Controlling Cholesterol with Statins

Too much cholesterol can increase a person's chance of getting cardiovascular (heart and blood vessel) disease. According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for both women and men in the United States.

Both HIV negative and HIV positive individuals are at risk for the development of cardiovascular disease. However, people with HIV may be at higher risk due to their use of antiretroviral drugs or perhaps due to chronic viral infection itself.

The following is a edited summary of a consumer update from the U.S. Food and Drug Administration (FDA) about the use of statin drugs to manage elevated blood cholesterol:

Statin Therapy Tablets

When it comes to keeping your heart healthy, what foods you eat and the genes you inherit matter a lot in terms of your cholesterol levels. However, several non-antiretroviral medications can effectively lower blood cholesterol levels -- a key factor in good heart health. Chief among these medications are the statins.

Statins (also known as HMG-CoA reductase inhibitors) are a class drugs used to lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that is responsible for making cholesterol.

Understanding Cholesterol

Cholesterol is a waxy substance found in all parts of the body. It is critical to the normal function of all cells. The body needs cholesterol to make hormones, digest dietary fats, build cell walls, and other important processes. Your body makes all the cholesterol it needs, but cholesterol is also present in some foods.

When there is too much cholesterol in your blood, it can build up on the walls of the arteries (blood vessels that carry blood from the heart to other parts of the body). This buildup is called plaque. Over time, plaques can cause narrowing or hardening (loss of elasticity) of the arteries -- a condition called atherosclerosis. In short, too much cholesterol can clog your arteries and keep your heart from getting the blood it needs.

Cholesterol Numbers That Matter

There are no warning symptoms of high cholesterol. However, a simple blood test is available to measure the different kinds of cholesterol.

Low-density lipoprotein (LDL) or "bad" cholesterol can clog the arteries. Lower LDL numbers are best. The higher the LDL level, the greater the risk for heart disease.

High-density lipoprotein (HDL) or "good" cholesterol carries bad cholesterol out of your blood and back to the liver, where it can be eliminated to keep it from building up in the arteries. The higher the HDL level, the lower the risk for heart disease.

For further information on what your cholesterol numbers mean, visit www.nhlbi.nih.gov.

What Affects Cholesterol?

The following factors can affect blood cholesterol levels:

• Certain foods - eating too much saturated fat, found mostly in animal products, and too much cholesterol, found only in animal products;

• Heredity - genes play a role in influencing cholesterol levels;

• Weight - excess weight tends to increase total cholesterol levels;

• Exercise - regular physical activity may not only lower LDL cholesterol, but it may increase the level of desirable HDL cholesterol;

• Smoking - cigarette smoking lowers HDL cholesterol;

• Age and gender - cholesterol levels naturally rise as men and women age. Menopause is often associated with increased LDL cholesterol in women.

State of the Statins

The main goal of cholesterol management is to lower LDL to levels that will not lead to or worsen heart disease. When a patient without cardiovascular disease is first diagnosed with elevated blood cholesterol, the National Cholesterol Education Program (NCEP) guidelines advise a 6-month program of reduced dietary saturated fat and cholesterol, together with incraesed physical activity and weight control, as the primary treatment to bring levels down.

When diet and exercise alone are not enough to reduce cholesterol to desirable levels, doctors often prescribe medication, the most prominent being the statins. By interfering with the production of cholesterol, statin medications can slow the formation of plaques in the arteries.

Statins are relatively safe for most people, but some inidviduals can respond differently to the drugs. Certain people may experience fewer side effects with one statin drug than with another. Some statins, in paricular lovastatin (Mevacor) and simvastatin (Zocor), are known to interact adversely with other drugs. This information, coupled with the degree of cholesterol-lowering desired, will help guide the decision about which statin to use, or whether another type of drug should be used.

Statin medications (HMG-CoA reductase inhibitors) do the following:

• Work in the liver to prevent formation of cholesterol;

• Are effective in lowering bad LDL cholesterol and raising good HDL cholesterol;

• Are not recommended for pregnant women;

• Should be used cautiously by people with active or chronic liver disease, including hepatitis B or C;

• Can cause serious muscle problems (rhabdomyolysis).

Statins currently available by prescription include the following:

• Lovastatin (Mevacor, Altoprev);

• Pravastatin (Pravachol);

• Simvastatin (Zocor);

• Fluvastatin (Lescol);

• Atorvastatin (Lipitor);

• Rosuvastatin (Crestor).

Tips for Consumers

• Have your blood cholesterol levels checked at least once every 5 years if you are age 20 years or older.

• Check with your doctor. You may be able to lower your cholesterol levels by eating better and exercising more.

• Maintain a healthy weight. Being overweight increases your risk for heart disease.

• Stay active every day.

• Use food labelsl to choose foods lower in saturated fat -- including trans fats -- and calories.

• Eat more fruits and vegetables.

• Do not stop taking any cholesterol-lowering medications you may be on without first talking to your doctor.

HIV Positive Patients Taking Antiretroviral Therapy

The preferred first step toward achieving healthy cholesterol levels is the combination of smoking cessation, regular exercise, and a healthy diet. Some statin medications can interact with certain antiretroviral drugs. Speak with your doctor about the current status of your cholesterol levels and whether it would be useful to take medication to lower your levels of LDL cholesterol.

5/20/08

Sources

National Heart, Lung, and Blood Institute Health Information Center.

FDA Center for Drug Evaluation and Research.