cholesterol-lowering agents

Because diabetes is such a significant risk factor for the premature development of vascular disease (such as strokes, heart attacks or poor circulation to the legs - "peripheral vascular disease)" - we must aggressively work to reduce any and all other risk factors that may be present. That is why measures such as following a healthy diet, quitting smoking, confining alcohol to no more than moderate amounts, etcetera is so important. That is also why it is so crucial to have excellent cholesterol levels. Dietary modification and exercise are certainly helpful at getting your cholesterol (and triglycerides) in order, but unfortunately are not usually enough to get the results down to an ideal level; as such, we often have to resort to medication.

There are several groups of drugs to improve cholesterol (and triglyceride-that is, "fats") levels. As with oral hypoglycemic agents these groups (or classes) have different and complementary modes of action and hence people with problematic cholesterol (and triglyceride) levels not infrequently have to take more than one drug to achieve optimal levels.

The types of drugs available are:

Statins [e.g., atorvastatin (Lipitor), fluvastatin (Mevacor), lovastatin (Lescol), pravastatin (Pravachol), rosouvastatin (Crestor), simvastatin (Zocor)]

Fibrates (e.g., fenofibrate (Lipidil, Lopid)

Niacin

Ezetimibe ("Zetia" in the U.S.; "Ezetrol" in Canada)

Binding Resins [e.g., cholestyramine (Questran)]

They each have their own plusses and minuses. They vary in their potency, their side-effect profile and so on. Statins are usually the first choice. They tend to be tolerated well, but sometimes can cause muscle aching. Fibrates are a good alternative, but they too can, on occasion, cause sore muscles. Combining agents from different groups is often helpful and in this regard, ezetimibe works particularly well when given in combination with a statin. Incidentally, most statins should, in general, be taken in the evening as that way their peak effect matches the time that the liver is maximally producing cholesterol and better helps to combat this.

An important point worth noting about statins: A study from early 2000 (in a leading heart journal called Circulation) has shown that if you are on a statin, it should NOT be stopped if you have the misfortune of being admitted to hospital with a heart attack as it would increase your risk of developing ADDITIONAL heart problems whilst in hospital by THREE FOLD. The lead author of the study is quoted as saying: "The message to physicians is: Don't stop statins...Withdrawal of statin therapy shortly after the onset of symptoms completely eliminated the protective effect of statins in coronary heart disease patients hospitalized with severe chest pain." If you or someone you know is on a statin, pass the message along. (Of course, hopefully the attending doctor will already know this, but as you no doubt are well aware, it is always a good idea to be an "informed consumer)." Incidentally, this study was not specifically for people with diabetes, but no doubt the same results would apply to this group.

The Heart Protection Study suggests that virtually every person with diabetes over the age of forty should be on statin therapy even if your cholesterol is perfectly normal. Their study is very compelling, indeed.