Healthy Living Newsletter
Stay in the Game: Why You Should Take Your Cholesterol-Lowering Drugs
Eric didn’t like to take pills. Jeanne got behind on her bills and thought she could save money by cutting back on her cholesterol-lowering medication. Meg simply wasn’t sold on the idea of treating high cholesterol — something she couldn’t see and had no symptoms.
Heart disease kills nearly a million Americans a year, and cholesterol-lowering medications are frequently prescribed to individuals at high risk.
Yet one study found that about 14 percent of patients never filled their prescriptions and 13 percent didn’t take the drugs they brought home. After that first prescription, the compliance rate continued to fall; over a five-year period, only 26 percent of patients took their medicine regularly.
Doctors, of course, don’t take the prescription of cholesterol-lowering medications lightly. When cholesterol is high, the patient is usually advised to first make lifestyle changes — a lower fat diet, exercise and weight loss. A three-month trial of lifestyle changes is usually recommended for all but those deemed to be at higher risk.
Even after the drugs are started, diet and exercise are still considered important components of treatment.
Medications generally produce more dramatic changes than can be accomplished by most individuals through lifestyle changes alone, but they are not magic.
Why Lower Cholesterol?
 Meg probably should have asked her doctor for more information. The role of cholesterol as a risk factor for heart disease was established several decades ago.
When total and HDL cholesterol levels are elevated, there is a greater chance that plaque will be deposited within the walls of blood vessels. While continuing research has pointed to factors such as inflammation that play a role in the disease process, there is still little doubt about the role of cholesterol.
The National Cholesterol Education Project recommends that total cholesterol should be lower than 200 milligrams/deciliter, and LDL less than 130 mg/dL. HDL, the good cholesterol, should be greater than 40 mg/dL, and triglycerides, under 150 mg/dL.
In practice, doctors look at a patient’s cholesterol profile in the context of other risk factors such as smoking, high blood pressure, family history, obesity and a diagnosis of diabetes. If your overall risk of having a heart attack or stroke is low to moderate, your doctor may not prescribe cholesterol-lowering medications until the numbers on your test become extreme.
On the other hand, some individuals considered very high risk (such as those who have suffered a previous heart attack or persons with severe diabetes) may be asked to get LDL under 100 — a level that may be difficult to impossible to reach without medication.
To produce the desired effects for the individual patient with the fewest adverse effects, doctors can choose one or more medications from several different types currently available.
Like Jeanne, many persons taking cholesterol-lowering medications are shocked by the cost. Costs will become less of an issue as more of these drugs become available as generics. A generic version of Lovastatin came on the market in 2002. It is a possible choice for individuals needing modest cholesterol reduction (20 to 30 percent). Pravachol and Zocor lost their patent protection in 2006; others will follow.
The benefit of taking these medications, when they are prescribed, is without dispute. Three landmark studies published between 1994 and 1996 established that cholesterol-lowering medications were effective in reducing the number of heart attacks, strokes and heart-related deaths. Many of these drugs are now among the most widely prescribed in the country. So, there is good reason for patients to take full advantage of the benefits they offer.
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