Simvastatin 40 mg belongs to a class of drugs called statins. These drugs are essentially known as the anti-cholesterol or hypolipidemic drugs in that they lower special kinds of cholesterol known for triggering cardiovascular disease and at the same time increasing the presence and effects of the healthy cholesterol.

Simvastatin comes in other dosages both higher and lower than 40 mg, and Simvastatin 40 mg is the highest regular dose that is generally prescribed, for doctors found that in most cases, going higher than 40 mg equals more side effects risk while only giving more anti-cholesterol controlling properties.

Simvastatin is known as the first statin drug that became available for use in treating high levels of unhealthy cholesterol, and being the first also meant that it was subjected to the most studies and trials ensuring its effectiveness and relative safety. Since only a physician or doctor can diagnose unhealthy cholesterol levels, Simvastatin and other statin drugs can only be bought with a prescription.

What side effects can occur as a result of taking Simvastatin?

The side effects of Simvastatin are similar to the other statin drugs and are directly caused to a negative reaction on the body with the properties of the statin drugs. There are a few people with known sensitivity to statins and they are prohibited from taking them, while others can take Simvastatin or any other statin and experience no allergic reaction or side effect in any way.

Side effects that are known to occur more often but considered less serious are tiredness and stomach problems such as constipation, diarrhea, indigestion, and abdominal pain. These reactions and any other are better addressed to your doctor. Cramping muscles and aches around the joints might need immediate medical attention, and extremely rare side effects like seizures, fainting, persistent vomiting and irregular heartbeat will require emergency care.

Drug side effects can also take place when two medicines interact with each other. Simvastatin can affect they way regular painkillers function, change Coumadin levels in the blood, affect Lisinopril’s vessel-relaxing qualities or inadvertently mess with the use of Methotrexate in cancer or autoimmune diseases. This means

Simvastatin should not be carelessly handled, and consuming other drugs both special prescription or over the counter should not be attempted without consulting your doctor. Observing the Simvastatin dose assigned to you and not skipping or taking more of the drug will also help keep you in good health and more protected from side effects.

Furthermore what are the normal levels to start with? If you know what’s normal then at least you can set goals to work towards if your numbers are on the high side. If this sounds like a situation you are in, not to worry. You’re not the only one. As a medical student, this used to be a big question my patients would ask me soon as the   attending doctor left the room.

Sometimes doctors tend to be so busy they forget that taking the time to talk and  explain to their patients what exactly they are dealing with goes along way on the road to recovery or at least getting people to realize why they are on a medication and what are their goals.

What cholesterol number are you trying to achieve to lower you health risks. Before we look at what the different lipid profile numbers are lets first understand what high cholesterol does to your body and the health implications.

In order to understand how Cholesterol plaques form to cause atherosclerosis we need to understand what LDL and HDL are. LDL stands for Low Density Lipoprotein which is the “Bad cholesterol” and HDL is High Density Lipoprotein which is the “Good Cholesterol” (VLDL is simply Very Low Density Lipoprotein). This is where people usually get confused and say “hey wait, shouldn’t the low density LDL be the good and HDL which is high density be bad?”

One would think that, but one very important thing to realize is that HDL takes cholesterol from the circulation back to the liver to be metabolized and processed while LDL does the opposite, that is to say it stays in the circulation which allows for the deposition of cholesterol into the wall of your blood vessels causing atherosclerosis.

The word Atherosclerosis when broken down to its latin meaning, translates into Athero- meaning atery and sclerosis- means hardening. That is exactly what happens; your blood vessels start to harden, a plaque forms causing occlusion,  hence you have a decrease in the flow to blood which in turn means there is a decrease in oxygen coming to that organ or area of a body and that is what leads to cell and tissue injury in the heart and is how you get a heart attack.

In some instances the plaque that  is forming in the vessels tends to get dislodged and travels to smaller vessels and blocks them, stopping blood flow (known as an embolism). So you can see that it may seem like your doctor is constantly raving and persistently nagging you about your cholesterol level being high and you need to get those number down, but know you know why!

