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Cholesterol-lowering medications are one of the most commonly prescribed medications to Malaysians. This is because as many as 38.1% of Malaysians have high blood cholesterol levels, with 24.6% of them not knowing they actually have it. (Source: NHMS 2019)
8.1% of Malaysians (1.7 million people) not only have high blood cholesterol but also high blood pressure and diabetes. This is important because high blood sugar (diabetes), high blood pressure and high blood cholesterol increase the risk of cardiovascular diseases.
When we say that high blood cholesterol increases your risk of cardiovascular diseases, what we actually mean is that having too much LDL-cholesterol raises your risk of heart attacks, strokes, and other health problems. That’s why if your blood cholesterol is too high, you should do something to lower it, either through lifestyle changes, taking medications or both.
On the other hand, we have another type of cholesterol known as HDL-cholesterol, which is the “good” kind that lowers risks of cardiovascular diseases. You can learn more about cholesterol in our previous article.
The scientific evidence that supports the use of cholesterol-lowering medications is overwhelming. Meta-analyses have shown that therapy that lowers the LDL-cholesterol improves the risk of dying, reduces heart attack and strokes.
To know if you have high blood cholesterol and require cholesterol-lowering therapy, visit a doctor to conduct a blood test. Your doctor will interpret your blood test result and your personal condition to determine if you really need to start a cholesterol-lowering therapy or not.
Chances are, if it is your first time that you found out you have high blood cholesterol, the doctor would recommend that you start adopting a healthy diet and active lifestyle. If such a measure does not improve your blood cholesterol after six months, then the doctor will only start prescribing medication to you.Your doctor will let you know the target blood cholesterol level that you should be aiming for.
There are many types of medications that can lower your blood cholesterol. They usually work on the liver, where the cholesterol is manufactured in your body. Some of them work on the cholesterol that you ingest from food.
If your doctor thinks that you can benefit from cholesterol-lowering medications, he or she will decide the type of medication based on the best available scientific evidence, how well you tolerate and benefit from the medications and your financial ability.
Statins are the most prescribed cholesterol-lowering medications. If you have been diagnosed with high blood cholesterol or some forms of cardiovascular diseases, and modification of diet and physical activity did not improve your blood cholesterol level, it is likely that you are taking one of the statins.
Statins work by inhibiting HMG-CoA reductase, an enzyme the liver uses to manufacture the cholesterol. Without this enzyme, the liver cannot produce more cholesterol and therefore your blood cholesterol drops.
Different statins may have different ways of taking them. For instance, you should take simvastatin at night whereas you can take atorvastatin and rosuvastatin at anytime of the day. In general, all statins are safe but they may lead to some side effects; a rare but serious side effect is muscle injury. People with liver diseases should not use statins.
Because statins are so widely used, we dedicated an article solely on statins, you can read it here.
Fibric acid derivatives are mostly used to lower triglycerides ‒ another ‘culprit’ for cardiovascular disease. Learn more about the differences between triglyceride, cholesterol and saturated fats here. With that being said, fenofibrate is the fibric acid derivative that can lower both triglyceride and LDL-cholesterol. They may cause side effects such as stomach upset, muscle injury and cholelithiasis. People with severe liver and kidney diseases should not take fibric acid derivatives.
Ezetimibe works by blocking the absorption of cholesterols ‒ including those in your food and those produced by your liver. This sends a signal to your liver telling it that “Hey, I don’t need so much cholesterol, stop spouting it out.” Ezetimibe is a relatively safe medication with no major side effects have been reported; although it is rarely used alone and is mostly used in addition to statins.
Have you ever done makeup? If yes, then you would know how to use make-up remover to remove your make up. Bile acid is like the “make-up remover” produced by our own body to absorb fat droplets and cholesterol. So what bile acid binding sequestrants do is that they bind to bile acids to promote their secretion into the intestines, so that these bild acids can work more frequently and take up more cholesterol in your body.
Niacin, also known as vitamin B3, is used to lower triglycerides; its effects on lowering LDL-cholesterol is modest. That being said, the vitamin B in your supplements is not enough for such function. Niacin is available as tablets of 50mg, capsules of 100 mg and 250 mg.
Depending on your blood cholesterol level and the target your doctor suggests you to achieve, various classes of cholesterol-lowering medications can be combined to achieve optimal results. Always get your cholesterol-lowering medications from legitimate sources only and strictly follow your doctor’s instructions on taking them.
Cholesterol-lowering therapy such as statins are very effective at lowering your blood cholesterol, but they only work as long as you’re taking them. This is why cholesterol-lowering treatment is lifelong.
If a lifelong cholesterol-lowering therapy adds too much financial burden to you, consult your doctor to switch to generic brands, which are way cheaper than the original brands and just as effective.
Most importantly, taking cholesterol-lowering medications is just as important as adopting a healthy lifestyle. The following recommendations are backed up by evidence to show that they’re beneficial in lowering your blood cholesterol level:
Avoiding red meat, butter, fried foods, cheese, and other foods that have a lot of saturated fat and trans fat
Opt for a diet high in fibre, fruits, vegetables, wholegrain; and low in salt
Regular exercise – Studies show that regular aerobic exercise can raise your HDL-cholesterol by 3-10% and reduce triglyceride by about 11%. These improvements reduce your risk of cardiovascular diseases.
Quit smoking – Smoking is a strong predictor of cardiovascular disease because it promotes the formation of plaque, which can lead to chest pain, heart attack or stroke, depending on the place it stucks at. Study also found that upon quitting smoking, the person may experience an increase in HDL-cholesterol (the “good” cholesterol). Just within the first 6 months of stopping smoking, there is a significant reduction of cardiovascular diseases risk. If you’re interested to quit smoking with the help of nicotine-replacement therapy, approach any community pharmacist or healthcare provider you trust.
Some research has shown that certain supplements can lower cholesterol. But there is almost no research showing that supplements can help prevent heart attacks, strokes, or any of the problems caused by high cholesterol. Examples of supplements that might help with cholesterol are:
Red yeast rice – This supplement can contain monacolin K, a compound that is chemically identical to lovastatin. As you can probably tell from the name, that belongs to the statins group of cholesterol-lowering medications. Hence, red yeast rice may lower blood cholesterol levels and can cause the same types of side effects and drug interactions as lovastatin. However, because the dietary products are less regulated in Malaysia’s market compared to prescription medications, the red yeast rice product you purchase may not always contain monacolin K.
Omega-3 fatty acid supplement – Recent studies have found no evidence that omega-3 could reduce the risk of cardiovascular diseases. Nonetheless, some omega-3 fatty acid supplements, such as krill oil supplements, might help lower cholesterol.
If you have any questions related to cholesterol and cholesterol-lowering medications, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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UpToDate - Patient education: High cholesterol (The Basics)
UpToDate - Patient education: Can foods or supplements lower cholesterol? (The Basics)
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