Common drug treatments

When a patient without heart disease is first diagnosed with elevated blood cholesterol, doctors often prescribe a program of diet, exercise, and weight loss to bring levels down.

But sometimes diet and exercise alone are not enough to reduce cholesterol to goal levels. Perhaps a patient is genetically predisposed to high blood cholesterol. In these cases, doctors often prescribe drugs. Some form of cholesterol-lowering drug therapy are recommended . The most prominent cholesterol drugs are in the statin family, an array of powerful treatments that includes Mevacor (lovastatin), Lescol (fluvastatin), Pravachol (pravastatin), Zocor (simvastatin), Baycol (cervastatin), and Lipitor (atorvastatin). Many doctors say statin drugs have revolutionized patient care.

Statins work by interfering with the cholesterol-producing mechanisms of the liver and by increasing the capacity of the liver to remove cholesterol from circulating blood. Statins can lower LDL cholesterol by as much as 60 percent, depending on the drug and dosage.

But patients can respond differently to drugs. Some patients may have fewer side effects with one drug than another, such as stomach cramps with Zocor.

Other Drug Treatments

• Nicotinic acid (niacin) -- This lowers total and LDL cholesterol and raises HDL cholesterol. It also can lower triglycerides. Because the dose needed for treatment is about 100 times more than the Recommended Daily Allowance for niacin and thus can potentially be toxic, the drug must be taken under a doctor's care.
• Resins -- Doctors have been prescribing Questran (cholestyramine) and Colestid (colestipol) for about 20 years. These "resins" bind bile acids in the intestine and prevent their recycling through the liver. Because the liver needs cholesterol to make bile, it increases its uptake of cholesterol from the blood.
• Fibric acid derivatives -- Used mainly to lower triglycerides, Lopid (gemfibrozil) and Tricor (fenofibrate) can also increase HDL levels.
• Aspirin -- Because studies have shown that aspirin can have a protective effect against heart attacks in patients with clogged blood vessels, doctors often prescribe the drug to patients with heart disease.

The decision of which drug to prescribe is one the doctor makes based on factors such as degree of cholesterol lowering desired, side effects, and cost.

The potential for drug interaction is a crucial concern, Some statin drugs are known to interact adversely with other drugs, and that information may guide a decision about which statin to use.

Though it is impossible to know yet just how many lives cholesterol-lowering therapies have saved, public health experts say awareness efforts are getting the word out to Americans about heart disease, its prevention and management.