A comprehensive analysis on how to lower cholesterol suggests high doses of statin drugs are often the best approach, but some are more effective than others and should only be considered after patients first try dieting, losing weight, and adopting a regular exercise routine.
The review, published in the Annals of Pharmacotherapy, examined the range of treatment options for high levels of LDL “bad” cholesterol; low HDL “good” cholesterol levels; elevated triglycerides; and other issues that affect millions of people around the world.
Researchers concluded that use of statin drugs, which effectively lower LDL cholesterol, is appropriate for both moderate and high-risk patients, and those who have already had a heart attack or angina as a result of cardiovascular disease. But it also found that in most cases simply increasing the statin dose is a more effective way to reduce the risk of serious cardiovascular problems than using other drugs or combinations of medications.
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"Statins are proven medications that can reduce heart attacks and strokes by about 30 percent in the patients that need them," said lead researcher Matt Ito, a professor of pharmacy practice at Oregon State University, author of the study and president-elect of the National Lipid Association.
"What we looked at here was whether adding other drugs or therapies to the use of statins could further reduce problems, and in most cases the research indicates that they didn't help," Ito said. "What did help was increasing the statin dose to higher levels within the range for which they are approved. And there did not appear to be a significant change in side effects based on any approved dosage."
The study noted statin drugs can cause some side effects, including muscle pain and damage, that doctors need to factor into decisions about prescription dosages. Other medications sometimes used ti treat high cholesterol have less value or even pose additional risks, the review found. This includes fibrates to lower triglyceride levels; niacin to lower triglycerides and raise HDL levels; and omega-3 fatty acids that safe, but not more effective than statin drugs.
"We found that only in patients with extremely high triglycerides and very low HDL would use of fibrates be appropriate to use in addition to statins," Ito said. "Otherwise the increased risks outweigh the benefits, especially in women."
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