Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

How Can I Control My Cholesterol Levels?

Monday, 12 April 2010 09:34 AM

Question: I am unable to take any statin drugs because they induce severe muscle cramps. My current cholesterol level is 268. My HDL is 45, LDL is 176, and triglyceride level is 233. What can I do to control this problem?

Dr. Hibberd's Answer:

Statin drugs have greatly simplified the management of cholesterol disorders, though they need periodic supervision with liver function tests. I advise most patients to use CoQ10 100 mg (up to 200 mg) daily since this co-enzyme is depleted by statin use. Muscle aches are definitely more common in patients who do not use CoQ10.

Once muscle aches occur, it is very important to stop the statin, and check the CPK level (creatine phosphokinase) for any elevation that may be associated with a rare, but dangerous, side-effect called rhabdomyolysis. Assuming the CPK is normal, resume the statin with the addition of CoQ10 or change to an alternative statin. Some statins will selectively cause aches in some people, and changing to an alternative statin may solve the problem.

Remember, don't eat grapefruit or drink grapefruit juice, which can elevate statin levels to toxic levels. Be sure to avoid niacin or fibric derivative cholesterol drugs (such as Lipofen and Lopid) if muscle aches occur, as combination therapy is often more problematic. I also find that the newer generation statins such as Lipitor seem to have a lower incidence of muscle aches than the older generation statins, such as Mevacor, even though there is little hard data to back this observation. Long-term, head-to-head published statin studies are hard to find.

If you can't use statins, your treatment will be more complex. With your cholesterol readings, I would want to know your glucose readings and your thyroid status because if you have diabetes, with or without hypothyroidism, your cholesterol readings may correct themselves with appropriate management of underlying conditions. So, the answer is to check for underlying conditions, correct them, and add lipid management as indicated.

You want your HDL (protective cholesterol reading) to be over 50, your LDL (bad cholesterol reading) under 100 (under 80 is better), and your triglycerides under 150. Many patients find that niacin works well for increasing HDL and controlling triglycerides and cholesterol, but often with nuisance flushing that is minimized by using prescription preparations. Do not use sustained release niacin. It has been removed from the market for safety reasons, yet I find it is still available by Internet.

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