Articles on Medical Diseases and Conditions

Category: Guide to Preventing and Treating Heart Disease

Essential Information You and Your Family Need to Know about Having a Healthy Heart

  • The DASH Diet

    The National Heart, Lung, and Blood Institute (part of the National Institutes of Health) has developed a comprehensive eating plan called the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet is low in saturated fat, cholesterol, total fat, and sodium. It emphasizes fruits, vegetables, and low-fat dairy foods; it includes whole grain products, ?sh, poultry, and nuts; and it recommends less red meat and fewer sweets. Major studies have demonstrated that the DASH plan works better than other heart-healthy eating plans to help most people reduce their blood pressure. Most people who stick to the plan for a month can signi?cantly lower their blood pressure, and the effect lasts as long as you stay on the plan. The DASH plan also works for people with normal blood pressure who are trying to prevent an increase. In any case, along with following the DASH diet you should make or con- tinue modi?cations to your lifestyle, including exercising and stopping smoking.
    Following the DASH diet may enable some people to go without medication, or to use fewer medications than they otherwise would. However, do not discontinue any medication or lower the dose with- out talking to your doctor ?rst.
    The DASH plan is two-pronged, involving the eating plan itself and

    lowering sodium intake as a means of treating hypertension. The diet can be adapted to different levels of sodium intake, depending on a per- son’s individual sensitivity to salt. The reduction of blood pressure is greatest at the lowest level (1,500 mg or less of dietary sodium per day).
    In many instances, diets or eating plans are based on the ideas or the- ories of one or two people, sometimes doctors but not always. In the case of the DASH diet, you can be assured the bene?ts of the DASH eating plan were proven in two research studies funded by the federal government and conducted in several cities.
    The DASH diet coupled with sodium reduction is a remarkable approach for treatment of high blood pressure for many reasons:
    • It works for a wide variety of people—those with or without high blood pressure, old and young, men and women, blacks and other races, obese or slender, active or inactive.

    • The diet is more effective in lowering blood pressure than other heart-healthy diets, and the low-sodium version is even more effective than other low-sodium diets.
    • The plan works quickly, lowering blood pressure readings in as lit- tle as 2 to 4 weeks.
    • In addition to its effectiveness at lowering blood pressure, it also lowers blood cholesterol levels, another important factor in pre- vention of heart disease (see page 23).
    The DASH eating plan is especially rich in fresh fruits and vegeta- bles (eight or more 1?2-cup servings per day) in part because these foods are low in salt. They are also rich in potassium, calcium, and

    magnesium. Grains and grain products are another major component of the diet (seven to eight servings per day) because they supply energy and ?ber. The plan limits the amount of meat, sweets, and sugary drinks in order to reduce intake of fats and sugars, as well as sodium. The plan teaches you to sharply reduce your salt intake by avoiding processed foods, which are the source of most of the salt that Americans eat.
    If you are on the DASH plan, as with any other diet, the foods that you eat at one meal or over the course of a day may add up to more than the recommended servings. You also might consume more sodium on one day than on another. The important point is that your average for several days or a week should be close to the recommended amounts in order to derive the health bene?t.
    You also need to keep in mind that if your doctor has prescribed medication for your high blood pressure, you should not stop taking it. If you feel that following the DASH diet (or another diet plan) may have lowered your blood pressure, have your blood pressure checked at your doctor’s of?ce and discuss the numbers with him or her.

    Following the DASH Plan

    The abbreviated DASH eating plan shown here gives you an idea of what types of foods are recommended and in what amounts. This plan is based on 2,000 calories per day. Servings can be adjusted depending on your calorie needs and your desired level of sodium intake. You and your doctor can tailor a plan to suit you.

    Cutting Back on Salt and Sodium

    Small amounts of sodium occur naturally in fresh foods, but most processed foods are high in sodium content. Most is added in manufac- turing and processing. Most restaurants add a lot of salt to foods they prepare. The only way to know for sure is to check the nutrition label carefully. You can cut back on sodium substan- tially by remembering a few general tips:
    • Start by eliminating your use of table salt; an herbal salt substitute—available in a variety of flavors—is often helpful.
    • Learn to use spices instead of salt. Flavor your food with herbs, spices, lemon or lime juice, vinegar, or salt-free seasoning blends.
    • When you buy vegetables, choose fresh or frozen without sauce instead of sauced or canned.
    • Rinse canned foods, such as beans or tuna, to remove some of the sodium.
    • Always choose low-salt or no-salt prod- ucts when you can.
    • Buy fresh poultry, fish, and lean meat rather than canned, smoked, or processed forms.

