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Lipid levels and affects on liver with medication

  Im not sure if this is the right "topic area" but...
  A friend of mine just recently joined a gym..they gave him a "Welcome to the gym" cholesterol level test.  After finding out that his cholesterol level was in the 300's  and Triglycerides were 1000 he made an apt with his Dr. only to find out that it was worse.
  His lipid profile:
  Cholesterol = 224 - down from 345 after a week of changing diet
  Triglycerides = 554 down from 1000  
  HDL Cholseterol = 12
  Chol/HDL ratio = 18.7
  LDL Calculated = 101
  This profile was only after a week of changing his diet. His Dr informed him that medication was needed, but also told him that medication used to lower cholesterol levels had side effects on the liver. His concern is messing up one thing, while fixing another.  My concern is that he says he would like to wait about a month and continue his diet change to bring the levels closer to what they should be. He was told that it would probably not make much difference. I've been told by "others" that these levels were very bad, and he's a walking candidate for a heart attack. My question (s)
  1. Would the continued diet change make enough of a difference? to where medication was not needed
  2. What are the "side effects" on the liver from medication to lower cholesterol
  3. I desperately dont want to loose him and think he should start medication now.  I feel like waiting a month is to risky. Just how bad are these levels?
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238668 tn?1232735930

Dear  Joanna,
Thank you for your question.  First of all let me say that information presented here is not intended to replace the advice of your personal physician.  He/she is the one who knows your particular case the best and will make recommendations that are specific to you.  So I would recommend following your doctor's advice for treatment questions.
Cholesterol has been identified as a major risk factor in the development of heart disease.  Early studies established high cholesterol as a risk factor for developing heart disease.  Lowering cholesterol for secondary prevention, that is preventing second heart attacks in persons who already had had one, was next demonstrated in the eighties and primary prevention of heart attack and stroke (In persons who had never had a prior event) demonstrated in the nineties.  
Total cholesterol is broken down into different categories.  High density cholesterol (HDL) is the "good cholesterol" that acts as a cleaning cholesterol.  Low density cholesterol (LDL) is the "bad cholesterol" that clogs up arteries throughout the body.  LDL is not usually measure directly but is calculated from the following equation: LDL=Total-HDL-triglycerides/5.  If the triglycerides are too high the LDL calculation is not valid.  Triglyceride is another type of cholesterol whose significance is not well established.  Very high levels (>1000) can lead to pancreatitis and other health problems.   Cholesterol should be measured after an 8 hour fast.
Guidelines have been established as to the treatment of high cholesterol.  It has been recommended that everyone over that age of 25 has their total cholesterol and HDL measured.  If these are abnormal a full cholesterol panel should be done.  Guideline for the treatment of cholesterol depend upon the risk factors that the person has.  Risk factors are a family history of heart disease, high blood pressure, male >45 yrs or female >55 yrs, diabetes (counts as two risk factors), smoking and obesity.  Someone at low risk should have a goal LDL cholesterol less than 130 and should be on a special diet if LDL is greater than 160 and on medication if it is  greater than 190.  Someone with one or two risk factors should start medical treatment at 160.  Someone with more than two risk factors or with established heart disease should have a goal LDL of less than 100 with medical treatment started at 130.
Medical treatment of cholesterol includes resins which bind cholesterol, niacin, gemfibrazole (useful for elevated triglycerides) and statins.  All of the drugs except the resins may have a negative effect on the liver and liver function tests should be monitored.  If there is an increase in the liver enzymes it is usually reversible if the drug is stopped.   A rare but potentially serious side effect is myositis (muscle inflammation) and if muscle pain should occur the drug should be stopped and the prescribing doctor notified.
Further information can be found at the site below:
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.


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