High levels of low-density lipoprotein cholesterol is one of the main risk factors for atherosclerosis, the number one cause of death for the American population. In atherosclerosis, the medium and large arteries have plaque filled with connective tissue, calcium, blood clots, white blood cells and cholesterol. The treatment includes exercise and a change of diet, but it may also include taking cholesterol medication.
Types of Cholesterol Medicines
There are four main kinds of cholesterol medications: bile acid-binding resins, fibric acid derivatives, HMG-CoA reductase inhibitors and niacin. The bile acid-binding resins do not cause any liver damage. The other three types of cholesterol medications may. Bile acid-binding resins include colesevelam, cholestyramine and colestipol, writes Mary Molloy, M.D., Clinical Professor of Pediatrics and Medicine at the University of California in "Basic & Clinical Pharmacology." They bind to bile acids, which the liver makes from cholesterol, so the bile acids can be excreted. This forces the liver to break down more cholesterol to make more bile acids.
Fibric Acid Derivatives
Fibric acid derivatives stimulate an enzyme called lipoprotein lipase. This causes a decrease in the triglyceride and low-density lipoprotein levels. Low-density lipoproteins have the nickname of "bad" cholesterol because high levels of this cholesterol lead to coronary artery disease. The fibric acid derivatives include gemfibrozil and fenofibrate. They can cause hepatitis, or inflammation of the liver, but usually only if people are taking other cholesterol medication as well, according to Daniel Rader, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine in "Harrison's Principles of Internal Medicine."
HMG-CoA Reductase Inhibitors
HMG-CoA reductase inhibitors interfere with an enzyme called HMG-CoA reductase, as explained in "Basic & Clinical Pharmacology" by Dr. Malloy. Enzymes are proteins that the cells use to speed up processes, and the liver uses this enzyme to produce cholesterol. Fluvastatin, atorvastatin and lovastatin are examples of this medication, also called the "statins." Some people have liver enzymes, called ALT and AST, up to three times the normal amount. This is a sign of liver damage. Those with a history of alcohol abuse or liver disease may have levels over three times the normal level.
Niacin
Niacin is vitamin B3. Physicians prescribe niacin as a cholesterol medicine because it lowers high triglyceride and low-density lipoprotein levels, and raises low high-density lipoprotein levels when consumed in large doses. If you take more than 2g of the sustained-release form of niacin, you can develop liver damage and there are reports that this form can also lead to liver failure, explains Robert Mahley, M.D., Ph.D., Director of the Gladstone Institute of Cardiovascular Disease in "Goodman & Gilman's The Pharmacological Basis of Therapeutics." Regular niacin can also cause liver abnormalities.
MedWatch
The Food and Drug Administration, or the FDA, has a service called MedWatch. It is their Medical Product Safety Information and Adverse Event Reporting Program. Anyone can check online to see if the FDA has any current negative reports about medical products, cosmetics, supplements, vaccines, safety labeling of medications and even medicines, including any reports about cholesterol medications and liver damage. In one of their reports, the FDA states that atorvastatin, an HMG-CoA reductase inhibitor, should not be used in someone who has liver damage.
References
- "Basic & Clinical Pharmacology"; Bertram Katzung, M.D., Ph.D., Susan Masters, Ph.D., Anthony Trevor, Ph.D.; 2009
- FDA: Caduet (amlodipine besylate/ atorvastatin calcium) tablets
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics"; Laurence Brunton, Ph.D.; 2006
- "Harrison's Principles of Internal Medicine"; Anthony Fauci, M.D., Dennis Kasper, M.D., Dan Longo, M.D. et al.; 2008
