WE ORE
fl mays

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Bar MG

changes aren't enough and a pa-
tient's cholesterol level may still
put them at risk of heart attack
or stroke, particularly if the pa-
tient has other risk factors for car-
diovascular disease," says Dr.
Krakauer. "Fortunately, there
are now several types of drugs
available that can reduce choles-
terol levels or triglycerides and
prevent plaque build up and even
reduce it."
One of the older medications
are resins or binders (Questran
and Colestid). They've been in use
about 20 years and they lower the
cholesterol indirectly by binding
with bile acids. Bile acids are
made in the liver from cholesterol
/-' and are needed for food digestion
By tying up the bile acids, the
drugs signal the liver to make
more bile acids. Since the liver
uses cholesterol to make the
adds, less cholesterol is available
to reach the blood stream. The
side effects of resins is that they
can cause constipation and bloat-
ing and may decrease the effec-
\-, tiveness of other medications
/- taken at the same time.
Triglyceride-lowering drugs
(Lopid) or large does of niacin also
can reduce triglyceride produc-
tion and remove triglycerides
from circulation. Niacin, howev-
er, sometimes causes skin irrita-
tions and redness, or can elevate
a patient's blood sugar, or ag-
gravate a stomach ulcer.
Consuming more soluble fiber
/- also helps reduce HDLs. Meta-
mucil or Perdiem, for instance,
are bulk-forming laxatives that
work by absorbing water and
softening the stools in the intes-
tine. A diet high in fiber foods
works the same way.
Statins (Lescol, Mevacor, Zo-
cor, Pravachol, Lipitor), intro-
duced in the late 1980s, in tablet
,_ or capsule work directly in the liv-
er to block a substance the liver
needs to manufacture cholesterol.
Depending on the dose, statins
can reduce cholesterol by as
much as 40 percent and bring the
LDL levels to the recommended
guideline. They are becoming the
most widely prescribed drugs to
lower cholesterol.
"Which lipid-lowering drug a
\- -doctor recommend for a patient
/---
depends on many factors, such
as age, whether other medica-
tions will destroy its impact, and
whether there's already been an
encounter with cardiovascular
disease," says Dr. Krakauer.
"Sometimes a doctor may rec-
ommend a combination of drugs
because there isn't one that's best
suited for everyone. The decision
\/ -__- to take a medication is serious,
because once started, the patient
has to stay on that drug for the
rest of his life. That means check-
ing the patient's liver every three

GOOD AND BAD page 67

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