Now that we understand what happens, lets take a look at what our Cholesterol goals should be. The NHLBI (National Heart Lung and Blood Institute) has developed the ATP III (Adult Treatment Panel III) which  they revise and modify every few years as new clinical research evidence and newer drugs come to the market or if they have new studies which show evidence of benefits in increasing an existing drugs dose or if it need to be taken of the market and so on.

The test done for cholesterol levels is called the Lipid Panel it must be conducted after fasting for 9-12 hours (hint get an appointment with your doctor as early in the morning as you can so you don’t have to go hungry all through the day). It measures Total Cholesterol, LDL, HDL and Triglycerides in mg/dl (milligrams per deciliter)

Total Cholesterol

<200  Desirable
200-239   Borderline high
>240   High

LDL

<100   Optimal
100-129   Near optimal/above optimal
130-159    Borderline high
160-189    High
>190    Very high

HDL

<40 Low
>60 High

Now that the implications are end results of high cholesterol are clear you are able to appreciate why we need to watch those number and keep them in line. Usually before a doctor prescribes drugs such as statins, fibrates or niacin they will encourage you to try and get those numbers back in line with diet and exercise and if that fails then the drugs can be added to help you lower you cholesterol.

There are so many different weight loss supplements on the market and so many inflated claims about their effectiveness that it can be difficult to decide which ones are worth taking and which ones to avoid. Some, such as fish oil, are not effective at all (although fish oil benefits do in fact include improved cardiovascular systems), whereas some (like Alli) actually do work. And then some have unknown or serious side effects, and should obviously therefore be avoided.

Green tea is often hyped as a weight loss supplement by manufacturers, and is often included in various multi-supplement weight loss aids. While probably a safe addition to the diet, and a proven way to reduce cholesterol and improve blood pressure and other cardiovascular health problems, green tea can also increase the metabolism safely. An increased metabolism will tend to burn fat more than a lower metabolism. However, green tea’s effects are probably too weak to result in a noticeable weight-loss effect.

Bitter orange is a stimulant that has become one of the standard replacements for ephedra in recent years. Ephedra was an effective weight loss aid that was banned in the US by the FDA because of potential side effects that included stroke and even death! After the ban, other stimulants were used in multi-supplements. However, bitter orange has some of the same potential side effects as ephedra, and as a result may not be safe to take. Also, it is again not generally very effective.

Hoodia has become popular recently. An appetite suppressant, hoodia is a plant that has gained the interest of supplement manufacturers as they have tried to extract and synthesize the main active chemical in it (known as P57). Success has not been forthcoming, and some extracts have included potentially negative by products that may decrease its effectiveness. Safety and effectiveness are unknown at this point and are not supported by strong scientific evidence. So we’ll count that as another dead end.

Caffeine, like bitter orange and ephedra, is a stimulant and thus may help to suppress appetite and increase metabolism, thus improving weight loss. However, there is no evidence at this time to suggest that it can make a noticeable difference to dieting.

Alli is an over-the-counter drug with an active ingredient called orlistat. There is evidence from scientific studies that orlistat may actually help increase weight loss by up to 10% in some individuals. The only caveats are that side effects include greasy poop, as well as a potential for liver damage in some very rare cases, although the jury is still out on the latter.

It also has to be said though that if you choose to keep the weight and treat your high cholesterol with statins and drugs that suppress cholesterol absorption then these exact same side effects are also a significant factor. On balance then, at the moment it would seem that Alli is probably the best diet pill as far as actual effectiveness goes, and it is available over the counter in the US.

Home Cholesterol Tests Kits

First things first; why use a home cholesterol test kit anyway? For some people, they simply want to find out what their cholesterol level is so as to know whether or not they need to do anything about it or seek further medical advice. For others, they might already be aware that they have raised cholesterol levels and thus wish to monitor their condition without the effort and delay involved in booking an appointment to see a doctor. Then there are those who simply like to monitor their health on a regular basis and obtaining frequent cholesterol tests through their doctor would be frankly impractical as well as unnecessarily expensive.

