While lifestyle changes remain important, medications are often required to control cholesterol, especially in high-risk individuals. However, misconceptions about cholesterol-lowering medicines remain a challenge in the treatment and management of the condition.
Often, people tend to choose home remedies over drugs. "Many people are worried that this medicine has to be taken lifelong. Lifelong medication is usually required in patients with heart disease or stroke, or those who have undergone procedures such as angioplasty or bypass surgery, as well as in individuals with genetic conditions like familial hypercholesterolaemia. The dosage can be adjusted according to the suggestion of the physician," said Dr Vinod Thomas, head of the department of cardiology at Rajagiri Hospital, Aluva.
There are three classes of drugs used for lowering cholesterol – statins, ezetimibe and bempedoic acid. Statins inhibit cholesterol production in the liver and are highly effective in lowering cholesterol, particularly LDL levels. Ezetimibe is a molecule or drug that prevents the absorption of cholesterol from the intestine. The third molecule is bempedoic acid, a drug that reduces cholesterol by preventing its synthesis in the liver. "Those who take cholesterol-lowering medicines require frequent monitoring of their blood and symptoms as well. Monitoring LDL and HDL levels at three to six month intervals is important. The dosage can then be adjusted to ensure effective treatment and minimise side effects," he said, adding that whenever a patient is taking a medicine, whether used alone or in combination, it is important to monitor the liver function, muscle enzymes and uric acid every three to six months.
According to Dr Sandip R, senior consultant, interventional cardiologist, Aster Medcity, Kochi, most lipid-lowering agents, especially statins, exert their effect by inhibiting the enzyme HMG-CoA reductase, a key regulator of hepatic cholesterol synthesis. "Abrupt discontinuation of these medications can result in a rapid rebound increase in cholesterol levels, thereby negating prior therapeutic benefit," he said.
Stopping the medicine can also lead to complications, including rebound cholesterol elevation. "It is better to stop medications on the advice of the treating physician. Many times, when the cholesterol level is low and when there is no cardiovascular condition, the doctor may stop the medications depending on the values and lifestyle modifications. Stopping statin or cholesterol-lowering medicine suddenly can lead to an increase in the values in two to three months, creating the risk of cardiac events, cholesterol deposits in the arteries and rupture,” Dr Vinod added.