Medical Questions Answered » Cholesterol

Why should I be on a statin drug if my cholesterol is normal?

admin — Thu, 20 Jan 2011 07:04:00 +0000

A very important research study called the Heart Protection Study (HPS), published in the medical journal The Lancet in 2002, followed almost four thousand people who had diabetes but did not have heart disease, as far as they knew. Many of them even had normal cholesterol levels. Those who took 40 mg of simvastatin every day had 30 percent fewer heart attacks during the next five years compared to a matched control group who took a placebo (sometimes called a “sugar” pill or “dummy” pill), even when their cholesterol started out normal and didn’t go down that much.

This remarkable result suggests that statin drugs may do more than just lower cholesterol. They may have other effects, such as reducing the inflammation inside your blood vessels. It also means
that anyone with diabetes who is over the age of forty should consider starting a statin drug. Some people go as far as to suggest
that anyone with diabetes at any age should take a statin, but I disagree with that. The benefit of any drug depends on what your
overall risk is. If a twenty-year-old athlete with great cholesterol numbers and no family history of heart disease suddenly develops
type 1 diabetes, his or her future risk of getting heart disease is still
incredibly small. We have no evidence that starting such a person on
a statin would be beneficial. Your risk for heart disease changes over
time, so it is a good idea to discuss with your doctor what your risk
is and whether a statin or other drug would be a good thing for you to take.

What drugs can lower your cholesterol?

admin — Thu, 20 Jan 2011 07:02:00 +0000

There are several different types (or classes) of drugs that help lower cholesterol. The most important, by far, are the statins. These drugs have revolutionized the treatment of atherosclerosis (the disease that promotes fat deposits building up inside your blood vessels) and have saved many thousands of lives around the world. There are several available, including lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and atorvastatin (Lipitor). They vary in price (both lovastatin and simvastatin are now generic, which makes them cheaper) and in how powerful they are at bringing your cholesterol down, but the beneficial effects apply to all of them.

The statins are particularly good at bringing down LDL cholesterol. Side effects are remarkably rare. Less than one person in a thousand gets some inflammation of the liver that is bad enough that the drug needs to be stopped. Another side effect is aching muscles.

This is usually mild and gets better over time, but occasionally, it can be severe and require that the drug is stopped. It usually takes six weeks after starting a statin (or changing the dose) to see the full effects. So if you are started on one of these drugs, you should expect to be asked to come in for a blood test about six weeks afterward to check how much lower your LDL cholesterol is. A blood test to look for inflammation of the liver may also be done at this time.

There are other drugs that can reduce the amount of cholesterol that you absorb from your intestines. These include cholestyramine (Questran) and ezitimibe (Zetia). You may find cholestyramine less pleasant to take than most drugs since it comes as a gritty powder that you mix with water or juice so that it feels as though you are drinking sand. Most people who take cholestyramine need to take several grams of it a day. However, it is a very safe drug and has been shown in well-designed research studies to lower cholesterol and decrease heart attacks and deaths. Ezitimibe is easier to take but is a newer drug, and so we have no results from research studies telling us whether or not it actually decreases your future risk of heart attacks or stroke or death.
High doses of the B vitamin nicotinic acid can also lower LDL cholesterol and raise HDL cholesterol slightly. The side effects of nicotinic acid include flushing of the skin that some people find very unpleasant. It can also make you more resistant to insulin, and so the drug or insulin treatment that you are taking to control your blood glucose may need to be changed when you take nicotinic acid.
Various natural treatments, including fish oil, can lower your cholesterol and reduce your risk of heart disease. You should talk to your doctor about which ones of all these options might be best for you.

Can you lower your cholesterol with lifestyle changes?

admin — Thu, 20 Jan 2011 02:29:00 +0000

Improving your diet (by eating less fat overall, especially less animal
fat, and increasing the amount of high fiber carbohydrate) can certainly lower your cholesterol level to some extent. If you have been eating a very high-fat diet, then changing to a healthier diet will have a big effect on lowering your cholesterol. Doing thirty minutes or more of moderate exercise every day will help bring down your LDL and increase your HDL. However, no matter how much you exercise or how much you improve your diet, those things may not be enough to bring your cholesterol down to normal levels if you have inherited the genes that make your body produce too much cholesterol. For that, you will need to take cholesterol-lowering drugs as well.