How Cholesterol Testing Kits Work

So what’s available? Well, all home cholesterol test kits work by analyzing a blood sample, but beyond the initial business of extracting some blood (usually by pricking your finger – an Auto-Lancet which is a push-button pen device can help if you find this difficult) the main difference is how much analysis you get. Simple test kits provide an overall cholesterol level, which while useful and commonly used as a shorthand summary as to whether action might be required, doesn’t tell the whole story.

More sophisticated kits provide figures for not only total cholesterol but also LDL (Low Density Lipids, or “bad” cholesterol), HDL (High Density Lipids, or “good” cholesterol) and triglycerides and possibly glucose levels. The way that these typically work is by supplying separate types of test strips; you thus require a separate blood sample for each strip. Note that LDL is often inferred using the following calculation: LDL = total cholesterol – HDL – triglycerides/5.

Be aware that the actual test strips are sold separately and you may not be supplied with a full set of different test types. Also, you will eventually use up all the originally supplied strips and will have to purchase more so be sure you can obtain these at a reasonable price.

The testing process itself very often uses “reflective photometry” to analyze the light transparency (discernible as a change in color intensity) of the blood sample which means it can be sensitive to interference from strong light sources and changes in room temperature.

Interpreting Cholesterol Test Results

This is all very interesting, but the fact is that unless you also understand how to interpret for example the LDL/HDL ratio or account for your own personal factors such as age, gender, size, medical history, lifestyle and so on then these numbers won’t mean very much to you. Also, if you’re already being treated with statins then the blood test that your doctor performs may examine other indicators such as your serum creatine kinase level in order to check for possibly side effects (statins in high doses can in rare cases cause muscle and liver damage which can be detected in this way).

In short, the test itself and the range of values available are an important component, but the crucial part is the ability to understand and evaluate this data in order to determine for example the risk of heart disease. But assuming that you’re comfortable with interpreting your results well enough to monitor your condition, the next best thing to do is calibrate your home test kit with the results obtained by medical professionals. In other words, shortly before or after you go for a full blood test use your home kit and compare the two results in order to gauge the margin of difference (if any). Most modern kits are pretty accurate but you do want to be certain that when you home kit assures you that your cholesterol levels are fine that you are not being misled.

Common Problems Using Home Cholesterol Tests

Where a home test kit can all go wrong is in the upfront part of obtaining a blood sample. You need a clean, fresh sample which is not always easy to arrange. Obviously an absolutely key start point is ensuring that you have clean hands so as not to contaminate the sample. This can also be advantageous because dipping your hands in warm water will ensure that it is easier to extract blood. Blood retreats from your extremities when they are cold making extraction that much harder and more painful.

If you’re not familiar with deliberately making your finger bleed or you take too long or squeeze too hard to get the blood out then you can again inadvertently affect the result. As noted above an auto lancet can save a lot of time (and discomfort). You also don’t need to use a finger – some people prefer a toe as they find these on the whole less sensitive.

The other commonest cause of inaccurate results is failure to read the instructions carefully, in particular not noticing that you must not eat or drink anything other than plain water for about 12 hours prior to conducting the test.

Cholesterol production is triggered by ingesting food of any description – so even sipping a drink that contains sugar (as do all alcoholic drinks for instance) or milk will be enough to raise your cholesterol levels and give a false reading. You should also not perform a test if you are pregnant or have been subject to extreme physical stress such as a major accident or after an operation.

Other “user errors” are not placing enough blood onto the test strip collection well, or taking too long about it, so it is no longer a fresh sample when the test is performed (both usually connected with difficulties extracting blood in the first place – see above). Also some test kits are particularly sensitive to light and should be kept away from direct light sources while they perform the test process otherwise the results will not be accurate.

Your cholesterol, like your blood pressure (something else you can monitor at home if you want), varies normally throughout the day and over time depending on what you’ve eaten and what activities you engage in. Monitoring it frequently really is unnecessary and counterproductive. Depending on your pre-existing condition you should only need to test between a handful of times a year at most and once every 5 years. The most important element in using a home cholesterol test kit effectively is not the frequency of use but acting upon the information appropriately.

