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15 Cheshvan 5766 - November 16, 2005 | Mordecai Plaut, director Published Weekly
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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

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.

 

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