Between 30 and 40 per cent of Canadians have high cholesterol, and many don’t even know it. And they may continue not knowing it until they get a lab result, or, worse yet, a heart attack.
Cholesterol is the broad term used for lipoproteins and triglycerides found in the body. By accumulating in blood vessels, cholesterol can lead to narrowing of the vessels, along with inflammation and even damage to vessel walls.
Those are not symptoms you want when your goals are to have your blood circulate efficiently through your body and your blood pressure to remain normal.
There are several types of cholesterol. Low-density lipoproteins or LDLs are considered “bad” cholesterols because they accumulate in blood vessels, as do triglycerides. High-density lipoproteins or HDLs are termed “good” cholesterols because they carry away the “bad” cholesterol.
A lab test breaks down the various types of cholesterol, and that’s what you want because you want to know how much “bad” and “good” cholesterol you have. Home cholesterol tests and screening clinics usually only give you a total cholesterol, not the information about the types of cholesterol.
Cholesterol has two sources. Dietary fats contribute to increased cholesterol levels, and the first recommendation for high cholesterol treatment is to eat a low-fat, high-fibre diet. However, up to 75 per cent of cholesterol is actually manufactured by the body, so sometimes, no matter how well you eat, you still cannot reduce your score.
The mainstay of high cholesterol treatment is the statin group of compounds, which all share the “statin” suffix. These drugs inhibit HMG-CoA reductase, an enzyme essential for the manufacture of cholesterol. Without the enzyme, your body doesn’t manufacture cholesterol, and your cholesterol levels drop.
Atorvastatin and rosuvastatin are considered higher potency drugs in that they have a greater effect on cholesterol levels. Often if you have had a heart attack, if you have a very high cholesterol lab value, or if you are at high risk for cardiovascular problems, you will be started on one of these statins. It doesn’t matter when during the day you take the higher potency statins, so they are certainly convenient.
Lower potency statins include fluvastatin, lovastatin, pravastatin, and simvastatin. They don’t have as great an effect on cholesterol levels, and to have the best effect they need to be taken at supper or bedtime in order to be in the body overnight when cholesterol is manufactured.
In general statins, are well tolerated, although muscle aches and pains sometimes limit their use. However, if you experience muscle symptoms, check to see if they could be the result of any other activity because the incidence is about 1.5 cases per 100,000 people. If you do think it might be statin, changing to another one or reducing the dose might solve the problem. Sometimes, vitamin D supplementation will alleviate the symptoms.
Other cholesterol-lowering drugs are aimed at reducing the amount of cholesterol your body absorbs from your diet, for example ezetimibe, which is sometimes combined with a statin.
Before the discovery of statin, bile acid sequestrants were the only cholesterol-lowering drugs, but they are not as effective as statin, need to be mixed with water, and have unpleasant adverse effects like gas, bloating, nausea and diarrhea.
Ideally, you want to maintain low cholesterol levels to have good cardiovascular health. You want to eat a low-fat, high-fibre diet, and know what your cholesterol levels are.