    Limit cured foods (such as bacon or ham), foods in brine (such as pickles, olives, and sauerkraut), and condiments (such as MSG, mustard, ketchup, and barbecue sauce). Limit even low-sodium versions of soy sauce or teriyaki sauce (which contain lots of MSG); measure them as you would table salt.

    • Cook rice, pasta, and hot cereals without salt. Cut back on flavored rice, grain, or pasta mixes; they are loaded with salt.

    • Rely less on frozen dinners; canned soups, broths, and sauces; and bottled salad dressings. You can make a large quantity of something like tomato sauce using a low-salt recipe, and freeze it in smaller amounts for later use. You can make sim- ple vinegar-and-oil salad dressings in small quantities to use for a few days.

    • Most restaurants add a lot of salt to the foods they prepare. When you eat in a restaurant, ask which items can be pre- pared without adding salt. Ask if other spices can be used.

  • Prevention: A Healthier Lifestyle

    By now you’ve gotten the picture: preventing your blood pressure from creeping up, or bringing it down to a desirable level, always begins with healthy choices in many areas of your life. The bene?ts are by no means

    limited to your blood pressure alone; they also improve your heart health, reduce your chances of stroke and kidney disease, and give you an overall sense of well-being. No matter how many predisposing fac- tors for high blood pressure apply to you—being male, being black, having hypertension in your family, being older—you can reduce your blood pressure somewhat with changes in lifestyle. These are the areas to work on:
    • Start eating a low-fat, low-salt diet such as the DASH diet (see below).
    • Lose weight if you are overweight.
    • Exercise regularly.
    • Drink alcohol in moderation.
    • If you smoke, quit.
    • Learn to manage stress.
    • Do not take over-the-counter medications that can raise blood pressure, including decongestants or “energy products.”

  • Treatment Strategies

    Lifestyle changes or medication, or a combination of both, can lower your blood pressure. Lifestyle changes are recommended for everyone with elevated readings of any kind. For many people, the results of losing weight, exercising, limiting salt, and generally adopting a healthy eating plan can be as signi?cant as the use of any single medication. Many different types of medications are available, and different drugs or drug combinations work better for some people. You and your doctor have lots of options, and your treatment will be most successful if you work together to ?nd the treatments that work best for you.
    Your doctor will help you set a target reading and determine how to reach it. Do not hesitate to tell your doctor as much as you can about your eating, smoking, and drinking habits; whether you exercise regu- larly; or what other medications or supplements you take. The more you understand about the factors that contribute to your high blood pressure reading, the more likely you are to bring it down.
    Your doctor will approach your treatment by considering three fac- tors: the blood pressure reading itself; whether there is already some damage to your arteries or other organs; and whether you have other conditions, such as diabetes, that might affect your treatment. If you are still in the prehypertensive category and have no other complications, you may be able to bring your blood pressure down to less than 120/80 mm Hg in a year just by changing your lifestyle (see below).
    If you have stage 1 or stage 2 hypertension without organ damage or complicating conditions, the goal will be to bring your reading down to a prehypertensive level. Doctors have found that many people will need to take more than one medication to reach their target blood pressure. If you are at stage 1, lifestyle changes are an essential ?rst step. If lifestyle changes fail to achieve your target blood pressure, your doctor may subsequently prescribe a diuretic and maybe other drugs as well (see page 59). If you are in stage 2 hypertension (a reading of 160/100 mm Hg or higher) without complications, you will almost certainly need to take more than one drug, one of which will probably be a diuretic, to achieve good blood pressure control. But continue making lifestyle modifications—improvements in your diet and exercise habits—while taking the medications.
    If you have high blood pressure (stage 1 or stage 2), and you have another condition—for instance, you have already had a heart attack, you are at high risk for developing coronary artery disease (see page
    211), or you have kidney disease or diabetes—your doctor will prescribe medications that have proven to be bene?cial for your conditions. Of course, a healthier lifestyle is a must as well. With these conditions, achieving a blood pressure goal as low as 130/80 mm Hg may be the wisest course.
    Warning: Be alert for any signs of stroke. These include headache, confusion, weakness, numbness, dif?culty speaking, slurred speech, or weakness on one side of the body. If you have any of these signs, seek emergency treatment at a hospital promptly.
    No matter what your blood pressure reading, personal medical situ- ation, history, or treatment plan, sticking to the treatment is the only way to reach your goal. That goal starts with a number, but it is much more than that.