What To Do With A Troubling Result

Regardless of the type of kit you use, if the data suggests there is potentially an issue with your cholesterol then it is time to book an appointment with your doctor (who will promptly run another test just to be sure). These kits are intended to act as a heads up to a possible problem, not to replace qualified medical guidance. In many cases the initial way to lower cholesterol is simply to change your diet and take more exercise, but in other cases it will mean prescribing drugs, invariably one of the various types of statin in some particular dosage to suit your own particular situation.

In summary, home cholesterol test kits can be quite accurate and an effective means of monitoring your own levels if you study and follow the directions carefully, understand what it is you’re actually monitoring and how to diagnose good cholesterol levels, and respond to any troubling results by following up with a medical professional.

The first step is to examine your lifestyle and make changes that are known to be beneficial in lowering cholesterol levels. None of this is rocket science: it is well known that being overweight, eating fatty foods, drinking, smoking and not taking enough exercise are significant contributory factors in causing high cholesterol. So the obvious recommendation is to stop doing these things and see if that alone is sufficient to bring about the necessary reduction in cholesterol levels.

This is something you can do on your own initiative – you certainly don’t need medical advice or supervision, but do begin slowly; if you have become unfit and/or overweight then suddenly going out for a long run for example could make you seriously ill (or even cause a heart attack).

When adopting self-help measures to lower cholesterol it’s helpful to understand that there are broadly 2 types of cholesterol – HDL which is considered “good” and LDL cholesterol which is considered “bad”.

LDL is most affected by what you ingest, so a healthier diet and cutting down on the fags and booze will help lower LDL cholesterol levels. HDL on the other hand is influenced by exercise and can be increased by being more active; higher levels of HDL cholesterol are in turn likely to bring down LDL levels. So as you can see, both watching what you eat and doing more physical exercise can be highly effective in lowering cholesterol levels.

But what should you look out for in your diet? Put simply, saturated fat. This is most commonly found in butter, hard cheese, red meat, cakes/biscuits/pastries and the like. Some types of food actually contain cholesterol (known as “dietary cholesterol”) but these don’t affect the cholesterol in your bloodstream to anything like the degree that saturated fats do. Examples include shellfish, liver, kidneys and eggs.

As well as reducing saturated fat content, there are foods that can actively help to lower cholesterol. Soluble fibre, which is present in most vegetables, fruit, oats (but not wheat) and beans, as well as plant sterols (commonly found in cholesterol lowering spreads), can help reduce LDL cholesterol levels.

Indeed, before you decide (or are compelled) to go down the route of prescription medication you might want to consider adding natural supplements based on plant sterols to your daily intake. The relationship between the acai berry and cholesterol provides an interesting example of how what you eat can quite significantly affect your cholesterol levels.

In addition to keeping an eye on what you eat, you may also need to monitor how much you eat. Shedding excess weight can also lower LDL and boost HDL cholesterol levels.

If the “self-help” route outlined above doesn’t appear to lower your cholesterol levels sufficiently after a couple of months you should consult a doctor as the cause of your high cholesterol may be due to other factors (such as genetically inherited familial hypercholesterolemia – FH for short), or it may be that your body needs a helping hand.

You can be sure though that any medical professional will still expect you to play your part and modify your lifestyle in conjunction with any drug treatment they may prescribe and since they get to periodically check your blood test results and take your weight they can easily tell who’s not sticking to the rules.

The standard medical treatment for hypercholesterolemia (high cholesterol) is a class of drugs called statins. These work by depressing production of LDL cholesterol in the liver and are available in a range of potency. The most commonly prescribed (together with their brand names) are listed from weakest to strongest below:

• pravastatin (Lipostat)
• simvastatin (Zocor)
• atorvastatin (Lipitor)
• rosuvastatin (Crestor)

Generally there are few side-effects from taking statins (which incidentally are supplied in pill form) but they can cause damage to muscle tissue and the liver, particularly at high doses.

Getting the right type and dose of statin can be more of an art than a science since there is no reliable way to determine how effective they might be in any given individual. If your doctor decides to prescribe statins for you it is likely that they will request further blood tests to monitor their effectiveness and to also check for signs of any side-effects.

