LIPID-LOWERING DRUGS
Fibrates
Fibrates, such as gemfibrozil (Lopid) and clofibrate (Atromid-S), do not substantially lower LDL and are used more often to lower triglycerides. Clofibrate is used less today because it was associated with considerably increased general mortality in the World Health Organization Cooperative Trial even though it reduced coronary events by 25 percent. Although the Helsinki Heart Study showed a significant reduction in coronary heart disease with gemfibrozil, it may increase the number of deaths due to cancer. Gemfibrozil is associated with gallstones, hepatitis, and myositis (painful, inflamed muscle tissue). Combined with lovastatin or pravastatin (see the following section), gemfibrozil can cause life-threatening muscle destruction and subsequent kidney damage.
Statins
Statins block the liver enzyme for cholesterol synthesis, HMG-CoA reductase. LDL levels fall be 20 to 45 percent, depending on the dose, and triglyceride levels are slightly decreased, while HDL levels may increase slightly.
Lovastatin (Mevacor) was the first, then simvastatin (Zocor) and pravastatin (Pravachol) were introduced. Despite occasional gastrointestinal side effects, they are considered well-tolerated drugs. You may want to take them at night, the peak period of cholesterol synthesis.
People using these drugs are warned about possible liver inflammation, and their liver enzymes are measured periodically. If you take gemfibrozil along with a statin, your chances of severe myositis and muscle and kidney damage may be increased beyond any benefit of lowered cholesterol.
Marine triglycerides
Researchers speculate that a diet rich in omega-3 fatty acids can prevent or delay atherosclerosis and thrombosis. Saltwater fish such as mackerel, herring, sardines, trout, and salmon contain these omega-3 fatty acids. The Inuit people, whose dietary protein is supplied from marine animals and fish, have a very low heart attack rate.
While doctors regard increased consumption of these fish as pru¬dent, they fear the administration of high-dose supplements may in¬crease gastrointestinal side effects, allow unwanted bleeding, and reduce inflammatory or immune responses. The use of omega-3 fatty acids to prevent restenosis (when the new artery closes off) in patients having angioplasty remains controversial because clinical trials have generated conflicting results.
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Tags: General health