The amount of medications prescribed after a stroke can be staggering. Not only is it imperative to keep your blood pressure under control, but it is of the utmost importance to control your cholesterol, as well. Cholesterol can cause plaques on the sides of arteries that can either decrease the size of the lumen or break off and block the artery deeper into the brain. In either case, high cholesterol is a large risk factor for a secondary stroke.
To understand the medications, it helps to understand a little about cholesterol. Three different types of cholesterol are talked about when you are trying to reduce your numbers. LDLs or low-density lipoproteins should be as low as you can manage to make them. HDL or high-density lipoproteins are considered helpful cholesterol and should be as high as you can manage. Triglycerides are a special subset of cholesterol, and most medications aim to make them lower. All medications affect these three metrics on some level, but some are more impactful than others are.
Statins are the most popular drug type used to reduce cholesterol levels. In fact, they are among the most prescribed medications in the world. Some examples include Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin), although there are many others. These drugs work by lowering both the LDLs and the triglycerides. Unfortunately, they do not have much of an effect on HDLs. Muscle pain and weakness are the primary problems with statins. It can lead to a condition known as rhabdomyolysis, but this is a very rare side effect. However, simple muscle pain is quite common, and some herbal supplements, such as Coenzyme Q10, have been studied for their use in blocking this side effect.
Bile Acid Binding Resins
Bile acid binding resins are not used as often as statins, but they are still helpful in lowering LDLs. If you find that you are not getting the therapeutic effect of the statins or the muscle pain is just too great, then these drugs may help. Some examples include Colestid (colestipol) and
Questran (cholestyramine/ sucrose). Usually, the side effects tend toward GI upset, such as nausea, vomiting, and diarrhea, but one troubling effect is that it can raise triglycerides. If you take this medication, you may need to take a supplemental one to control this metric and possibly one to help raise HDLs.
Cholesterol Absorption Inhibitor
Another common medication prescribed for cholesterol is the cholesterol absorption inhibitor, the only one of which is Zetia (ezetimibe). As with the other medications, this drug tends to significantly affect LDLs and can lower them well. Unfortunately, it only has minor actions on HDLs and triglycerides. This is why diet and exercise are important in cholesterol management to help these other metrics become therapeutic. Vytorin is a combination drug of this medication and simvastatin. Both drugs together can really improve LDLs, and the side effects of Zetia are nearly identical to the statins.
While other medications are great at lowering LDLs, fibrates are specialists in raising HDLs and lowering triglycerides. For this reason, they are often prescribed with the statins, or possibly Vytorin, for LDLs that are far from therapeutic. A few examples of fibrates include Lopid (gemfibrozil) and TriCor (fenofibrate). Very rarely are these medications taken without a drug for LDLs, and this may help you understand your treatment plan with a bit more clarity. Nausea and stomach pain can be side effects of this medication, but the one that causes the most concern is gallstones. If your gallbladder has been removed, then you need not worry about this, but stomach pain in the right upper quadrant can indicate that you have this serious condition.
A supplement that is often used in controlling cholesterol is vitamin B3 or niacin. While you could dose yourself with niacin over the counter, more potent and more reliable preparations are available via prescription. Niacin can help to decrease LDLs, decrease triglycerides, and increase HDLs, making it an all-around stand out in the cholesterol medication puzzle. Some patients do experience side effects, particularly flushing around the face and neck. Vomiting, diarrhea, blood sugar spikes, and peptic ulcers are also a possibility, although they are not generally seen. This supplement is also combined with lovastatin to produce Advicor. Taking this combination can attack the cholesterol metrics on all fronts and reduce your intake to one medication.
Omega-3 Fatty Acids
Finally, omega-3 fatty acids, found primarily in fish, have shown great promise in decreasing cholesterol levels. While many patients simply increase their food intake of this nutrient, it is not often enough to control significantly increased cholesterol metrics. Some patients take supplements of omega-3 fatty acids over the counter, but this can often lead to large pills, confusion on how much to take, and questions over the potency of the supplement. For this reason, there are currently two prescription preparations of this supplement: Lovaza and Vascepa (Icosapent ethyl). What many patients don’t realize is that this supplement really only lowers triglycerides. You may need other medications to handle the other metrics. Side effects are rare and mild, such as a fishy aftertaste, belching, and rarely an increased risk of infection.