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MEDICATIONS OFTEN PRESCRIBED FOR PATIENTS WITH HEART DISEASE: CHOLESTEROL-LOWERING DRUGS
Many drugs can effectively lower cholesterol. As detailed below, cholesterol lowering is one of the cornerstones of the prevention of recurring heart attacks in many patients. The most effective of these drugs are known as statins (technically, HMG CoA reductase inhibitors), substances that decrease the manufacture of cholesterol by the body, in particular “bad cholesterol,” carried in so-called low-density lipoproteins (LDL). These drugs can lower blood cholesterol very substantially, much more powerfully than even the most stringent diets. As well, they are extremely effective at lowering the incidence of death, recurring heart attack and other heart problems in many patients following a heart attack, especially patients with high cholesterol. Recent research studies have also shown that people with “normal cholesterol” who have had a heart attack can also benefit from these drugs. It appears that the ideal cholesterol level for patients with a history of coronary heart disease is in the low-normal, and even below-normal, range. The target value, for the technically minded, is a low-density lipoprotein cholesterol (which is only part of all the cholesterol in the blood) of less than 2.6 mmol/L (equivalent to 98.8 mg/dL). It should be noted that blood cholesterol is reported by most laboratories as “total cholesterol,” for which the normal value is 200 mg/dL or 5.2 mmol/L.
Statins are quite safe, rarely causing muscle or liver problems, but patients can be monitored for both and such problems are reversible if the drug is stopped. The drug is prescribed for lifelong use.
Other cholesterol-lowering drugs such as fibrates and their derivatives are used in particular patient groups such as diabetics, and are probably also effective but less clearly well established to lower heart attack rates than are the statins.
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