The voluntary withdrawal of cerivastatin (Baycol), a statin linked to about 100 deaths worldwide from a severe muscle deterioration condition called rhabdomyolysis, had raised concerns about the safety of statins. However, the largest study of statins, released in November by investigators in the United Kingdom, concluded that statins are safe and can benefit men and women, people of all ages, diabetics, and even those with normal cholesterol levels. The FDA however after long discussion has felt that they should not be available over the counter without a doctor’s prescription as cholesterol levels and liver function tests need to be checked on a regular basis.
Bile acid sequestrants. These drugs also lower LDL levels and can be used alone or in combination with statin drugs. This type of drug includes cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol). Bile acid sequestrants keep the body from the body from absorbing or reabsorbing cholesterol and can be unpalatable and cause intolerable gastrointestinal effects (such as bloating, gas, abdominal pain, and constipation) at the level of dosage required to lower LDL cholesterol levels. Because of these potential side effects, these drugs are mostly used in combination with statins when further lowering of total cholesterol or LDL cholesterol is needed. They also can be used alone for patients who cannot take statins. A newer drug, ezetemibe has been very popular and has also been combined with simvastatin to lower cholesterol in the hope that it would further lower the risk of cardiovascular events. To this point the combination appears disappointing in clinical studies (Vytorin).
Niacin (nicotinic acid). Niacin, a B vitamin, lowers LDL and triglyceride levels, and raises HDL cholesterol levels. It is the most effective drug available for raising HDL cholesterol levels. Side effects include hot flashes, nausea, indigestion, gas, and high blood sugar. As with statins, some combination pills have also been approved with other medications. High doses of niacin can also cause liver abnormalities. Multiple preparations promise lesser side effects but not all deliver.
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