Medications for High Cholesterol

Sometimes, despite making changes to their diet, some people continue to have excessive serum cholesterol concentrations. This situation occurs in patients with the nephrotic syndrome, and in those diabetics who have relatively high rates of protein excretion. These high serum cholesterol levels usually can be treated readily in patients with and without renal failure, including people with diabetes, by the administration of a statin drug. These drugs are just as effective in renal disease as in its absence, and no more toxic. They are being used more and more widely, and seem to have other beneficial effects; some may reduce the incidence of Alzheimer's disease, and some may reduce the incidence of osteoporosis.

If you're taking a statin, your blood should be tested for signs of liver damage at regular intervals; if liver tests become abnormal (at least twice the upper limit of normal), withdrawal of the offending drug and its replacement by another of the same class often is effective, and no clinical liver toxicity results.

Also, muscle damage can occur from statins and can lead to the release into the blood of a protein from damaged muscle, myoglobin, that can cause the kidneys to shut down entirely. This form of acute renal failure has caused the deaths of a number of patients and recently has led to the withdrawal from the market of one of the statins, Baycol. Muscle pain is the first sign of this condition. It also can be detected by monitoring the blood level of an enzyme from muscle called creatine kinase, but this test is not used much for monitoring purposes; muscle pain is more likely to signal this problem.

Despite these dangers, the consensus at present is that statins are worth the risk for people with high levels of cholesterol despite an appropriate diet, and may even be advisable for people whose cholesterol is within normal limits. Clearly people on these drugs should be closely monitored and should be told to quit the drugs if their muscles start to hurt.

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