Preventing Heart Disease by Reducing Cholesterol

by Food and Drug Administration (FDA)

(Page 3 of 3)

Statins, including Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin), are used in addition to dietary therapy to reduce elevated total and LDL cholesterol. Side effects are generally minimal, but may include constipation, abdominal pain, nausea, and bloating. The NCEP report notes that because they have not been proven safe over the long term, they may not be appropriate for younger people, who might take the medication for many years.

Fibric acids such as Lopid (gemfibrozil) are approved for use in addition to diet in patients who have low HDL levels and high LDL and high triglycerides in whom diet and other drugs (bile acid sequestrants, niacin) have proven ineffective. They may also be used in patients with very high triglyceride levels (more than 2,000 mg/dL) who are at high risk for pancreatitis. Side effects may include abdominal pain and upset, abnormal liver function, and possible increased risk of gallbladder problems.

Lorelco (probucol) may be used to reduce cholesterol in patients with high LDL levels who have not responded to diet and weight reduction. However, the drug's LDL-lowering effect is modest and its long-term safety is limited. A range of adverse reactions — including gastrointestinal distress, heart problems, dizziness, fainting, headache, blood problems, rashes, vision disorders, and impotence — have been associated with its use.

When considering whether to recommend estrogen replacement therapy for a postmenopausal woman, some doctors take into account whether she is at high risk for CHD. At present, estrogen is not approved by FDA for CHD risk reduction. Approved uses include treatment of some menopausal symptoms and prevention of osteoporosis. However, doctors may use an approved drug for unlabeled uses if they judge that the patient may benefit from it. Studies assessing the value of estrogen in lowering CHD risk are ongoing.

Side effects of estrogen therapy may include abnormal vaginal bleeding, leg or chest pains, sudden shortness of breath, headaches, nausea, dizziness, vision changes, breast lumps, and depression. There is some evidence that estrogen use may increase the risk for endometrial and uterine cancer, as well as gallbladder disease.

A doctor's decision about which drug to prescribe will be based primarily on an assessment of a patient's risk factors and the potential side effects of the drugs. Physicians measure patients' LDL levels four to six weeks after starting drug therapy, and again at three months to see whether the therapy is effective.

Patients should report side effects of any medication to their doctors. William Cole, M.D., director of Heartsavers Program, New York Downtown Hospital in New York City, cautions patients never to try to adjust dosages on their own or to self-medicate with a different drug. He adds that drug therapy should be regarded as a "lifetime commitment." Generally, if medication is stopped, cholesterol returns to higher levels. Although dosages may be reduced in some instances after improvement, it is unlikely that drug therapy can be stopped completely.

Roma Krause of FDA's Health Fraud Staff in the Center for Drug Evaluation and Research notes that some "unscrupulous marketers" have taken advantage of the public's concern about high cholesterol to promote various products to treat or prevent high cholesterol levels. Unless these products are approved for this purpose, such promotion may be considered fraud.

Consumers concerned about their cholesterol levels are best advised to eat a balanced diet low in saturated fats and cholesterol and to eliminate lifestyle CHD risk factors such as smoking and lack of exercise.

Before any other treatment is undertaken, a doctor should be consulted and blood cholesterol levels should be determined by laboratory tests.

Treatment Talk

Here are some terms doctors often use when discussing cholesterol, heart disease, and dietary and drug therapy.

Atherosclerosis: A thickening of the walls of arteries, causing narrowing of the vessels and impaired blood flow.

CHD (coronary heart disease): A broad term used to describe damage to or malfunction of the heart caused by narrowing or blockage of the coronary arteries, which supply blood to the heart muscle.

Cholesterol: A type of fat, or lipid, produced in the body by the liver and also absorbed directly from cholesterol-rich foods such as eggs and whole milk dairy products. Cholesterol is transported in blood in the form of lipoproteins.

HDL: High-density lipoprotein, or "good" cholesterol; a high HDL level helps protect against heart disease. Hydrogenated fat: A type of fat added during processing to such products as crackers, cookies, and peanut butter. Hydrogenated fat, like saturated fat, may promote the development of atherosclerosis.

LDL: Low-density lipoprotein, or "bad" cholesterol, is a risk factor for CHD and a primary target of cholesterol-lowering therapy.

Lipoprotein: The form in which cholesterol is transported in blood.

Saturated fat: A type of fat primarily found in foods of animal origin (meat, fish, poultry, dairy), but also in some vegetable oils, such as coconut. Too much saturated fat in the diet may promote the development of atherosclerosis.

Triglycerides: A type of fat that, like cholesterol, is transported in the body in the form of lipoproteins. Their role in the development of heart disease is unclear.

Unsaturated fat: A type of fat found in foods that does not appear to be linked to the development of atherosclerosis.

Preventing Heart Disease by Reducing Cholesterol

A Step-By-Step Guide

If you are an adult without CHD, you can expect your doctor to measure your total blood cholesterol and HDL cholesterol at least once every five years, and to assess other risk factors for CHD during regular visits. Depending on the findings, you may be counseled on ways of reducing CHD risks, including dietary changes. If you have high blood cholesterol, additional tests will be taken.

About the Author

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