Abstract
My grandmother used to caution me, "An ounce of prevention is worth a pound of cure." That saying is certainly applicable to coronary heart disease (CHD). CHD remains a major cause of death in the United States today despite modern medical technology. The primary results of CHD, myocardial ischemia and myocardial infarct, when not deadly, often mean a seriously impaired lifestyle. However, since the 1960s, we have known that there were identifiable risk factors related to CHD. One of the major modifiable risk factors is an elevated lipoprotein level (e.g., hyperlipidemia), and today, we have an armament of lipid-lowering medications that are one means of preventing CHD for many individuals.
In this article, the major classes of medications with lipid lowering effects are examined. Some of these medications are not new, but with the knowledge that the earlier they are used the more effective they may be, increasing numbers of people are now using nicotinic acid, bile acid-binding resins, fibric acid derivatives, or reductase inhibitors. As a result of the increased focus on lipid-lowering medications, nurses caring for middle-age and older adults are seeing and will continue to see larger numbers of their patients with prescriptions for these drugs. Nurses who are knowledgeable about the many antilipidemics on the market today will be more prepared to answer patient's questions and educate patients about reducing risk of CHD.
A brief overview of the physiology of lipid metabolism, the pathophysiology of atherosclerosis, and risk factors for CHD make the rational for using these medications more understandable. Recommendations for early identification of individuals at risk for CHD are identified. In this Part 1 of a two-part series, two of the four major classes of lipid-lowering drugs are examined by looking at the mechanism of action and possible side effects of selected drugs in these classes. In Part 2 (May / June 2004), the other two classes of antilipidemic drugs will be examined and the recommendations of the National Cholesterol Education Program for clinical management of high blood cholesterol will be reviewed.