  • What Your Blood Pressure Reading Means

    National guidelines place your blood pressure into one of three categories: normal, prehypertensive, or hypertensive . Normal blood pressure is considered to be less than 120/80 mm Hg. If your blood pressure is equal to or higher than this for two or more readings on different days, you are classi?ed as either prehypertensive or hypertensive. The guidelines, based on the impact of high blood pressure, are aimed at getting you and your doctor started as soon as possible to bring your blood pressure down to healthy levels.

    Prehypertension

    If you have prehypertension (with readings consistently 120/80 or higher but below 140/90), you are in a group that used to be called high normal. Almost one-third of the U.S. adult population now falls into the prehypertensive category. The most recent guidelines identify this range as a warning zone, because people in it are considerably more likely to develop true hypertension later in life. The designation of “prehypertension” re?ects evidence showing that the risk of heart disease actually begins to climb at readings above 115/75 mm Hg. From that level, every increase of 20/10 mm Hg doubles the risk of death from heart disease. Changing to a healthy lifestyle is the only way to prevent this progression into high blood pressure.
    If you are in the prehypertensive category, you have a good reason to get motivated to start managing your blood pressure immediately through nondrug treatment. Even though you do not have high blood pressure, you can start making changes in your lifestyle that will bring your readings down to a lower, healthier level without medication; see pages 46–47. Lifestyle changes alone are likely to help you at this early stage. You and your doctor can start talking about setting priorities and taking de?nite steps to form some new habits.
    Start with your eating habits. Eat 8 or more servings of fruits and vegetables each day and less fat and saturated fat. Limit salt intake to less than 1,500 mg per day, or about 3?5 of a teaspoon of salt. If you are overweight, losing weight can be important. The bene?ts of weight reduction start early, with a loss of as little as 10 to 15 pounds, because with every 3 pounds you lose, there is an average corresponding drop of about 2 mm Hg in your systolic pressure. Build just 30 minutes of exer- cise into your schedule, at least ?ve days a week. Limit your alcohol intake to no more than one drink per day for women and two drinks for men (whether hard liquor, wine, or beer). These changes may not seem easy at ?rst, but they will pay big dividends if they mean you will not have to take medications.

    Systolic Hypertension

    The guidelines also say that systolic pressure (the top number) of more than 140 mm Hg should be treated regardless of the diastolic level (bottom number). Either your systolic or your diastolic number—or both—may be elevated. As you get older, your diastolic pressure usually decreases and the systolic pressure begins to rise.
    If only your systolic reading is high and your diastolic reading is nor- mal, you have the most common form of high blood pressure. It is called isolated systolic hypertension, and new guidelines emphasize its importance. Treating isolated systolic hypertension early, with lifestyle changes and medications if necessary, reduces the future risk of devel- oping heart disease and stroke. For example, with each reduction of 5 mm Hg in your systolic blood pressure, death from stroke is reduced about 14 percent and from heart disease by 9 percent. The potential impact on your quality of life is enormous.

