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Do I need drugs for high cholesterol?

Q: I have been advised by my doctor to take TG Tor 10 mg. My lipid profile report: total cholesterol - 289.0 mg%, HDL cholesterol direct - 51 mg%, triglycerides - 150 mg%, LDL cholesterol - 208 mg%, VLDL cholesterol - 30.0 mg%, TC/HDL cholesterol ratio - 5.67 ratio, LDL/HDL ratio - 4.08 ratio and thyroid stimulating hormone - 1.53.

A:Several decades ago, individual doctors used to decide the therapy for their patients. Such a course of action meant that while one doctor prescribed a drug A for blood pressure, the other prescribed drug B while a third did not prescribe any medicine but asked for weight reduction, brisk exercise and salt restriction. Obviously all could not be right. Lately, nationally and internationally accepted guidelines on the appropriate treatments for various disorders have been discussed and agreed upon based on hard scientific evidence and clinical trials. As per guidelines issued by the British National Institute of Health and Clinical Excellence (NICE) and endorsed by top specialists around the globe, the treatment of high cholesterol levels should be as follows: Cholesterol levels: 200 mg or less (ideal), 200-239 (border line), over 240 (to be treated). VLDL and LDL: less than 160 (ideal). Triglycerides: 160 mg or less (ideal). TSH: 0.5 to 4.7 (normal). You would notice that except for cholesterol, your tests are fine. Hence only cholesterol levels need to be brought down. As per details given by you, there are no cardiac risk factors such as family history, smoking, high blood pressure, high fasting triglycerides, diabetes, severe obesity. Hence the treatment should be for primary high lipid levels. No drugs are required initially. Step 1 diet (total fat below 30% of calories with no more than 10% as saturated fat) + exercise (such as brisk walk for 45 minutes to cover no less than 4.5 km 5 days a week. Reduce weight to ideal. Continue for 3 months. If no or inadequate improvement: Step 2 diet (total fat below 25% of calories with no more than 7% as saturated fat) + exercise (such as brisk walk for 45 minutes to cover no less than 4.5 km 5 days a week. Reduce weight to ideal. Continue for 3 months. If the above measures fail (highly unlikely), then and then only drugs (such as atorvastatin sold under the trade names of Atorva, TG Tor etc) should be given. There is no place for short cuts in good clinical practice because ultimately patients suffer from both monetary loss and side effects.

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