Aug 2, 2011
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
You can lead a horse to water, but you cant make him drink. As Barret was talking about last week with stroke prevention, it can be difficult to convince people to take medications for chronic conditions. If someone has high cholesterol now, they dont feel bad. High cholesterol doesnt hurt. So why should they take their cholesterol pills?
What is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Although cholesterol is essential for life, you dont have to eat any. Your liver can make all the cholesterol you need.
So why does your doctor test your blood for cholesterol if it is essential for life? Why does your doctor care if your cholesterol is too high? Well actually you doctor doesnt really care about your cholesterol. Your doctor is using cholesterol as a surrogate marker for heart attacks and strokes. Heart attacks and strokes account for about one third of all the deaths inCanada. That is more than any other disease.
Your doctor knows that if you have high cholesterol you have a greater chance of having a heart attack or stroke. How much greater chance? Lets look at an example. Our patient is a 65 year old woman with Total Cholesterol of 6.2 mmol/L, HDL cholesterol of 0.9 mmol/L, and takes pills which keep her blood pressure at 140/75. She doesnt smoke and isnt diabetic. Her chance of having a heart attack or stroke in the next 10 years is greater than 30%. She has about a 1 in 3 chance of having a heart attack or stroke. She is considered a high risk patient.
So what can our patient do? Diet and exercise are very important to prevent and treat heart attacks and strokes. However, this patient already follows a good diet and gets a lot of exercise golfing and geo-caching. So now what? Well the primary target of cholesterol lowering therapy is something called LDL. If LDL or bad cholesterol is high we have many, many studies saying high LDL increases the chances of the patient having a heart attack or stroke. The most common LDL lowering medications are called the statins. The statins stop the liver from making as much cholesterol. The statins do a good job of reducing LDL. We have lots of studies that show if we reduce someones LDL with statins we can reduce the chances of heart attacks and strokes by 25% to 35% with five years use
What does all this LDL, HDL, VLDL stuff mean? When your liver makes cholesterol, it puts it into the blood stream. Cholesterol is a kind of fat. Since blood is mostly water, cholesterol doesnt mix well with it. The liver has to mix the cholesterol with proteins to get it to stay in the blood. This mixture of cholesterol (which is a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast in a centrofuge, it separates based on density. Different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called bad cholesterol because it transports cholesterol from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called good cholesterol because it transports cholesterol away from the cells lining the blood vessels. This can decrease the chance of blockages.
Whenever we talk about putting people on a medication, they ask about side effects. Statins are also generally well tolerated. Statins can cause some stomach upset which can usually be fixed by taking them with food. It seems that everyone is concerned that their statin will cause muscle pain or liver damage. These are possible side effects but they are very rare. If you get muscle pain all over on your statin, inform your doctor. They will probably take you off your statin, and the muscle pain will resolve on its own. As for liver damage, your doctor will do blood tests. If there are signs of liver damage, again they will take you off of the statin and the liver damage will resolve.
The average patient who walks into the pharmacy weighs a few hundred pounds less than an average horse. But I cant stand beside a patient 24 hours a day and make them take their pills any more easily than I can force a horse to drink. I just hope we can present the reasons why their cholesterol pills will improve their health and they will make the right choice.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
Heart Attack and Stroke Risk calculator: www.cvdriskcheck.com/FraminghamVSReynolds.aspx
For more info on Cholesterol Guideline visit: