Fibric acids. These medications lower LDL a bit but are used mainly to treat high triglyceride and low HDL levels. The most well studied of these agents is gemfibrozil (Lopid). Fenofibrate (Tricor), and other preparations are members of this class. Fibrates are generally well tolerated but can occasionally cause some side effects such as nausea, bloating, gas, and the formation of gallstones. Since these drugs are only somewhat effective in lowering "bad" cholesterol levels, fibrates are often used in conjunction with another drug, such as statins, to reduce LDL levels. These drugs can also cause some muscle discomfort.
Word of caution on estrogens
Estrogen helps to decrease LDL cholesterol levels in postmenopausal women. For a long time, experts in the field of women’s health and heart disease considered estrogen replacement therapy (or hormone replacement therapy) an effective way to reduce a postmenopausal woman’s risk of developing future heart disease. A number of large, well-designed studies have demonstrated however that estrogen replacement does not help lower future risk of heart disease. For some women, especially those that are older, hormone replacement therapy may even increase the risk for developing future manifestations of heart disease. In view of these findings, estrogen or combinations of estrogen and progesterone are no longer recommended to reduce risk in menopausal, or post-menopausal women. In those women undergoing the vasomotor side effects of the change should discuss the treatment with their health care provider. Fortunately, the other medications (e.g. statins) currently available for lowering LDL cholesterol levels appear as equally effective for women as men.
Next steps
Once your "bad" (LDL) cholesterol goal has been reached, your doctor may prescribe treatment to lower your triglycerides, increase your level of "good" (HDL) cholesterol, or both. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a prescribed medication.
Sources
National Heart, Lung, and Blood Institute. National Cholesterol Education Program. High blood cholesterol. What You Need to Know. Accessed January 17, 2002.
National Heart, Lung, and Blood Institute. Coronary heart disease explained. Accessed January 17, 2002.
What you should know about cholesterol. The Aging Female Patient. June 2001, Volume 26 (supplement), pages 49-50.
National Institutes of Health. NCEP Issues Major New Cholesterol Guidelines [press release]. Accessed January 17, 2002.
National Heart, Lung, and Blood Institute. National Cholesterol Education Program. ATP III guidelines at-a-glance. Quick desk reference. Accessed January 17, 2002.
James McKenney; New guidelines for managing hypercholesterolemia. Journal of the American Pharmaceutical Association. July/August 2001, Volume 41, No. 4, pages 596-607.
Joel B. Braunstein, MD, et al; Lipid disorders. Justification of methods and goals of treatment. Chest. September 2001, Volume 120, No. 3, pages 979-988.
Qureshi AI, Suri MF, Guterman LR, Hopkins LN. Ineffective secondary prevention in survivors of cardiovascular events in the US population: Report from the Third National Health and Nutrition Examination Survey. Archives of Internal Medicine. July 9, 2001; Volume 161, No. 13, pages 1621-1628.
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