Cholesterol - reducing the risks

Many people with type I and type 2 diabetes need to take medication to lower their cholesterol. There are a number of medications available that will do this effectively. The two major ones are the statins and the fibrates.


What is cholesterol and why is it important?
Everyone has heard about cholesterol and most people think it is bad for you. This is not true as our bodies need cholesterol and it is vital for building new cells, making essential hormones and keeping our nerves healthy. Our livers usually make enough cholesterol for our needs, and it is having too much cholesterol that is bad for you. The extra cholesterol we get comes from our food. Some foods are particularly high in cholesterol and it is best to avoid eating too much of these if you have high cholesterol levels or other risk factors for heart disease such as diabetes. Milk, eggs and meat are foods that are particularly high in cholesterol. Special proteins called lipoproteins in our blood are designed to take fat around our body. If they have a lot of fat they are called LDL and those with less fat are called HDL.

If we have too much cholesterol, then we will have a lot of LDL-cholesterol and if we have lower levels then we have more HDLcholesterol. Having a lot of LDL-cholesterol puts you at a greater risk of getting problems with your heart. This is because cholesterol and other fats called triglycerides are sticky and clog up your arteries by sticking to their walls. Then your heart muscle gets less oxygen, which is carried in the blood, and has to work harder. This can cause your heart to over-strain itself and you can get a heart attack.


What are the ideal cholesterol levels for someone who has diabetes?

• Total cholesterol 4.5 mmol/l or less
• HDL cholesterol 1 mmol/l or less
• LDL cholesterol 2.5 mmol/l or less
• Triglyceride 1.8 mmol/l or less


Why do we need low cholesterol?
Having low cholesterol or specifically less of the ‘bad’ type called LDL-cholesterol reduces the risk of having a heart attack or stroke. It is particularly important for those who have had previous heart problems and those that are at higher risk than normal.

There are a number of factors that put you at higher risk:

• Being a smoker
• High cholesterol levels
• High blood pressure
• Being overweight
• Having diabetes
• Not taking enough exercise
• A previous heart-attack or stroke
• A family history of heart disease
• Your age and gender – the older you are the greater the risk and males are at greater risk than females.

If you have diabetes and also have one or more risk factors, your risk of heart disease goes up. So if you have diabetes, it is extremely important that you keep your cholesterol levels low.

The most important ways to reduce the level of ‘bad’ cholesterol in your body include:

• Having a healthy diet
• Exercise
• Taking any medications your GP prescribes for you.

The best way is to do all three and not just rely on your medication alone.

In theory, there are ideal target levels of cholesterol, but these are not always achievable or practical. Your doctor will set your own individual goals tailored for you. It is important to remember that even small reductions in your cholesterol levels can have a profound effect on your well-being.


What are statins?
Statins are the most commonly prescribed cholesterol lowering drugs and they interfere with how the body makes cholesterol. They are very effective drugs at reducing your risk of heart trouble and reduce the amount of total cholesterol and importantly the amount of ‘bad’ cholesterol.

Some examples of statins include:

• Lipitor (atorvastatin)
• Lipostat (pravastatin)
• Zocor (simvastatin)
• Crestor (rosuvastatin)
• Lescol (fluvastatin).

Statins are generally considered pretty safe drugs with most people suffering mild and transient side effects that usually go away after the first few weeks. Side effects can include stomach pain, nausea and myopathy (muscle pain). Muscle pains are rare but if you get them then you need to tell your doctor as you may need to stop the medication.

Your doctor will recommend some liver tests when you start on statins and during treatment.

Those with liver disease or who drink too much alcohol are at particular risk if they take statins. Statins are not given to women during pregnancy or who are breastfeeding.

Statins can also be given together with other drugs to help lower your ‘bad’ lipids. Your doctor will decide if you need to do this depending on your risk, how well you are doing and how important it is to lower your cholesterol levels to reduce the risk to your heart. In some cases statins are given in combination with niacin (for example Advicor). Niacin is a vitamin B complex, which lowers LDL-cholesterol and increases HDL-cholesterol. Niacin can be taken as a nutritional supplement, but it is better not to take it unless it is prescribed by your doctor.

Other drugs that are given include ones that block cholesterol absorption from your food (for example Ezetrol (ezetimibe)) and it can be given in combination with a statin (Inegy (simvastatin and ezetimibe).

Drugs that block bile acid reabsorption also lower cholesterol (for example Colestid (colestipol) and Questran (cholestyramine)). Bile acids, which are full of cholesterol, are secreted into your intestine to help break down fats in your food. By blocking them from going back into your bloodstream, the drugs reduce your total cholesterol levels.


What are fibrates?
The other major class of cholesterol lowering drugs are the fibrates. It is not known exactly how they work, but they are thought to interfere with cholesterol absorption in some way.

Fibrates decrease triglyceride levels and increase HDL cholesterol and slightly reduce LDL cholesterol. They can be given with statins or other cholesterol-lowering drugs. Side effects include mild stomach pain and muscle pain.

They should not be taken during pregnancy or by anyone with problems with their liver or kidney. Some examples of fibrates include Tricor and Lipantil (fenofibrate), Lopid (gemfibrozil) and Atromid-S (clofibrate).


APP/KOL/AC 10/01/2008

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Volume 5 Issue 4 Winter 07/08 Diabetes Ireland Magazine

Last updated: January 2008