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Dx High Cholesterol Treatments: Read more..

Treatment of High Cholesterol

2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol: A Fresh Interpretation of Old Evidence

1. The task force found no scientific evidence to support specific treatment goals for either LDL or HDL cholesterol...the treatment targets have been abandoned.

2. When to initiate treatment?
(a). Adults with atherosclerotic heart disease
(b). Adults with diabetes, 40- 75 years of age, LDL 79-189mg/dl
(c). Adults with LDL 190 mg/dl or higher
(d). Adults with 7.5% or greater 10-year risk of atherosclerosis.

The end point is coronary events and strokes, not the level of LDL cholesterol.

Treatment is limited to a [simple] statin therapy.
"As a primary treatment for LDL Cholesterol, the other drugs or classes-- fibrates, niacin, bile acid sequestrants, ezetimibe, and omega-3 fatty acids generally lack consistent or compelling evidence of health benefits necessary for major public health recommendations".

CONCLUSION: "The goal of therapy is not the achievement of a target level of LDL cholesterol, an approach the previously have required multiple drugs. he primary aim of drug therapy is the use of a first-line drug among those likely to benefit, an approach designed to improve the health of the public. the interpretation of the evidence provided by the task force team has helped patients and clinicians move closer to that goal."

Recommendations 2013: Atorvastatin 40mg- 80mg. No recommendation for adding fibrates, niacin, rosumvastatin or ezetimibe.

Recommendations 2015: Ezetimibe under special considerations.

Medications Used in Treatment:
1. Statins: Lipitor®/atorvastatin, Pravachol®/pravastatin, Zocor®/simvastatin, Crestor®/rosuvastatin, Mevacor®/lovastatin, Livalo®/pitavastatin
2. Fibrates: Lofibra® Tricor® Antara®/fenofibrate,Trilipix®/fenofibric acid, Lopid®/gemfibrozil
3. Cholesterol Absorption Inhibitors: Zetia®/ezetimibe,
4. Nicotinic Acids: Niaspan®ER/niacin, Simcor®/niacin-simvastatin
5. Omega-3 Fatty Acids: Lovaza®/fish oil-omega3, Vascepa®/icosapent ethyl
6. Cholesterol Absorption Inhibitor/Statin Combination: Vytorin®/ezetimibe-simvastatin
7. Bile Acid Sequestrants: cholestyramine, Colestid®/colestipol, Welchol®/colesevelam

Slim had a total cholesterol over 500mg/ml before medical therapy. He was found to be hypogonadal and started testosterone replacement with weekly intramuscular injections. His physician was surprised when his total cholesterol was 167mg/ml without cholesterol lowering medications.

*[Editor] The effect of intramuscular testosterone on cholesterol and triglycerides has been noted by TH Jones, M.D. in England. This is independent of testosterone's effect on body composition

*[Editor] A video lecture reviewing the important effects of hormones on Cholesterol can be found here, on-line.

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