  • A Diagnosis of High Blood Pressure

    If your doctor diagnoses you as having hypertension, your ?rst reaction may be surprise, because you feel ?ne. That is not unusual. High blood pressure usually has no symptoms, and many people go for years with- out knowing they have it. Your heart, brain, and kidneys can handle increased pressure for a long time, and you can live for many years with- out any symptoms or discomfort. But getting treatment to lower your blood pressure is extremely important, because hypertension is a major risk factor for serious disease.
    High blood pressure can affect your body in six main ways:
    • Atherosclerosis Uncontrolled high blood pressure can cause the walls of the arteries to thicken and become less ?exible. Fatty deposits are more likely to form on the rigid walls, and the chan- nel in the artery narrows.
    • Stroke If a blood clot forms and lodges in a stiffened artery trav- eling toward your brain, it can cause a stroke. If the clot is in an artery that supplies blood to your heart, it can cause a heart attack. High blood pressure may also cause a stroke if a weakened blood vessel ruptures.
    • Aortic aneurysm High blood pressure contributes to the widening of a weakened aorta, and an aortic aneurysm can be fatal if untreated.
    • Enlarged heart High blood pressure forces your heart to work harder. Over time, the muscle thickens and stiffens, or the heart muscle may enlarge and weaken. As it weakens, it pumps less ef?- ciently, and you will feel weak and tired more often. Fluid may back up and congest the lung tissue.
    • Kidney damage The kidneys ?lter waste products from the blood. If the vessels of the kidneys are thickened and damaged,

    your kidneys will begin to fail, causing waste to build up in the bloodstream. Treatment for kid- ney failure requires dialysis, a mechanical means of ?ltering the blood.
    • Eye damage If you have diabetes, high blood pressure can cause the capillaries in your eyes to bleed. This condition, called retinopathy, can eventually lead to blindness.

    These potential complications of blood pressure are genuinely alarming, but remember, blood pressure can be significantly lowered with treatment. The great decreases in death from heart disease and stroke in this country in recent years are partly the result of success- ful treatment of high blood pressure, speci?cally:
    • The incidence of stroke can be reduced by 35 to
    50 percent.
    • The incidence of heart attack can be decreased by
    20 to 25 percent.
    • The incidence of heart failure can be decreased by more than 50 percent.

    The Silent Disease

    Some people think that high blood pressure causes symptoms such as nervousness, sweating, or difficulty sleeping. None of these is a symptom of hypertension, and these are not necessarily related. Many people who look and feel perfectly fit have high blood pressure, while some peo- ple who are overweight, smoke, or show other risk factors for heart disease have normal blood pressure. That’s why the only way to know for sure if you have high blood pressure is to be tested.
    A person with severe, un- treated high blood pressure may have headaches, dizziness, or nosebleeds, but probably not until the condition has reached an advanced, life-threatening stage. Again, even many people with uncontrolled high blood pressure still do not have any of these symptoms. Getting tested and getting treatment are the only answers.

  • Factors That Increase Your Risk for High Blood Pressure

    The vast majority of people—90 to 95 percent—with high blood pres- sure have a type called essential or primary hypertension, which means that the exact cause or causes are unknown. In other people, high blood pressure may occur because of an underlying problem such as a blood vessel abnormality, kidney disease, or thyroid disease.
    However, there are well-known factors that increase your risk of developing high blood pressure or tend to worsen an existing condition. If one or more of these risk factors applies to you, you are at greater risk.
    You may have these factors contributing to hypertension, some of which are not within your control:
    • Gender Men are somewhat more likely to develop high blood pressure until age 70 than women, but after age 70 women are at greater risk.
    • Race Blacks develop high blood pressure more often than whites, and it tends to develop earlier and be more severe.
    • Family history If your parents or siblings have high blood pressure, you are more likely to develop it.
    • Age Generally, the likelihood that you have high blood pressure increases as you age. However, it is not a normal part of aging, and some people never develop it. Men tend to develop it after age
    . Women are more likely to have it after menopause. Other factors are within your control:
    • Weight As your body weight increases, your blood pressure rises.
    • Lack of exercise An inactive lifestyle increases your likelihood of being overweight and of having high blood pressure.
    • Salt Many people with high blood pressure are sensitive to salt;
    eating too much salt raises blood pressure in most people.

    • Unhealthy diet A diet low in fruits and vegetables or high in fat increases your risk of developing high blood pressure.
    • Drinking too much alcohol Heavy regular intake of alcohol can increase blood pressure signi?cantly.
    • Medication Over-the-counter decongestants and nutritional supplements may increase blood pressure. Birth control pills may also increase blood pressure in some women.

