What happens if my second cholesterol level test is still raised?

You will need medication. Fortunately, the medications that you might be given are safe, simple to use and very effective - usually your cholesterol levels will begin to fall within 21 days.

What medications are there to treat high cholesterol levels and are there any side effects?

he commonest medications that you may be prescribed are known as the statins (see Table 2.4). They reduce the production of cholesterol in the liver. Side effects are rare but you may get

indigestion, muscle aches and pains, sleep disturbance, rarely a rash, and possibly a reduced sex drive or impotence. After you have been on one of these medications for 3-4 weeks, your doctor will want to check your cholesterol again to make sure that the dose is right and that you are not suffering from any of these side effects. Always tell your doctor if you feel that you are having side effects.

The next most common group of medications is the fibrates. These are used more when your HDL is low and your triglycerides high. Stomach upsets and skin rashes occur sometimes as side effects.

Sachets of medications known as the resins are used less these days as they can cause a lot of stomach trouble and they taste like wallpaper paste (not that I have tried it) or sand. Ezetimibe acts to prevent the absorption of cholesterol and is often used when statins are not fully effective or causing side effects. It can be used in combination with statins to provide additional cholesterol lowering (see later).

A combination of medications is occasionally used to increase their effect, when a single medication is not enough to get the levels right.

I have been prescribed cholesterol-lowering medication, although I am only 50. Will I always need medication?

Usually, yes. Occasionally, after a time when you have been losing weight and eating healthily, the medication can be stopped for a month to see what happens; usually your cholesterol goes up again, but at least you've proved that you do need medication.

If you have coronary disease, lowering your cholesterol will help reduce your chances of a heart attack or the need for heart surgery or angioplasty. Lowering your cholesterol will also help to lengthen your life. For most people, one, or occasionally, two tablets a day plus a healthy lifestyle are all that is needed. The tablets are easy to take, with few side effects. This is one occasion when 'keep on taking the tablets' is very good advice and, in terms of healthcare, very good value.

When I have finally got my cholesterol level under control, how often should I have it checked?

Every 12 months.

I have been on cholesterol-lowering medication for some time now. When I go for a check-up, my doctor checks my liver. Why?

t is in the liver that the statins, in particular, get to work, and, very rarely, cause an upset; the tablets then have to be stopped. If you are unfortunate enough to have this side effect, you will be pleased to know that the liver will get better, once the medication has been withdrawn. Statins do not cause cancer.

Can lowering cholesterol levels be harmful, as I have read that lowering cholesterol increases the chances of suffering a violent death or suicide?

There were some reports suggesting this but, by proper scientific study, they have been disproved. This is called evidence-based medicine. Lowering cholesterol reduces your chance of dying from heart disease and does not increase your chance of dying from anything else. There is no increased risk of cancer.

I have had a heart attack and even though my cholesterol was only 4.51 have been put on a statin - why is this?

If you have coronary disease, the level of cholesterol at which you developed it is too high for you. Studies have shown a significant benefit in reducing heart attacks, strokes or death in those with known coronary disease or those at high risk (such as those with diabetes), who start with a cholesterol as low as 3.5 mmol/litre. Statins have other properties other than lowering cholesterol and can reduce the inflammation in the narrowing of arteries, preventing disruption. So, once the disease is known about, the treatment is more aggressive because the benefits are substantial.

I have read about a new cholesterol drug called Ezetrol - when is this used?

Ezetrol is the UK trade name for ezetimibe; this is a drug that acts to prevent the absorption of cholesterol in the bowel. It is a fixed dose of 10 mg and lowers LDL cholesterol by 10-20% when acting on its own or added to statin therapy. Side effects are not common -mainly nausea and bloating and occur in only 2% of people taking it. It is used when statins are not tolerated at all or when the dose needed to achieve your target for LDL cholesterol causes side effects - it can then be added to a lower dose of statin, which is tolerated, to get an additive effect. To date there is no evidence that it reduces heart attacks, so statins are the number one choice. There has been some concern about an increased cancer risk but a detailed review of the research did not confirm this. Like all new drugs, its use will be carefully supervised.

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