Types Of Cholesterol - Ask The Pharmacist

Jun 3, 2014
Express Scripts cardiovascular specialist pharmacists can help answer questions about cholesterol and good cardiovascular health.
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  • High Blood Cholesterol

Understanding atherosclerosis can help save lives. Consider this: Cardiovascular disease is the No. 1 killer in America and atherosclerosis – the hardening and narrowing of arteries – is the most common cause of this disease that increases heart attack and stroke risks.

The biggest controllable risk factor for atherosclerosis is high cholesterol. As blood cholesterol levels rise, so does the risk of coronary heart disease. But not all cholesterol is bad.

Good and Bad Cholesterol

There are two types of cholesterol and the difference is significant. Good cholesterol that decreases heart disease risk is known as HDL, and bad cholesterol that increases heart disease risk is known as LDL.

As a specialist pharmacist in the Express Scripts Cardiovascular Therapeutic Resource Center®, I counsel patients on maintaining healthy cholesterol levels – and if needed – proper medication management.

Here are a few lifestyle changes that can help keep cholesterol levels balanced:

  • Eat healthy: Patients should choose a diet rich in fresh fruits and vegetables, and low in salt, fat and cholesterol. For example, simply eating an apple a day has been found on average to reduce LDL cholesterol by 23%. Apples are rich in the soluble fiber pectin, which blocks cholesterol absorption and encourages the body to use cholesterol rather than store it.
  • Know your fats: Saturated fat, trans fat and dietary cholesterol raise LDL levels. Saturated fats come from animal fats and dairy products, and trans fats are found commonly in baked goods.
  • Eat the right fats: Patients should choose good fats from seeds, nuts, oily fish and olive oil as part of a healthy diet.
  • Lose extra weight: Losing as little as 5% to 10% of body weight can significantly reduce LDL levels.
  • Exercise: Regular physical activity raises HDL levels. Thirty minutes of aerobic activity such as brisk walking or jogging three to five days a week can help one's body produce more HDL.
  • Stop smoking: Cigarette smoking decreases the good HDL cholesterol.

Understand Drug Therapy Options

Lifestyle modifications are primary and must be continued even with drug therapy, but when diet and exercise alone are insufficient, drug therapy may help. Drugs such as niacin are effective in raising HDL levels. Fibrates, bile acid resins and ezetimibe are effective to lower LDL cholesterol levels, but the primary treatment for elevated LDL levels is statins.

Statin Medications

Statins are the only class of drugs that not only lower LDL cholesterol levels, but also are proven to reduce the risk of cardiovascular events. Every 10% decrease in cholesterol reduces the chance of a heart attack and stroke by 15%.

Statins do have side effects. Muscle pain is the most common side effect reported in 5% to 15% of patients. In these cases a lower dose of the same medication, a change to another drug in the class or a change in the frequency of administration can help. If a decision is made to discontinue the statin, the pain should subside within two weeks. If pain persists, it may be caused by unrelated activities such as exercise or gardening, other medical conditions such as arthritis or possibly even low vitamin D levels.

Statins also have been found to increase the chance of developing Type 2 diabetes in some patients. However, studies have not shown a direct cause and effect relationship. Other factors such as weight, family history and ethnicity also may contribute to the risk of developing diabetes. For a vast majority of patients, clinicians agree that the cardiovascular benefits of statins far outweigh the diabetes risk.

Some side effects, such as memory loss, may not be as worrisome as previously thought. While there have been rare reports of reversible memory impairment with statins, large randomized studies have not shown a link between statins and this side effect. In fact, researchers found that long-term statin use may have a protective effect on memory and cognition. 

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