Identifying Meds That Raise Cholesterol: Finding the facts on hormones and HDLs, Discovering how diuretics affect blood fats, Protecting statins and Naming the problems with vasoconstrictors.

Identifying Meds That Raise Cholesterol

In This Chapter

� Finding the facts on hormones and HDLs

� Discovering how diuretics affect blood fats

� Protecting statins

� Naming the problems with vasoconstrictors

Believe it or not, several common medications, such as diuretics (also known as water pills), work like a dream to cure or alleviate conditions they were designed to treat, such as swelling caused by water retention, but may send your “bad” cholesterol up, your “good” cholesterol down, and your triglycerides heaven- knows-where (see the section “Lowering Fluids with Diuretics” later in this chapter).

The following sections make up a representative list of medicines that may alter your cholesterol levels, sending some kinds of cholesterol up and others down. But hey, forewarned is forearmed.

Hankering for Hormones

In the past few decades, hormone products have become part of everyday life. The female sex hormones estrogen and progesterone are used for birth control, “morning after” pills, and postmenopausal hormone replacement therapy. Some athletes skirt the law by using steroids (male hormones) to build muscles. In each case, the use of hormones, like the ones listed in this section, can have unexpected effects on cholesterol levels.

Birth control pills

The most popular oral contraceptives (OCs) are a combination of the female hormones estrogen and progestin (a synthetic form of progesterone, the second female sex hormone). The less effective and thus less frequently used “mini- pill” is plain progestin.

Estrogen seems to be the more cholesterol-friendly female hormone. Estrogen lowers total cholesterol and boosts HDLs, the “good” cholesterol. But higher doses of progestins lower HDLs. You can read all about it for yourself in this quote from the package insert that comes with all OCs sold in the United States:

A positive association has been observed between the amount of estrogen and progestogen [another way to say “progestin”] in oral contraceptives and the risk of vascular disease. A decline in serum high-density lipoproteins had been reported with many progestational agents. Estrogens increase HDL cholesterol. The net effect of oral contraceptives depends on a balance achieved between doses of estrogen and progestogen. Most scientists now believe that the reason women on hormone replacement therapy had a higher incidence of heart attacks is because the therapy stimulates the clot- ting system, and since the first event in a heart attack is a clot forming in the coronary arteries, that is the reason for the increased number of heart attacks and not the effects of cholesterol.

Hormone replacement therapy (HRT)

Now that researchers have proven the link between HRT and a higher risk of breast cancer and disproved the assumption that taking hormones after menopause lowers a woman’s risk of heart disease, fewer women are using these pills.

For those who do — or for those women who take estrogen for a few weeks or months after a surgical menopause (translation: total hysterectomy that removes both the uterus and the ovaries) — I want to point out that estrogen does increase levels of HDLs. Wait. I already said that in the preceding section.

Table 13-1 lists the words used for “estrogen” or “progestin” on the labels for birth control pills and postmenopausal hormone-therapy products.

Muscle builders

The male sex hormone testosterone promotes muscle mass, which is why the average man has bigger biceps than the average woman.

In medicine, anabolic androgenic steroids (muscle-building, testosterone-like compounds) are used legally to treat the results of abnormally low levels of testosterone, such as delayed male puberty, some forms of impotence, and the wasting of lean muscle mass associated with certain illnesses — AIDS being one of them.

Although these meds are banned from all legitimate athletic competition, some athletes use them secretly in an attempt to enhance performance. In the long run, it’s a losing game. According to the National Institute on Drug Abuse (www.nida.nih.gov), steroid abuse — using the drugs to build muscles for athletic competition — comes with a full complement of horrible side effects, including liver tumors; liver cancer; yellowish pigmentation of skin, tissues, and body fluids; high blood pressure; kidney tumors; severe acne; trembling; shrunken testicles; infertility; increased risk of prostate cancer; male pattern baldness (in men and women) . . . no, no, I can’t go on. This book is called Controlling Cholesterol For Dummies, not Steroids For Dummies, so I have to stick with the main event: Taking anabolic androgenic steroids raises LDLs and lowers HDLs. No gold medal there, guys.

Lowering Fluids with Diuretics

Diuretics are drugs that make you urinate more frequently, eliminating excess fluids from your body tissues. Some ingredients, such as caffeine, in over-the- counter (OTC) products have a diuretic effect, but the most effective diuretics are the ones available only by prescription.

