By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TRY LIFESTYLE CHANGES FIRST, THEN DRUGS, TO IMPROVE CHOLESTEROL

Question: My cholesterol is around 225, and my doctor wants to start me on medication for it. I have heard things about “statins” that make me leery about using them. I have heard they can damage your muscles. Is there anything else I can do for my cholesterol?

Answer: Cholesterol is an important compound in the body. It is used to build the walls of cells, make hormones and is a precursor to Vitamin D synthesis. That’s the “good side” of cholesterol. The downside is that too much cholesterol can coat and eventually clog your arteries. This, in turn, increases your risk of heart attack, stroke or poor leg circulation.

There are three different measures of cholesterol that together form your “cholesterol profile.” The 225 figure you mention is for total cholesterol. Two subtypes are known as high density lipoprotein, HDL, and low density lipoprotein, or LDL. HDL has been called “good cholesterol” because it tends to carry cholesterol away from the arteries, preventing build-up in them. On the other hand, LDL has been called “bad cholesterol” since at high levels it can cause build-up in the arteries. To help determine your personal risk for a heart attack or stroke or other “cardiovascular event,” I suggest you discuss your cholesterol profile with doctor.

According to the American Heart Association, a total cholesterol level of under 200 mg/dl is desirable, a level between 200 and 200-239 is borderline/high risk, and 240 and above is high risk. In terms of HDL, the higher the number the better. Men with less than 40 and women with less than 50 are at a higher risk for heart disease. LDL is the opposite -- lower numbers are better. Less than 100 is optimal, with anything above 160 considered high.

Before starting on cholesterol medication, many patients are advised to make some lifestyle changes such as weight loss, increased exercise and improving their diet to include more fish, fruits, vegetables and fiber. If these measures do not make enough difference in the cholesterol levels, then many physicians recommend medications.

Basically there are several categories of cholesterol lowering medication. These include the statins, and the bile acid sequestrants (resins), Vitamin B3 (niacin), fibrates, and cholesterol absorption inhibitors.

Statins are a very commonly used and are usually well tolerated. They are quite effective is lowering total cholesterol and LDL, as well as in raising HDL. There can be side effects from this medicine, with the most common being constipation, abdominal pain and cramps. They also can cause low vitamin D levels. More serious side effects include the muscle problems that you mentioned, as well as liver toxicity, kidney toxicity and pancreatitis.

The resins have very few serious side effects, but can cause intestinal gas and upset stomach. Niacin is very effective as a cholesterol reducer as are the cholesterol absorption inhibitors. The fibrates are very effective as well.

If diet modification and other lifestyle changes have not improved your cholesterol profile, medication might be the next logical step. Talk to your physician about the various options. The two of you can decide which medication is best for you and if its benefit outweighs its risk.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.