Director, Emergency Services, Bikur Cholim Hospital
Someone sent me an interesting report on the use of statins
for cholesterol. Cholesterol is not my strong point, but I
will tell you what I know.
Cholesterol is produced by the liver and is absorbed by the
colon. Most foods have very little if any cholesterol (eggs
are the exception) so the body makes its own — usually
through the absorption of fat. Cholesterol is a building
block to all cells in the body and for hormones — the
most famous being steroids. The cholesterol production line
can go haywire, and these folks will have a high
cholesterol.
Why is that bad? Because this substance will clog up arteries
and can cause low blood flow states that result in heart
attacks and stroke. Cholesterol comes in three types: HDL,
the good cholesterol which actually protects against heart
attacks, LDL, and VLDL. The last two are bad. Triglycerides
are also bad. These are just fat globules floating around in
the blood. Niacin is a great lowering agent, but it causes
flushing and is poorly tolerated. There are resins that
absorb well too, but they cause flatulence.
In 1987, Mevacor came out. It was the first statin, a
medication that lowered cholesterol by blocking the enzyme
that created it. These drugs were improved and became very
economical, but the article that was sent to me questioned
their effectiveness at this point. I do not know what to say.
I take a wait and see attitude. Exercise and lowering your
weight will definitely help.
Just remember, all statins can cause some minor muscle
damage, but it may be enough to cause a rise in CPK —
an enzyme which is also found in the heart — and may
cause confusion as to whether there is a heart attack.
Plavix is a good drug. It lowers the risk of heart attack
with a lot less bleeding than aspirin. But it is very
expensive, and as time goes on, we are having problems
justifying the cost. There are some good alternatives. For
example: aspirin + Plavix is great to prevent stroke, but
Aspirin + Cardoxin (in America Persantin) — is as good
or even better, and is much, much cheaper. The medicine does
work, but you will need a Kuppah approval to get it. Write me
in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Seroxat is a superior antidepressant with very
few side effects, I have seen many people returned to normal
living through the use of this drug for depression. It can
make a difference.