  • Measuring Blood Pressure

    Because your heart pumps in pulses, your blood pressure naturally rises and falls with each surge, even when you are at rest. Blood pressure peaks when the heart’s ventricles contract (the pumping or systolic phase) and falls to its lowest level after the contractions (the resting or diastolic phase). To accurately assess blood pressure, you need a reading for both phases, systolic and diastolic.
    You have probably had your blood pressure measured many times—just about every time you have any kind of a physical checkup. The familiar instrument your doctor uses, the blood pressure cuff and pressure gauge, has an unfamiliar name: sphygmomanometer.

    This instrument works by measuring how high the pressure in an artery in your arm can raise a column of mercury, so the measurement is expressed in millimeters of mercury (mm Hg). The reading is always expressed with the sys- tolic (pumping) pressure on the top and the diastolic (resting) pressure on the bottom. A healthy reading in an adult is less than 120/80 mm Hg.

    6

    Checking your blood pressure
    If you have been diagnosed with high blood pressure, your doctor will encourage you to acquire and use a device for monitoring your own blood pressure at home. This is especially important if you are taking new medica- tions or if your drug dose has been changed.

    Healthy adults should have their blood pressure checked at least every two years. If you have not had it checked recently, make an appointment to do so soon. It is an easy, pain- less, and inexpensive test. You can have a reli- able blood pressure check in many different settings—a hospital clinic, a nurse’s office, a company clinic. You may be tempted to consult the free blood pressure testing units that you see at some drugstores or shopping malls, but you should not rely on them alone. They may not be checked regularly for accuracy, and they may suffer from wear and tear. If you try out one of these machines, record the reading and then compare it with a read- ing from your doctor’s of?ce.
    When you know you are going to have your blood pressure checked, you can do several things to help ensure an accurate reading:
    • Do not drink coffee or smoke 30 minutes before the check; both caffeine and nicotine raise your blood pressure temporarily.
    • Try to arrive at your doctor’s of?ce at least 5 minutes before the check and sit comfortably, so you are not feeling hurried.
    • Wear short sleeves.
    Some people have a response called “white-coat hypertension,” which means that their blood pressure actually rises when they are undergoing a checkup. This phenomenon is quite common. If you or your doctor thinks you may be responding this way, you can try having your blood pressure checked in another setting, or you can buy a blood pressure device to do your own reading at home (see page 55). Your doctor can compare your home and of?ce readings to get a clearer idea of your average blood pressure.

    If your doctor is concerned about your blood pressure, he or she will initially take measurements on several different days, because there are so many normal variations. It is not unusual to have a high measure- ment on a single day and then have it return to normal when you are tested again. Your doctor will probably not diagnose you as having high blood pressure unless your measurement is high on two or more read- ings taken at separate visits.
    If your readings are 120/80 mm Hg or greater over several different days, your doctor will evaluate your condition in other ways. He or she will take a detailed medical history to determine if you have other risk factors for heart disease or stroke. He or she may use an instrument called an ophthalmoscope to look at the blood vessels in your eyes. This is the only place in your body where a doctor can directly look at your blood vessels to see if they are damaged. Thickened, narrowed, or burst vessels in the eyes can be another indication of high blood pressure.

    If your doctor diagnoses high blood pressure, he or she may order several tests. These tests are used to determine if there is an underlying cause of high blood pressure, to detect any organ damage, to assess other risk factors for heart disease, and to identify other conditions that might affect the course of treatment.
    In addition to conducting blood tests, your doctor also might order a chest X-ray (see page
    128) to check the size and condition of your heart and lungs. An electrocardiogram (ECG; see page 122) may provide evidence about whether your heart is enlarged and if there is any damage to the heart muscle. It is not uncommon to have a routine ECG in the doc- tor’s office that reveals signs of an enlarged heart or a previously unknown heart attack.
    You may have blood and urine tests to deter- mine if your kidneys are working properly or if there are any underlying problems causing the blood pressure to rise. In rare cases, people may have an intravenous pyelography, a procedure that examines kidney function by injecting a harmless dye into an artery and watching its passage on an X-ray screen. A few people may need more advanced tests to evaluate blood ?ow, such as an MRI (magnetic resonance imaging; see page 141), a nuclear scan stress test (see page 135), or a coronary angiogram echocardiogram.

