How Healthy Is Your Heart?

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Heart Disease Drugs You Should Know

Most doctors, however, remain firm proponents of controlling cholesterol and will generally recommend improving diet and exercising more as first steps. By losing weight, you can shift the balance of LDL particles, lowering the levels of small ones while increasing the number of large particles, Dr. Krauss points out. If that doesn't improve your cholesterol profile enough, your doctor may prescribe cholesterol-lowering drugs. Fibrates, which were first introduced late in the 1960s, raise HDL, lower LDL and apoB levels, and alter the size and composition of LDL from small, dense particles to large ones. Prescription-strength niacin, an even older cholesterol-lowering drug, has similar effects. Either treatment may be given alone or, if your LDL is especially high, in combination with a statin. While statins do not affect LDL particle size, they are particularly effective at lowering total LDL particle levels, and in the last two decades they've become the most widely used of all cholesterol-lowering medications.

All of these drugs have side effects, which, though rare, you should discuss with your doctor. Fibrates can cause nausea, stomach upset, diarrhea and, after long-term use, gallstones. Niacin can cause flushed or itchy skin, headaches, and heart palpitations. And statin side effects include stomach upset, constipation, abdominal cramps and muscle pain, and weakness. Finally, taking any of these medications requires close monitoring of your liver function by your doctor.

The Future of Cholesterol-Lowering Drugs

While most cholesterol drugs target "bad" LDL by blocking the liver enzyme needed to produce it, researchers at several drug companies, including Pfizer and Roche, are now racing to create drugs to boost HDL and rev up the body's ability to whisk excess cholesterol out of arteries and to the liver for elimination.

In 2003, Cleveland Clinic researchers found that a newly formulated drug called recombinant ApoA-1 Milano (a synthetic version of a naturally occurring "super" HDL component found among inhabitants of a small coastal town in Italy) significantly reversed hardening of arteries caused by cholesterol in just a matter of weeks. Patients who took ApoA-1 Milano saw benefits about 10 times greater than the plaque removal that statins produce over a period of years. ApoA-1 Milano remains a priority for the Cleveland Clinic, and a version of the drug is under development by Pfizer.

Another HDL-boosting medication in the wings is Pfizer's torcetrapib, which trials have shown raises good cholesterol by as much as 55 percent and may help stop the buildup of plaque. Torcetrapib could be on the market in the next several years.


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