It can cause hyperglycemia and worsen A1C control, but these increases are often clinically insignificant or readily treatable. Niacin is associated with several side effects. 20 Nicotinamide (niacinamide) should not be used in place of niacin because it does not effectively lower cholesterol or triglyceride levels. There is also a no-flush formulation available OTC however, the active ingredient is not niacin but inositol hexaniacinate, which has been shown to be ineffective as a lipid-lowering agent. The first two products are available OTC, while the extended-release products require a prescription. There are a variety of niacin products available: immediate-release, long-acting (sustained-, controlled-, or timed-release), and extended-release. 18,19 This effect is dose-related, requiring 1 to 4 g per day. 18 Niacin also reduces LDL-C levels by up to 25% and triglycerides by 20% to 50%. Niacin (Vitamin B 3 ): Niacin is one of the most effective agents to raise HDL-C levels it can raise HDL-C by almost 35%. Patients who are on anticoagulants and antiplatelet agents should be warned about this potential risk. Garlic has antiplatelet effects and can increase a patient’s risk for bleeding. The most common adverse effects include bad breath and body odor, upset stomach, and heartburn. Garlic is associated with several adverse effects and drug interactions. Data suggest that the benefits of garlic on cholesterol may be short-term, showing no significant benefit after 6 months. 12 This effect was seen if garlic was taken for at least 2 months. 13,15 However, a recent meta-analysis found garlic to have beneficial effects on total serum cholesterol and LDL-C, lowering each by 17 ± 6 mg/dL and 9 ± 6 mg/dL, respectively. 12-15 In pooled analyses of studies, garlic was shown to improve triglyceride and total cholesterol levels, but it had no effect on LDL-C or HDL-C. When crushed, alliin is converted to allicin, a substance that inhibits cholesterol synthesis however, clinical studies have demonstrated inconsistent results. Today, many people use garlic for its purported cardiovascular benefits, such as lowering blood pressure and cholesterol. Garlic: Garlic has been used as a medicinal agent for thousands of years. The following is a discussion of the more popular OTC agents utilized in the management of dyslipidemia. They can help patients make informed decisions based on the available data. 10 Pharmacists are in an ideal position to educate patients about the use of OTC products for the management of high cholesterol. 11 Fish oil and garlic, two supplements commonly used for the reduction of high cholesterol, were among the top 10 most frequently used natural products. 10 Cholesterol is included as one of the top 10 conditions for which adults are using CAM. are using some form of complementary and alternative medicine (CAM). Some of these patients may be looking for alternative ways to lower their cholesterol and reduce their risk for cardiovascular disease. 7 This can be attributed to many reasons, including cost, perceived susceptibility to cardiovascular risks, and, most commonly, fear and concerns regarding safety and adverse effects. 6ĭespite this, nearly half of treatment-eligible adults are not taking cholesterol-lowering drugs. 5 The National Lipid Association’s recommendations released in 2014 provide non–high-density lipoprotein cholesterol (non–HDL-C) goals, but like the ACC/AHA guidelines, treatment focuses on statins as the primary agent of choice. This shift in treatment can potentially increase the number of adults who are eligible to take statins by 12.8 million. 4 Rather than providing specific cholesterol targets, the current guidelines focus on intensity of statin treatment in four different groups ( TABLE 1). In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released guidelines for the treatment of blood cholesterol. There are many pharmacologic therapies to treat dyslipidemia, including HMG-CoA reductase inhibitors or statins, cholesterol absorption inhibitors, niacin, bile acid sequestrants, fibrates, and omega-3 fatty acids however, statins are the mainstay of treatment. 2,3 Adults aged >20 years should have their cholesterol measured at least once every 5 years. have total cholesterol levels >200 mg/dL (borderline high), and almost 74 million have high levels of low-density lipoprotein cholesterol (LDL-C). Approximately 100 million adults in the U.S. 1 Dyslipidemia is a major contributor to the development of CAD and other forms of atherosclerosis individuals with high total cholesterol levels (≥240 mg/dL) have about twice the risk for heart disease. Cardiovascular disease remains the leading cause of mortality and morbidity in the United States, with coronary artery disease (CAD) being the number-one cause of death.
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