    How Blood Pressure
    Testing Works

    The instrument used to test your blood pressure has four parts: an inflatable cuff, a pump, a pressure gauge, and a stethoscope. When you have a checkup, the tester wraps the cuff around your arm and inflates it so that the pressure in the cuff is higher than the pressure in your artery. The flow of blood is momentarily stopped and your heart- beat is inaudible through the stetho- scope. As the cuff deflates, the tester checks the pressure gauge as soon as he or she hears your heartbeat again. At this moment, the pressure in the cuff is the same as the pressure in your artery, and the reading is your systolic pres- sure. As the cuff deflates further, the tester listens for the moment the sound of the heartbeat disappears again— when the cuff pressure goes below the resting pressure in your artery. This reading is your diastolic pressure.

  • Just What Is Blood Pressure?

    As your heart pumps blood through your arteries, the moving blood exerts pressure against the arterial walls. This force is measured as blood pressure. Your blood pressure rises normally in response to many everyday in?uences, such as exercise, caffeine, medications, or stressful situations, and then returns to a normal level. But if the pressure in your arteries is consistently higher than is healthy, your heart needs to work harder and your blood vessels and heart can become damaged.
    Blood pressure is determined by the force of the heart as it contracts (systole) and the resistance of the main arteries and smaller arteries (called arterioles) to blood ?ow. The other force is diastole or relax- ation. Healthy arterioles are muscular and highly elastic and stretch eas- ily as blood is pumped into them. Their ready squeezing action keeps blood moving. When the heart is pumping more blood, as during exer- cise, many of the arterioles expand to accommodate greater blood ?ow. Healthy arteries are also wide open, clear of any buildup or obstruction so that blood can ?ow freely. Diseased arteries lose their elasticity, and pressure rises.

  • High Blood Pressure

    Today, high blood pressure (hypertension) is probably the most modi?able common major risk factor for heart disease and stroke in
    the United States. About one out of every three American adults has high blood pressure, and the numbers are increasing as our country ages and becomes more overweight. High blood pressure can cause damage to the heart, blood vessels, and, over time, the kidneys.
    Current ?ndings suggest that high blood pressure is an even more widespread health problem than previously understood. Today, at age 55, even a person who does not yet have high blood pressure has about a 90 percent chance of developing it at some point in his or her life. Further- more, recent evidence shows that the damage to arteries that leads to heart disease, stroke, and other major problems begins at blood pressure levels that doctors once considered normal. Independent of other risk factors such as high blood cholesterol level or being overweight, the higher your blood pressure, the higher your chance of heart disease or stroke.
    About one third of Americans who have high blood pressure don’t know it. Hypertension is often called the silent killer because by itself it does not cause symptoms, but over time it can cause stroke, heart attack, and kidney failure, any of which can be fatal. Most people who know they have the condition still do not have it under control; that is, their blood pressure levels are higher than is considered healthy.

    These numbers make clear how important it is to get your blood pressure checked, and to start as early as possible to prevent or treat the development of high blood pressure. The very good news is that it’s easy to be tested and treated. Even better, high blood pressure is largely preventable.

  • Medications to Lower Your Cholesterol

    If a healthful diet, regular exercise, and weight loss do not bring your total cholesterol or LDL levels down to your target, your doctor may prescribe a cholesterol-lowering medication, or a combination of more than one. You also may need to take these drugs if you have even mod- erately high cholesterol and also have a medical condition such as heart disease, thyroid disease (hypothyroidism), diabetes, or kidney disease. Your doctor will consider your age and family history as well as your risk status (see box, page 21) to determine what target cholesterol level is appropriate for you, and whether drugs are needed.
    If you are at high risk or very high risk, your doctor may recommend drugs to lower your LDL cholesterol aggressively, to less than 70 mg/dL. If you are at moderate risk, drugs will probably be recom- mended if your LDL is higher than 130. On the other hand, drug ther- apy is not necessarily appropriate for everyone—for example, for frail elderly people who have high cholesterol levels but who do not have heart disease or diabetes.
    It is important to discuss your medical history and lifestyle with your doctor before you begin taking cholesterol-lowering medications. Tell him or her about any other medications, vitamins, or herbal supple- ments you are taking. (Some drugs can interact with one another in a harmful way.) You and your doctor will also need to talk about what other illnesses you have, particularly if you have had liver problems, diabetes, gout, ulcers, or kidney or gallbladder disease, because some cholesterol-lowering medications can make these problems worse.