Common prescription diuretics

Prescription diuretics may be either single ingredient products or combination products. The active ingredient in a single ingredient prescription diuretic is most commonly either furosemide, spironolactone, or a member of the thiazide drug family. Table 13-2 lists some well-known single ingredient prescription diuretics.

The primary active ingredient in combination diuretic products is commonly a thiazide diuretic. The second active ingredient varies according to what the drug is designed to accomplish. This is done because diuretics make most blood-pressure-lowering drugs work better. For example:

� The active ingredients in Aldochlor are a thiazide diuretic (chlorothiazide) and methyldopa, a drug that lowers blood pressure by relaxing blood vessels.

� The active ingredients in Aldactazide are a thiazide diuretic (hydrochlorothiazide) and spironolactone, a drug that reduces the amount of the mineral potassium lost when you take a diuretic and urinate a lot (yes, your body eliminates potassium through urinating).

� The active ingredients in Lopressor HCT are a thiazide diuretic (hyrochlorothiazide) and metroprolol tartrate, a drug that helps control the rapidity and force of your heartbeat.

Diuretics and cholesterol levels

Taking either a thiazide or furosemide diuretic raises total cholesterol levels and levels of triglyerides (another blood fat described in Chapter 2). The increase, however, is believed to be small enough that it doesn’t increase the risk of heart disease. Because diuretics are so valuable for controlling high blood pressure, your doctor can work with you to establish a diet that helps control your cholesterol while allowing you to continue taking the water pills.

Any medicine, prescription or over-the-counter, that causes you to lose too much water can have serious effects, like causing you to collapse from dehydration. That’s why you should never use diuretics without the knowledge or consent of your own personal physician.

Sabotaging Cholesterol Therapy

Your cholesterol is on the high side, so your doctor prescribes a cholesterol- lowering statin drug, such as atorvastatin (Lipitor), pravastatin (Pravachol), or simvastatin (Zocor), or a statin combo drug, such as Vytorin. You take the pills right on schedule, but when your doctor tests your blood, your cholesterol level hasn’t gone down. Why? One possibility is that you’re taking a second medication that makes your statin less effective. Gee. Sometimes you can’t win for losing.

Considering interactions between cholesterol and meds, I thought it important to mention statin interactions. But for more on how the other meds you take can affect a statin’s ability to control your cholesterol, turn back to Chapter 12, which has absolutely everything you need to know about statins and other cholesterol-lowering drugs, including these pesky drug/drug interactions.

Narrowing Your Options

Having high cholesterol is risky because cholesterol particles in your blood- stream may snag on artery walls, catch other particles floating by, and build plaque deposits that block the artery, stop the normal flow of blood to your heart, and trigger a heart attack. Given this set of facts, you can understand why medicines that further narrow the blood vessels may be problematic for someone with high cholesterol or known coronary artery disease.

Drugs that make blood vessels constrict (narrow down) are called vasoconstrictors. Drugs that make blood vessels dilate (open wider) are called vasodilators. Vasoconstrictors raise your blood pressure and vasodilators lower it.

Vasoconstrictors are used in both prescription and OTC medicines, as you can see here:

� An example of a prescription vasoconstrictor product is the Epipen, a device that enables the patient to inject a dose of epinephrine.

� An example of an OTC vasoconstrictor product is a cold remedy, cough medicine, or anti-asthma product in which the vasoconstrictor functions as a decongestant, an ingredient that helps shrink swollen tissues in your nose and throat. Hemorrhoid relief products may also contain vasoconstrictors, but you apply them to your skin, so they’re less likely to be problematic.

By the way, if you’re still smoking, you should know that nicotine is a vasoconstrictor. For more about smoking and your cholesterol, check out Chapter 9.

Right now, take a look at Table 13-3, which contains a list of common decongestant ingredients from the Physicians’ Desk Reference 2001. All these ingredients are vasoconstrictors, so if you have high cholesterol, you want to ask your doctor before using these products.

Getting the Last Word

Every drug can be valuable — heck, even lifesaving — when prescribed for the condition it’s intended to treat and for a patient whose body tolerates the medicine. On the other hand, every drug has side effects. And sometimes a drug that works for one person is ineffective or downright dangerous for another person.

The trick is to maximize the benefits and minimize the risks. In other words, try to knock off the illness or medical condition without harming the patient. Doing that requires you and your doctor to work together. She by doing her homework so she knows what may go wrong; you by taking your meds as directed and reporting any problems immediately. And each of you needs to listen to one another. It’s a hard job, but you can do it. So do it.