With statins being hailed as the “drug of the century,” some experts have suspected that, within a few years, half of all Americans will be taking some form of this medication. Although statins are the most popular cholesterol-lowering drugs, there are other options. Many of these are used alone or in conjunction with statins.
If medication combined with lifestyle changes doesn’t enable you to reach your LDL goal within three months, your doctor may consider starting you on a second drug to boost results. Combination therapy can help reverse or slow the advance of atherosclerosis and further decrease your risk of a heart attack or death. Also, since both drugs may be prescribed in lower doses than if you were taking either alone, your risk of side effects may decrease.
Become familiar with non-statin drugs, their uses, and the possible side effects. But, as always, consult your doctor before starting any cholesterol-lowering medication.
Cholesterol Absorption Inhibitors
Two organs primarily control cholesterol levels in your blood: the liver, which produces cholesterol and bile acids (used to digest fats), and the intestine, which absorbs cholesterol both from food and from the bile. While statins primarily lower cholesterol by preventing its production in the liver, a new class of drug called cholesterol absorption inhibitors lowers cholesterol by preventing it from being absorbed in the intestine. The first approved drug in this class, Zetia (ezetimibe), hit American markets in 2002.
By itself, Zetia reduced cholesterol about 18 percent in studies. When the drug was paired with statin drugs, cholesterol levels dropped 25 percent more than with statins alone. That’s important, since on average only 60 percent of people who take statins get their cholesterol levels as low as they should. In one study just 19 percent of people taking statins alone reached their cholesterol goal; adding Zetia increased that figure to 72 percent. “Taking 10 milligrams of Zetia with a statin is equivalent to tripling the dose of statins,” says Antonio Gotto, Jr., M.D., dean at Weill Cornell Medical College in New York City. Zetia also has fewer side effects than statins. For instance, it doesn’t appear to cause any muscle problems. The treatment doesn’t come cheaply, however; the wholesale cost for a 30-day supply is $57.90. That’s on top of the cost of the statin. Merck & Co., the maker of the statin Zocor, is testing a pill that combines the two.
Side effects: The most common side effects include back, stomach, and joint pain.
Warnings: Not recommended for use in conjunction with fibrates.
Recommended dose: Zetia is administered as a once-daily tablet in a single 10-milligram strength and is taken with or without food.