    There are ?ve main types of cholesterol-lowering drugs, each with a different method of action in your body.
    • Statins (or HMG CoA reductase inhibitors). The most com- monly prescribed cholesterol-lowering drugs are statins, which block the activity of an enzyme (HMG CoA reductase) in your body that helps you make cholesterol. As your cholesterol produc- tion slows down, your liver makes more LDL receptors. These receptors attract LDL particles in your blood and further lower your LDL levels. In addition to lowering cholesterol levels, statins may have other positive effects such as reducing in?ammation and improving the working of the cells that line the blood vessels. Many people can take statins without dif?culty, but the drugs can cause side effects in some people such as constipation, abdominal pain, or cramps. These side effects are likely to lessen or disappear the longer you take the drug. Statins are usually taken at bedtime, because the body produces more cholesterol in the evening. If you develop any muscle cramps or muscle weakness, alert your physi- cian because this might represent a more serious side effect. Mus- cle aches affect both sides of the body and commonly occur in large muscle groups such as those in the shoulders and the thighs. While taking statins, you need to have a blood test periodically to make sure your liver is not being affected by the drugs. Examples of statins include lovastatin, pravastatin, simvastatin, atorvastatin, and rosuvastatin.

    • Bile acid sequestrants (or resins). Your liver uses cholesterol to produce bile, an acid involved in the digestive process. These drugs bind chemically to bile in the intestine, preventing the bile from being reabsorbed; the bile is subsequently eliminated from the body in the stool. Your liver responds by using more choles- terol, which is a building block of bile, to make more bile. As a result, less cholesterol is left to enter your bloodstream. Bile acid sequestrants may have side effects such as constipation, stomach bloating, upset stomach, or heartburn. Examples of bile acid sequestrants are cholestyramine, colestipol, and colesevelam.

    • Nicotinic acid (niacin). This product is a form of vitamin B that slows the liver’s production of certain components of LDL. It also can lower triglycerides and raise HDL. Possible side effects of nicotinic acid include ?ushing, upset stomach, a gout attack, or abnormal heart rhythms. The ?ushing can be reduced by taking an aspirin 30 minutes before taking the nicotinic acid. If niacin is prescribed, it should be started at low doses and increased gradu- ally. Alcohol should not be consumed for two hours after taking niacin because of a possible increase in ?ushing. Episodes of ?ush- ing may be curbed with a chewable adult-dose aspirin or liquid ibuprofen (like aspirin, a nonsteroidal in?ammatory product).

    • Fibric acid derivatives (or fibrates). These drugs inhibit the production of the particles that may contain triglycerides and also stimulate enzymes that break down fats. Fibric acid derivatives may be prescribed to lower your triglycerides. They can cause side effects such as upset stomach, vomiting, gas, or headache, and they may increase the risk of gallstones. Examples of ?brates include gem?brozil and feno?brate.

    • Cholesterol absorption inhibitors. This is a newer class of drugs that inhibits the uptake of cholesterol by the small intestine. Eze- timibe is the ?rst drug developed in this category, and it can be given with any statin. Currently, the statin drug simvastatin is manufac- tured with ezetimibe in a combination pill. Ezetimibe is often pre- scribed for people with high cholesterol levels who cannot take a statin. Side effects may include stomach pain, feeling tired, or aller- gic reactions such as swelling in your throat. Inform your doctor promptly if these side effects occur.

    You may not have any side effects at all from your medications, or you may experience some that are not mentioned here. Be sure to tell your doctor immediately if you think you might be experiencing side effects from the drugs you are taking. But don’t stop taking them without checking with your doctor ?rst; going off medication abruptly can make your condition worse. These drugs should not be used during pregnancy (with the exception of bile acid sequestrants) because the effects on developing fetuses are not yet known.