What is a normal blood pressure for someone with diabetes?

admin — Wed, 19 Jan 2011 07:12:00 +0000

You will hear two numbers when someone tells you your blood pressure.The first number is the systolic blood pressure. This is the pressure inside your arteries when your heart contracts to pump out
blood. The second number is the diastolic blood pressure, the lower
number that tells us the pressure inside your arteries when the heart
muscle relaxes before it beats again with a new contraction. Both systolic and diastolic pressure need to stay within a healthy range to
reduce your risk of heart attacks, strokes, kidney damage, and a number of other problems. Because people with diabetes are at higher risk for these things than people who don’t have diabetes, the
target blood pressure is lower.
Blood pressure levels are measured in old fashioned units that tell
how tall a column of liquid mercury can be held up. Some blood
pressure machines still use a thin glass column of mercury for measuring blood pressure, but most modern machines don’t. It is ideal if you can keep the systolic blood pressure below 130 mmHg (or millimeters of mercury) and the diastolic blood pressure below 80
mmHg. Some people find it easier to control their blood pressure
with a combination of changing their diet, exercising more, and taking one or more pills. Even if you can’t get your blood pressure below 130/80, the closer to that level you keep it, the better.

When should a high triglyceride level be treated?

admin — Wed, 19 Jan 2011 07:11:00 +0000

A high triglyceride level increases your risk for heart disease even
when your cholesterol is normal, so it is called an “independent risk
factor” for heart disease. If your HDL and LDL cholesterol levels
are normal but your triglycerides are above 150 mg/dL (1.7
mmol/L), then your doctor may advise you to take treatment to
get it below 150 mg/dL to lower your risk of heart disease. In addition
to increasing your risk of heart disease, when the triglyceride
levels get very high (over 500 mg/dL, or 5.6 mmol/L), it can cause
pancreatitis (inflammation of the pancreas), which can cause
severe pains in your abdomen and is a very dangerous condition
that usually requires emergency admission to a hospital for treatment.
The most common drugs to treat high triglyceride levels are
gemfibrozil and fenofibrate.

Incoming search terms:

triglyceride levels mmol
when to treat high triglycerides

What is a normal cholesterol level?

admin — Tue, 18 Jan 2011 22:25:00 +0000

The answer to this question keeps changing. An international group
of experts meets every few years to re-examine the scientific
evidence and come up with recommended levels for different
people. The ideal or “normal” level for you depends on how high
your risk is for having heart attacks and strokes in the future.
Diabetes is one factor that puts you at higher risk. If you smoke or
have high blood pressure or if a close relative had heart disease at an early age, then those factors also increase your risk. For people with diabetes, it is ideal if you can keep your total cholesterol less than 200 mg/dL (5.9 mmol/L), your LDL cholesterol below 100 mg/dL
(2.6 mmol/L), and your HDL cholesterol above 60 mg/dL (1.6 mmol/L). Even if you can’t get to these ideal levels, the lower you can get the LDL and the higher you can get your HDL, the better.

Where does cholesterol come from?

admin — Tue, 18 Jan 2011 22:24:00 +0000

You can eat cholesterol in your diet. There is a lot of cholesterol in egg yolks and animal fat, for example, so eating a diet high in animal
fat can increase your cholesterol level. But most of the cholesterol in
your blood you make yourself in the liver and in your bloodstream. How much cholesterol you have in your blood overall and what proportion is HDL and LDL depends a lot on the genes you inherited
from your parents. There are certain things you can do to change those proportions, too. Regular exercise will increase the “good”
HDL cholesterol, for example.

Why is cholesterol bad for you?

admin — Tue, 18 Jan 2011 22:21:00 +0000

There is so much talk on television and other media about drugs to lower cholesterol these days that you might imagine cholesterol is poisonous and that any amount of it in your body or in your blood is bad for you. That is not true. Cholesterol is an important substance in your body. You need cholesterol to help build healthy cell walls. Cholesterol is also a building block for many important hormones in your body. The problem is that there are different kinds of cholesterol, and too much of the bad kind can certainly increase your risk of getting fatty deposits stuck in the lining of your arteries. That can lead to blockage of your arteries, which causes heart attacks, strokes, and many other problems.
The simplest distinction that you will hear is that HDL cholesterol (which stands for high-density lipoprotein cholesterol) is the “good” cholesterol whereas LDL cholesterol (which stands for low density
lipoprotein cholesterol) is the “bad” cholesterol. HDL travels around in your blood vessels cleaning them out, whereas LDL travels around in your blood vessels encouraging fat to be deposited in their lining to block them up. Although that is a bit of an oversimplification, it is not a bad way to think about it. The higher your HDL cholesterol and the lower your LDL cholesterol levels are the less likely you are to have heart attacks and strokes.