and triglycerides and contribute to atherosclerotic plaque in the blood vessels
(“bad” lipoproteins).
When cholesterol, triglycerides, and LDL are elevated, the patient is at
increased risk for coronary artery disease.
Before antilipemics are administered, patients are treated with nonpharmaco-
logical methods to reduce cholesterol and saturated fats in their diet. Total fat
intake should be 30%. The patient is also encouraged to exercise. Hereditary fac-
tors have a great influence on cholesterol levels and are considered non-modifiable
risk factors.
Antilipemics include cholestyramine (Questran), colestipol (Colestid), clofi-
brate (Atromid-S), gemfibrozil (Lopid), nicotinic acid or niacin (Vitamin B2).
Clofibrate is not used for long-term treatment because of its many side effects
such as cardiac dysrhythmias, angina, thromboembolism, and gallstones.
Nicotinic acid is effective in lowering cholesterol levels, but it too has numer-
ous side effects including GI disturbances, flushing of the skin, abnormal liver
function (elevated serum liver enzymes), hyperglycemia, and hyperuricemia.
Required large doses make it intolerable for most patients.
Probucol is poorly absorbed and is not as effective as the other antilipemic
drugs. Probucol also causes diarrhea and is contraindicated in patients with car-
diac dysrhythmias.
Cholestyramine lowers cholesterol levels, but causes constipation and pep-
tic ulxcer.
Statin drugs inhibit the enzyme HMG CoA reductase in cholesterol biosynthe-
sis. They inhibit cholesterol synthesis in the liver, decrease the concentration of
cholesterol, decrease the LDL, and slightly increase the HDL cholesterol.
Reduction of LDL is seen in as early as two weeks.
Statins include atorvastatin calcium (Lipitor), cerivastatin (Baycol), fluvas-
tatin (Lescol), lovastatin (Mevacor), pravastatin sodium (Pravachol), and sim-
vastatin (Zocor).
A list of antihyperlipemic HMG-COa reductase inhibitor drugs is provided
in the Appendix. Detailed tables show doses, recommendations, expectations,
side effects, contraindications, and more; available on the book’s Web site (see
URL in Appendix).PERIPHERAL VASCULAR DISEASE
A common problem in the elderly is peripheral vascular disease. It is character-
ized by numbness and coolness of the extremities, intermittent claudication(^368) CHAPTER 19 Cardiac Circulatory Medications