Cholesterol-lowering drugs

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Who should take lipid-lowering drugs?

At risk groups for cardiovascular disease, e.g. familial hypercholesterolaemia, diabetics over 40, HTN.

Q-risk >20%

For primary and secondary prevention of cardiovascular disease
What conservative measures should be advised when trying to lower lipid levels?

Diet, exercise, smoking cessation, reduced alcohol consumption and weight management
What other drugs should be considered when prescribing lipid-lowering drugs?

Low dose aspirin

Anti-hypertensives
What options are there for lowering lipid levels?
- Statins
- Fibrates
- Bile acid sequestrant
- Nicotinic acid
What are the cholesterol targets when prescribing lipid-lowering drugs?

Total cholesterol <4mmol/l

LDL cholesterol <2mmol/l
How do statins work?

Competitively inhibits HMG CoA in the liver (cholesterol synthesis pathway)
When should you be cautious when prescribing statins?

Ensure hypothyroidism is well-managed

History of liver disease or alcoholism (measure LFTs at 3/12 and 12/12)

Risj of myopathy or rhabdomyolysis

Pregnancy and breast-feeding
What are the side effects of statins?

Myalgia, Myopathy, Myositis, Rhabdomyolysis

Rarely: hepatitis, jaundice, pancreatitis and liver failure

GI disturbance, Sleep affected, headaches, dizziness
What counsel should you give a patient before they start statins?

To report unexplained muscle pain, tenderness or weakness promptly
Give examples of statins

Atorvastatin (lipitor)

Simvastatin