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Cholesterol is in the news these days-and that's good. The public, in
the past, has too often been ignorant of cholesterol levels. With increasing
public awareness that cholesterol is a major risk factor for stroke and
heart attack, this is changing. Much of this increased awareness coincides
with the great treatment advances that have been made in the past several
years. The new class of medications called the statins has dramatically
affected our ability not only to decrease serum cholesterol but also to
significantly reduce the risks of stroke and heart attack associated with
this disorder. It therefore becomes much more important to have our cholesterol
checked and, if elevated, successfully treated.
However, not all elevations of cholesterol are bad. We now know that
cholesterol is made up of several subtypes and we can more accurately
predict which patients are at risk for the complications of elevated cholesterol.
"Good cholesterol," or HDL, actually protects us from a stroke or heart
attack. The higher this "good cholesterol" the better. Likewise, we can
also calculate the "bad cholesterol," or LDL. Low levels of HDL, or elevated
levels of LDL, place us at increased risk for stroke and heart attack.
Some people are blessed and will never have elevated cholesterol no matter
what they eat. Others will have a cholesterol level, which will go up
or down depending on their diet or activity. This group should be treated
primarily with diet and exercise. If their cholesterol levels are still
not in the desirable range, medical treatment should be considered. Those
who have a hereditary elevation of cholesterol may find it difficult or
impossible to lower their cholesterol level even with intensive diet and
exercise. This group will almost always need medication to lower their
cholesterol to an acceptable level.
If a person with elevated cholesterol has other risk factors for stroke
or heart attack, (hypertension, smoking, diabetes, a strong family history
of heart attack or stroke) they should be treated even more intensively.
Additionally, with so many of the studies showing reduction in stroke
and heart attack, the treatment guidelines are becoming more aggressive
as far as who we should treat.
There are many statins presently on the market and research is being
done on newer drugs in this class, as well as other cholesterol-lowering
medications not in the statin group. We hope these newer medications will
have even more potent effects on the LDL and HDL levels, while being at
least as safe or safer than current medications. While the present statins
are for the most part well tolerated, some people will complain of muscle
discomfort, or even more rarely, will develop a breakdown in the muscle
tissue called rhabdomyolysis. This is associated with pain accompanied
by elevation of the muscle enzyme called "CPK." Another uncommon side
effect may be inflammation of the liver. Symptoms associated with inflammation
of the liver are not always noticeable and therefore need to be monitored
by periodic liver tests, especially during the first year of treatment.
While all of the medications in this class may have these side effects,
if side effects occur, we often can switch from one medication to another
in the same class without recurrence of these side effects.
The Center for Pharmaceutical Research is presently conducting a research
study on a new statin compared to several already approved. This study
will offer dietary instruction and medication at no cost to study participants.
There is no placebo-all participants will receive a cholesterol lowering
medication.
If you want to see if you qualify for this research study, call 816-943-0770.
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