Hyperlipidemia - drug treatment

Your body needs cholesterol to work properly. But cholesterol levels that are too high can be life threatening.

Extra cholesterol in your blood causes deposits to build up on the inside walls of your heart’s arteries (blood vessels). This buildup is called plaque. It narrows your arteries and reduces, or even stops, the blood flow. This can lead to a heart attack, stroke, or other serious heart or blood vessel disease.

Total cholesterol is the amount of all of the fats in your blood. These fats are called lipids. There are different types of lipid that make up your total cholesterol. The two most important types are:

• LDL -"bad" cholesterol
• HDL -"good" cholesterol
  

High cholesterol, especially "bad" cholesterol (LDL), can clog your arteries. This may reduce blood flow to your heart. It can lead to heart disease, stroke, or heart attack. Cholesterol is measured in milligrams per deciliter (mg/dL).

If you have heart disease or diabetes, your LDL cholesterol should stay below 100 mg/dL.

If you are at risk for heart disease, your LDL cholesterol should be lower than 130 mg/dL.

Almost everyone else can benefit from LDL cholesterol that is lower than 160 - 190 mg/dL.

You want your HDL "good" cholesterol to be high.

For men, HDL should be above 40 mg/dL. For women, it should be above 50 mg/dL. Exercise helps raise your HDL level.

Your doctor may want you to take medicine for your cholesterol. This will depend on your age. Your doctor may also suggest cholesterol medicine if you smoke, are overweight, or have high blood pressure or diabetes.

Most of the time you will need to take this medicine for the rest of your life. Changing your lifestyle and lowering you weight may allow you to stop taking this medicine in some cases. But you will need to keep in mind that you have a cholesterol problem.

Make sure you know the best way to take your type of cholesterol medicine.

• Some medicines work best when you take them at bedtime. For others, the time of day does not matter.
  
• You should take some of these medicines with food.
  
• You should take your medicine at the same time every day. This makes it easier to remember to take it. It also makes you less likely to confuse different pills you may be taking.

Remember to take your medicine as directed. Things that could help are:

• Using a special pill box labeled with the time of day.
  
• Setting alarms
• Putting a reminder note in a place you are sure to see it.

Make sure you tell your doctor about all other medicines you are taking. This includes vitamins and herbal treatments. They may change the way your cholesterol drug works. Ask your doctor if you should avoid any foods or drinks.

Understand the side effects of your medicine. If you have any side effects, call your doctor.

Ask your doctor what you should do if you miss a dose of medicine. Keep all appointments with your doctor. Regular blood tests will tell your doctor how the drug is working. Plan ahead for refills and travel so that you do not run out.

Keep these and all other medicines stored in a cool, dry place where children cannot get to them.

There are several kinds of drugs to help lower blood lipid levels. They work in different ways. Some help lower LDL (bad) cholesterol. Some help lower another fat in your blood called triglycerides. Others help raise HDL (good) cholesterol.

Your doctor will prescribe the best medicine for you. Sometimes you may need to take more than one cholesterol-lowering drug. Three of these drug types are:

• Statins
• Resins
• Fibrates
  

When your doctor prescribes medicine to lower your cholesterol, ask:

• How much should I take?
• How often should I take it?
• What time of day should I take it?
• How should I take it? (With food, with water?)
• What other drugs cannot be taken at the same time?
• What are the possible side effects?
• How often should I get my blood retested?
• Should I also be taking aspirin?
• Should I be taking any special vitamins or using fish oil or other over-the-counter remedies?
• Should I avoid certain foods when I am taking this medicine?

Call your doctor if you:

• Have muscle or tendon aches or weakness
• Have stomach pain, cramps, or gas
• Feel sick to your stomach, or you are vomiting
• Have headaches
• Have diarrhea
• Feel more tired than usual
• Feel dizzy
• Have flushing (your skin is warm and turning red)
• Are unable to sleep

American Heart Association. Drug therapy for cholesterol. 2012 Jun 14. Accessed February 21, 2011. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp (accessed February 10, 2013).

Semenkovich CF. Disorders of lipid metabolism. Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia,Pa: Saunders Elsevier; 2011:chap 213.