By Ellen Campbell Grizzle - Pharmacy TodayDESPITE THE availability of effective medicines and good nutritional advice, the lowering of cholesterol remains a problem. Experts suggest that many patients with high cholesterol are not making the connection between this condition and its devastating impact on several chronic illnesses such as diabetes and hypertension. High cholesterol levels increase the risk of heart attack or stroke. There is a need for more public education on this subject.
We know that cholesterol, a fatty, waxy substance, is present and used by every cell of the body. Your liver makes about 80 per cent of the cholesterol in your body, the rest is taken in when you eat animal products.
The body coats cholesterol with a protein in order to transport it in the bloodstream. This cholesterol protein package is called lipoprotein. High-density lipoprotein (HDL) is often called good cholesterol because it helps to clean cholesterol from the blood vessels. In contrast, low-density lipoprotein (LDL) is referred to as bad cholesterol. Over time, LDL builds up in the blood vessels and combines with other substances to form plaques leading to blockage resulting in heart attacks and stroke.
The risk of cardiovascular disease increases if there is too much cholesterol. A diet low in fat and rich in phytochemicals, fibre and soy, plus weight loss and other lifestyle changes can bring cholesterol down. However, when this is not enough, there are powerful drugs that rapidly reduce cholesterol or triglycerides (another type of fat or lipid in your blood) levels. By reducing LDL cholesterol or other fats, the risk of plaque formation lessens. Those plaques that already exist are stabilised and this may prevent them from cracking or breaking off to cause obstructions or cause blood clots.
Lipid-lowering drugs primarily include resins, fibrates, niacin and statins. The statins were introduced in the 1980s and are now the most widely used class. Basically, they block a substance that is used in the liver to manufacture cholesterol. This depletes cholesterol in the liver cells and causes cholesterol to be withdrawn from circulating blood and plaques. They also reduce inflammation around the plaques. Along with lifestyle changes, your doctor may prescribe cholesterol-lowering drugs for you. This is usually done after laboratory tests accompanied by assessment of several other risk factors.
Niacin can cause skin flushing, raise blood-sugar levels, aggravate stomach ulcers or trigger a gout attack. The fibrates can lead to gallstones. Statins are well tolerated and have few serious side effects when taken as directed.
NO GRAPEFRUIT JUICE
Some persons temporarily experience nausea, constipation or diarrhoea. However, here are two important cautions:-
1) If you experience muscle pain while taking a statin, particularly in combination with antifungal medications or the popular antibiotic erythromycin, contact your doctor immediately.
2) Do not eat any grapefruit or grapefruit juice while taking statins. Grapefruit juice interacts with statins causing the blood levels of the medication to rise.
The decision to use cholesterol lowering medication is a serious one and may mean life-long treatment. The choice of therapy will be guided by your age, how much good or bad cholesterol you have and whether other lipids in the blood are high. Sometimes, a combination of lipid-lowering drugs may be selected. The bottom line is that, with optimum dosage regimens and monitoring, these drugs work to reduce the health risks associated with cardiovascular diseases. If you want to know more about how cholesterol lowering drugs work, ask your pharmacist, you have the right to know.
READERS' FEEDBACK
A reader from the USA asked about the registration of Omega 3 for use in Jamaica. Omega 3, containing fish oils, is registered and used in Jamaica, often in combination with dietary and other methods, for the regulation of lipids and general dietary supplementation. Sometimes, there is a difference in brand name and contents between countries so we would want to know the contents of the product to which the reader is referring.
Ellen Campbell-Grizzle, President of the Caribbean Association of Pharmacists (CAP) and Director, Information & Research, National Council on Drug Abuse (NCDA).
