When to use them
High cholesterol drugs are necessary when the correction of modifiable risk factors - in particular diet and exercise - fails the goal of bringing the lipidic structure back to acceptable values.
First of all, it should be clarified that cholesterol-lowering drugs must not replace, but be associated with, the correction of lifestyle; in this way it is in fact possible to exploit the synergistic action of the two therapeutic interventions.
The values of cholesterol in the blood for which it is necessary to adopt a drug therapy vary from patient to patient, in relation to individual cardiovascular risk. High-risk patients, for example, may need these drugs while presenting lower total cholesterol values than other subjects where drug therapy is not necessary.
Therefore, before prescribing these drugs, the doctor will evaluate factors such as the patient's age, the good HDL cholesterol values and their relationship with total or LDL cholesterol, smoking habits, blood sugar levels and blood pressure, weight body and the presence of underlying cardiovascular diseases.
Statins
The great progress in the treatment of hypercholesterolemia carried out in recent decades is largely linked to the discovery of statins, a class of drugs able to lower cholesterol synthesis in the liver up to 40%. On the other hand, the synthesis of good HDL cholesterol can increase up to 15%.
The most commonly used statins are simvastatin and atorvastatin.
A big advantage of these drugs, useful for lowering high cholesterol, is the lack of side effects which, when present, include suffering to the muscles of the arms and legs comparable to the soreness caused by the flu. The possible occurrence of these adverse effects generally occurs in the first weeks of treatment and must obviously be reported to your doctor.
Statins also weigh down liver function and are contraindicated in the presence of dysfunctions and pathologies affecting the liver.
Examples of medicinal specialties belonging to this category: Totalip, Torvast, Lovinacor, Zocor, Lescol, Selectin.
fibrates
Fibrates are another very important pharmaceutical class in the treatment of dyslipidemia. Although they are also very useful in reducing cholesterol (on average 10-15%), they are used above all to bring back high triglyceride values in the blood.
Fibrates can cause muscle pain in the first weeks of treatment and small gastrointestinal disorders, although they are generally well tolerated by the patient.
Examples of medicinal specialties belonging to this category: Lopid, Lipsin, Fulcro
Ezetimibe
Unlike fibrates and statins, which act on endogenous cholesterol (produced by the body), ezetimibe acts by blocking the absorption of the exogenous (food) and bile in the intestine. It is taken once a day in the form of tablets and can be taken in association with a statin or as an alternative to it in the case of intolerances.
Examples of medicinal specialties belonging to this category: Inegy, Zetia
Resins sequestering bile acids
The resins are able to decrease the reabsorption of cholesterol in the intestine, increasing the fecal excretion of bile acids. They are taken in the form of powdered preparations, from reefs in fruit juice, two or three times a day. Since they are not absorbed by the intestine, the resins do not cause significant side effects, even if their use can cause halitosis, belching, meteorism and constipation.
Examples of medicinal specialties belonging to this category: Questran, Cholestagel
Megadoses of niacin
When used at high doses, niacin helps lower the blood levels of triglycerides and LDL cholesterol, raising the good or HDL fraction. The benefits of this medicine include: lower cost than any other cholesterol-lowering drug; the ability to increase HDL levels by 15-35%, to lower triglyceridemia and, albeit to a lesser extent, LDL cholesterolemia. Among the acute side effects that cause the patient the most discomfort are pruritus, headaches and redness of the skin (mainly located on the face and neck). These unwanted effects appear shortly after ingestion, last a few tens of minutes at the most and tend to occur with less intensity as the days go by.
Examples of medicinal specialties belonging to this category: Olbetam.
In addition to the indicated side effects, for each class of drugs there are possible negative interactions with other medicines, such as to make it more appropriate to choose one active ingredient than another.
Supplements
Between the dietary and behavioral therapy and the drugs for high cholesterol, there are the fiber and mucilage supplements. Some of these, such as psyllium, guar gum and pectin, have demonstrated a noteworthy cholesterol-lowering effect. Other useful supplements to bring back the cholesterol values are soy lecithin, chitosan and fermented red rice, which acts in a similar way to statins.
