Hyperlipidemia (high cholesterol) is such a common problem that I find myself frequently answering questions about this condition and the treatment of it. I think it’s important to remember why we even care about cholesterol. These are not just random numbers that your doctor seems to obsess about. We know that having high cholesterol is a major risk factor for the development of heart disease. Put in simpler terms, if your cholesterol is high, you are more likely to have a heart attack. Cholesterol is one of the main components of atherosclerotic plaques. These are the “blockages” in arteries that cause heart attacks. More importantly, we know that lowering the level of cholesterol in your blood, with diet, exercise, and certain medications, we can stabilize or reduce the size of these plaques, and prevent people from having a heart attack. Preventing heart attacks and certainly death from heart attacks is what we are REALLY talking about when we discuss cholesterol numbers.
I always encourage my patients to work on a healthy diet and exercise plan before considering medication for cholesterol. People often don’t realize, however, that the cholesterol level in your blood is not just the result of what you eat. Your liver makes cholesterol as well. The amount and type it makes is often genetically determined, so high cholesterol tends to run in families. Some people are living an extremely healthy lifestyle, but still have high cholesterol. Although this is obviously frustrating, it means that the only way some people can lower their cholesterol is with medication. Cholesterol is not the ONLY determinant of heart disease, so the healthy lifestyle these people live does lower their risk of heart disease, but the risk of their genetics cannot be ignored. Some people believe that doctors just want to give people a bunch of pills. They actually think there may be some financial incentive for us to get people on these drugs. No doctor I know actually likes (or is incentivized by) writing more prescriptions. Obviously, we doctors want people to do everything they can to keep a healthy heart without taking a medication. We also are privy to a large volume of data that has revealed the benefits of certain medications in preventing heart attacks. I don’t ever recommend a medication I wouldn’t prescribe to my own family and loved ones. If I recommend a cholesterol-lowering medicine, it’s because I really think it’s the right thing for the patient.
So what does that mean? How do doctors determine if a cholesterol-lowering drug is “right” for you? We always have to weigh the risk and benefit of taking the medication against the risk and benefit of NOT taking it. For hyperlipidemia, usually this means a discussion of a “statin” medication with my patient. Thankfully, these medications are overall safe and effective, and for most people, can be taken without side effects. You are likely familiar with the brand names of these drugs: Zocor, Lipitor, Crestor, etc. There are also several available generics: simvastatin, lovastatin, pravastatin, and others. Some people can benefit from these drugs, but they are not for everyone. In the next blog, I will discuss these medications, and how to decide if one of them is right for you.