively helps to reduce the level of plasma cholesterol during a course of admission. It is used for complex and severe forms of hypercholesterolemia, when a mixed type of pathology is detected, with a hereditary predisposition to high cholesterol.
Indications for admission:
- hereditary hypercholesterolemia;
- pathology of the cardiovascular system;
- high risk of coronary artery disease and myocardial infarction.
The drug is well tolerated by many patients, but is not without side effects. These include the appearance of periodic pain in the joints, digestive disorders, constipation, pain in the lining. There may be signs of myositis – muscle soreness, increased blood sugar and liver problems. If any serious side effects occur, the drug is canceled and other classes are used.
The drug is contraindicated during pregnancy and lactation, with severe damage to the kidneys and liver. The drug is incompatible with grapefruit juice and the fruit itself.
2. Roxera
The drug is available only in tablets, sold strictly by prescription, the main active ingredient is rosuvastatin. This is the 4th generation drug, the most modern, with maximum effects and minimal side effects. It helps to reduce bad cholesterol against the background of an increase in good cholesterol, stimulates the cleansing of blood vessels from fatty deposits, and prevents the formation of cholesterol plaques inside the vessels.
Shown:
- for the prevention of atherosclerotic lesions against the background of unfavorable heredity;
- for the treatment of existing atherosclerosis and its complications.
The drug has several undoubted advantages compared to previous generations – it fights atherosclerosis and suppresses inflammation in the vessels, as an additional risk factor.
Take with caution for liver problems, in minimal doses. The drug is prohibited during pregnancy and lactation, incompatible with alcohol and any kind of antibiotics.
3. Lyvazo
The drug is available in tablets, sold by prescription. The main active ingredient is pitavastatin, a 4th generation drug. It has similar effects as rosuvastatin. This is the most suitable drug for people with diabetes. It does not affect the metabolism of glucose and does not increase its amount in plasma.
It is important to select the dose very strictly, it has a high activity, it can seriously reduce the level of lipids in the blood plasma.
4. Ezetrol
The drug is available in tablets, sold by prescription. The main active ingredient is ezetimibe. Belongs to the category of drugs that selectively prevent the absorption of cholesterol. These are cholesterol-lowering pills of a new class, they do not increase the secretion of bile acids and do not suppress the synthesis of cholesterol in the liver. The main action is a reduced flow of bile acids from the intestines to the liver. This leads to a decrease in cholesterol reserves and its increased removal from the blood for the needs of the body. The drug is especially effective in combination with statins. It is indicated for diabetes mellitus and related metabolic disorders of fats, for various forms of high cholesterol.
Side effects include allergic reactions, diarrhea and changes in the blood picture.
Contraindicated when taking fibrates, against the background of antibiotic treatment, during pregnancy and lactation, against the background of severe liver damage.
5. Ineji
The drug is available in tablets, sold by prescription. Belongs to a new class of drugs – a combination of statins with cholesterol absorption inhibitors – ezetimibe and simvastatin. Due to the combined action, the drug effectively lowers the concentration of bad cholesterol.
Indications:
- prevention of cardiovascular pathologies;
- IHD;
- stroke or heart attack, to prevent recurrence;
- severe hyperlipidemia resistant to other drugs and therapy;
- hereditary hypercholesterolemia.
The tool has a group of contraindications, among which it is necessary to highlight the allergy to components, liver problems, pregnancy and lactation, age up to 18 years, lactase deficiency. During therapy, there may be some side effects – joint pain, nausea, dizziness, depression, memory lapses.
How to choose pills that lower cholesterol
The drug recommendations suggest that people should talk to their doctor first about the risks and benefits of statin and other drug classes. This is especially important for:
- adults with a history of known cardiovascular disease, including stroke caused by atherosclerosis;
- patients with LDL levels above 190 mg / dl;
- adults 40 – 75 years old with diabetes mellitus;
- adults 40 to 75 years old, with LDL levels of 70 to 189 mg/dl and a high risk of developing cardiovascular disease due to atherosclerosis.
Some people who do not fall into these categories may also benefit from statin therapy.
It is important to discuss all medications you are taking with your doctor and understand their positive and possible side effects. Never stop taking your medication or change the dosage (or frequency of use) without first talking to your doctor.
Popular questions and answers
We asked questions about the choice of drugs for lowering blood cholesterol levels and treating atherosclerosis pharmacist, teacher of pharmacology, editor-in-chief of MedCorr Olga Zorina.
● unhealthy diet – in particular, eating a lot of saturated fats;
● smoking – a chemical called acrolin found in cigarettes stops the transfer of HDL cholesterol from body fat to the liver, causing narrowing of the arteries (atherosclerosis);
● diabetes or high blood pressure (hypertension);
● family history of stroke or heart disease.
There is also an inherited condition called familial hypercholesterolemia. This can cause high cholesterol even in those who eat healthy foods.
The need for statins depends on cholesterol levels and other risk factors for cardiovascular disease. Your doctor will consider all risk factors for heart attacks and strokes before prescribing statins. The first is the level of cholesterol and triglycerides.
In addition to cholesterol, other risk factors for heart disease and stroke are:
● tobacco use;
● lack of exercise;
● high blood pressure;
● diabetes;
● being overweight or obese;
● narrowed arteries in the neck, arms, or legs (peripheral artery disease);
● family history of cardiovascular disease, especially if it was before age 55 in male relatives or before age 65 in female relatives;
● old age.
To reduce risk:
● quit smoking and avoid passive smoking;
● Eat a healthy diet rich in vegetables, fruits, fish and whole grains and low in saturated fats, trans fats, refined carbohydrates and salt;
● be physically active as often as possible, sit less;
● maintain a healthy weight.
If your cholesterol—especially the LDL (“bad”) type—remains high after making healthy lifestyle changes, your medication needs to be addressed.