You might also be asked to take other drugs such as the cholesterol-absorption inhibitor ezetimibe (Ezetrol) in combination with statins and if your hypercholesterolemia has gone undetected for some time it is also likely you may be prescribed fibrates, nicotinic acid, aspirin and/or medication to lower your blood pressure.

The problem is that you cannot tell what your cholesterol levels (there are 2 main types of cholesterol) are by any means other than taking a blood test. A person with very a high level of cholesterol in their bloodstream will generally experience absolutely no adverse symptoms right up until their first cardiac arrest. Even if treated with cholesterol lowering drugs, they won’t actually feel any different at all.

Needless to say, waiting for a heart attack is not the best way of finding out whether your cholesterol levels are too high, because by then much of the damage has already been done. High cholesterol is a silent killer and the only way to detect it before it causes irreversible damage to your well-being is by periodic testing. Once you find out the hard way that your arteries have become clogged through years of unnoticed high cholesterol it is already too late – there may be few symptoms of high cholesterol per se, but the symptoms of resulting cardiovascular disease most definitely will intrude on your enjoyment of life.

So who should have their blood cholesterol levels checked? Pretty well everyone is the short answer, but obvious high priority candidates are those who are overweight or who take very little exercise, smokers, drinkers, anyone who favours a high fat diet, and most people over the age of 30. There is considerable evidence of a causal link between these specific factors and high cholesterol.

Young, fit and healthy people should also take a cholesterol test if there is a history of high cholesterol in their family, since although most of the cases seen these days are caused by environmental and lifestyle factors, there is also a genetic disorder commonly termed familial hypercholesterolemia (or FH) which is passed down through family lines. Certainly, if the incidence of premature cardiovascular disease features prominently in your family tree then FH could easily be the culprit.

What will a cholesterol test actually tell you? Most people and indeed medical practitioners refer to a single value, such as 5. This is in fact a summary of the 2 main types of cholesterol: HDL (often called “good cholesterol”) and LDL (characterized as “bad cholesterol”). HD stands for High Density, LD obviously for Low Density and the L prefix is short for Lipoprotein.

In general levels below 5 mmol/L are considered good, levels upto 6.2 are borderline (i.e. not good at all but not necessarily cause for alarm either), and values above 6.2 are treated as indicators of high risk for heart disease. There is an alternative scale which measures milligrams per decilitre and the boundaries are 200 and 240 mg/dL (corresponding to 5 and 6.2 mmol/L respectively).

If you have your cholesterol tested and the results fall in the low-risk bracket and there are no other factors weighing against you (i.e. you’re reasonably fit, maintain a healthy diet and haven’t noticed any trends towards sudden and untimely death among your biological relatives) then you really don’t need to be tested more than once every 5 years or so.

Those who fall somewhere in the borderline category should consider which of the known risk factors might be causing raised cholesterol levels and address them. It is well known that losing excess weight can correct a slightly high cholesterol reading without the need for further intervention. People who fit this borderline profile should also monitor their cholesterol levels much more frequently both in order to determine the effectiveness of measures to improve their levels and also to ensure that things aren’t deteriorating.

If you find yourself classified as high risk it’s important that you seek medical advice as to what may be the underlying cause of your condition and what treatment would be best. Obviously, if you find you have inherited FH then frankly there is no viable diet that can address this genetic disorder (though using this as an excuse to indulge in high fat food is akin to fighting fire with petrol).

In most cases, you will be prescribed a drug known as a statin. These vary in strength and your doctor will need to assess the amount of statin necessary to decrease and then maintain your cholesterol level below the approved limit (5.0 mmol/L). This is part educated guess and part trial and error – people react differently to different drugs and at the levels needed to treat cases of very high cholesterol the statins themselves can present a real risk of serious damage to muscle tissue and the liver.

Obviously, if this is you then the good news is that you should be able to easily reduce your cholesterol level well below 5.0 and keep it there quite effortlessly, simply by taking statins. The less thrilling news is that regular blood testing is going to be part of your life from now on – both to monitor cholesterol levels and check for any evidence of unwelcome side-effects from the statins.