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The Answer Doc by Dr. Chistopher Munger

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Posted: August 11, 2007 4:48 p.m.
Updated: August 26, 2007 5:00 a.m.
    I have recently noticed that I am frequently being asked about cholesterol medication.  Which ones work the best?  Why are they prescribed? Why is more than one medication being prescribed for bad cholesterol?
    Unfortunately, there are no simple answers to these questions.  As modern medicine begins to understand more about cholesterol and triglycerides and the role they play in heart disease, the more complicated the treatment of abnormal cholesterol and triglycerides levels has become.
    Let’s break down the different types of cholesterol and triglycerides, why they are treated and what medications are used to treat abnormal levels.

     LDL: Low density lipoprotein. This is also known as bad cholesterol.  Elevated LDL levels have been directly linked to increased risk of heart disease. Depending on your risk factors, your doctor may want your LDL number to be anywhere from 70-130. You may be prescribed these medicines for elevated LDL:
     1. Statins:  These are the most common cholesterol medications prescribed. They are the most effective drugs for reducing bad cholesterol. They work by reducing the production of LDL in the liver.  They can reduce LDL levels by 20-55 percent.  They may also slightly improve HDL and slightly decrease triglyceride levels. Common brand names for these drugs include:  Zocor, Lipitor, Pravachol and Crestor.
     2. Ezetimibe:  Also know as Zetia and found in Vytorin. This drug blocks intestinal absorption of cholesterol.  It is often added to a statin and can reduce LDL by 18-25 percent.

     Triglycerides: These are essentially free fats in your blood stream. Although not directly linked to heart disease, elevated triglycerides are predictive of an increased risk for diabetes and heart disease.  Most doctors want this number to be less than 150. Drugs commonly used to lower triglycerides:
     1.  Fibrates: these medications bind up and eliminate triglycerides from the blood stream. They can reduce triglyceride levels from 20-70 percent. Common fibrates include Lopid and Tricor
     2. Niacin:  Has been shown to decrease triglycerides by 20-40 percent, LDL by 15-30 percent and raise HDL slightly. Most commonly, Niacin is prescribed in an extended release formula called Niaspan.
     3. Omega-3 Fatty acid:  Often known as fish oil or prescribed as products like Promega or Omacor, Omega-3 fatty acids can reduce triglycerides by up to 30 percent.
 
     HDL: High density lipoprotein.  This is also known as good cholesterol.  Higher levels of HDL have been linked to reduced risk of heart attack or stroke. Most doctors want your HDL to be above 40 and many doctors want to push this number as high as possible.  There are no specific drugs designed to increase HDL, although many doctors use Niacin and Omega-3 fatty acids to increase HDL.  Consistent cardiovascular exercise and proper diet (which should be the groundwork for any cholesterol lowering program) have been proven to increase HDL.

    Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board- certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelors degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.
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