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Several types of statin drugs have been developed and sold under a variety of names. Because they have been on the market for so long, many of these are now also available in a generic form, which makes them more affordable. Some of the trade names we might see on our clients' medication lists include: Crestor (rosuvastatin) Lescol (fluvastatin) Lipitor (atorvastatin) Zocor (simvastatin) Rosuvastatin and atorvastatin (Crestor and Lipitor) are the types of drugs most often associated with statin-induced musculoskeletal symptoms. Interestingly, some studies suggest that simvastatin (Zocor) might actually be protective of connective tissue integrity, but thus far the findings are inconsistent. Multiple sources track prescription drug purchases in the United States, and statins are reliably high on the list. According to LowestMed (, an aggregator of prescription drug data, generic forms of Lipitor and Zocor were both in the top 50 drug prescriptions from mid-2016. 1 A CHOLESTEROL REVIEW Readers are probably aware that cholesterol is a form of fat that is manufactured in the liver. It serves important purposes, and we would be in trouble if we didn't have enough. Fortunately, healthy humans make plenty of cholesterol, and we also get it from any animal-based food source, including meat, dairy, and eggs. We use cholesterol to form healthy cell membranes, to make hormones, and for a variety of other things. Stats on Statins By Ruth Werner Readers may also be aware that we have different cholesterol carriers, and they have different functions. Under certain circumstances, low-density lipoproteins (LDLs) and very low- density lipoproteins (VLDLs) carry fat from the bloodstream into atherosclerotic plaques. In this way, they are thought to increase the risk of heart disease or stroke. We would like to keep our LDLs and VLDLs as low as we can, while still being healthy. By contrast, high-density lipoproteins (HDLs) carry fat out of plaques and to the liver where it can be routed to the digestive tract for removal from the body. We like HDLs, and we want to be sure they are a substantial proportion of our overall cholesterol carriers. A third player, triglycerides, simply stores excess fat for later use. High levels of triglycerides are also associated with a risk for cardiovascular disease. Pre-menopausal women tend to be really good at producing HDLs—this may point to why these women have a lower risk of heart attack and stroke than men of the same age. But after menopause, the cholesterol readings of women begin to resemble those of men. Not surprisingly, their risk of cardiovascular disease goes up too. When we get a cholesterol reading, we typically get several numbers that reflect the relative number of LDLs, VLDLs, HDLs, and triglycerides. The National Institutes for Health recommend that adults aged 20 and older should get a cholesterol reading at least once every five years. 2 Optimal cholesterol readings look like this: LDLs + VLDLs Less than 100 mg/dL HDLs More than 60 mg/dL Total level Less than 200 mg/dL Notes 1. LowestMed, "The Top 50 Prescription Drugs Filled in the US," June 16, 2016, accessed November 2017, 2. "Cholesterol Levels: What You Need to Know," NIH Medline Plus 7, no. 2 (Summer 2012): 6–7, accessed November 2017, www.medlineplus. gov/magazine/issues/summer12/articles/summer12pg6-7.html. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at digital extra

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