subject: Pharmacologic And Life Style Changes To Manage Cholesterol [print this page] Cholesterol management can be brought about in two ways,1)Pharmacologic therapy and 2)Life style modification. Not all the people who have elevated levels of cholesterol need the drug therapy. Life style modification is of prime importance for them. Dietary changes include consumption of low fat diets, avoiding fried and oily items.
The most important part in this life style modification is the increase in physical activity. It can be in the form of calorie burning exercises or body building stuff. About 45 minutes of work out for at least 3 times a week is an ideal training schedule for shedding the extra flab.
Pharmacologic therapy targets few specific high risk groups based on their elevated LDL-cholesterol levels and associated risk factors.
* Individuals whose LDL-cholesterol levels are still high even after potential life style modifications and diet modification are the main people who need pharmacological intervention.
* In the primary prevention of obesity, at least 6 months of dietary therapy should be followed before you move on to drug therapy.
Before instituting the drug therapy, the following things should be checked for; associated metabolic conditions which need immediate correction. Plant stanols and soluble fiber too should be considered. Hypothyroidism is one of the metabolic disorders that require correction before you start with anti obesity treatment.
Primary LDL-cholesterol lowering agents:
Statins: are a group of hypolipidemic agents which are derived from fungus or manufactured synthetically. It has a number of drugs under this category namely simvastatin, rosuvastatin, atorvastatin, etc. All these drugs have different properties but essentially have the same mechanism of action. All of them act by inhibiting the HMG Co-A reductase enzyme which is a rate determining step in the synthesis of cholesterol. This subsequently results in the decrease of intracellular cholesterol.
This is the directly mediated lipid effects of Statins. Apart from these, they have a number of potentially antiatherogenic mechanisms that involve endothelial function, inflammation, antioxidant activity, coagulation, and platelet function and platelet stabilization.
Bile acid sequestrants (resins): These drugs have the tendency to disrupt the enterohepatic circulation of bile acids with increased fecal loss. The resultant decrease in intrahepatic cholesterol results in a secondary increase in the expression of the LDL receptor and increased plasma clearance. These drugs are basically anion exchange resins with active sites coalescing in a large copolymer following oral administration. The drugs in this category are cholestyramine, colestipol and colesevelam.
Another novel class of anti obesity drugs is cholesterol absorption inhibitors. Ezetimibe is the main drug of this class which inhibits the sterol transporter present in the brush border of the villi of the intestinal epithelium.
Primary triglyceride lowering agents: Clofibrate, fenofibrate, gemfibrozil, bezafibrate and ciprofibrate are the drugs used in this class. They act by increasing the activity of lipoprotein lipase with enhanced degradation of triglyceride rich lipoprotein. It also enhances the oxidation of free fatty acids both in the liver and in myocytes in the periphery.
Increased consumption of fish oil is also associated with decreased cholesterol level which is by virtue of the omega-3-fatty acids.
