What's The Role Of Bile Acid Sequestrants (Resins) In Treating High Cholesterol?

Bile acid sequestrants are most commonly known as resins, and are a class of drugs prescribed as part of high cholesterol treatment. Resins have quite a unique way of lowering high cholesterol levels by binding to bile acids. What do you need to know?

How resins work

Since less bile acids return to your liver, this organ will create more of them. To make more, your liver needs more cholesterol, consuming the one that’s in your bloodstream, thus lowering your total cholesterol level.

While they are somewhat efficient in lowering LDL levels, they aren’t nearly as effective if you’re trying to boost your HDL levels. Studies have shown that taking a resins treatment will only result in an HDL rise of about three to five percent.

However, by taking drugs that reduce LDL levels, you are also balancing the ration between the bad and the good cholesterol in your bloodstream, thus giving your HDL levels a chance to do their job.

Some of the most commonly-spread types of resins are colesevelam, colestipol, and cholestyramine.

How efficient are resins?

Bile acid sequestrants are not nearly as efficient as other medications meant to lower cholesterol, such as niacin or statins. Even when pumping up the dosage to an approximate of 24 grams per day, resins are only capable of lowering LDL cholesterol levels by about 25 percent.

Because of that, they have proven way more efficient when combined with other types of cholesterol-lowering medications, such as statins.

Resins and dyslipidemia

Dyslipidemia is a medical condition reflected by blood lipids that are found in either high or low quantities. Typically, people who have dyslipidemia show signs of:

• High level of triglycerides in their blood.
• High levels of total cholesterol, as well as elevated LDL levels.
• Low levels of HDL cholesterol.

Bile acid sequestrants are prescribed to patients that need to lower their LDL levels, and have been used in high cholesterol therapies since 1980. Clinical trials with resins have posed quite some difficulties, mostly because of gastrointestinal side effects.

Colesevelam hydrochloride is the most prescribed type of bile acid sequestrants, since it can lower the lipid levels inside the body, both when used as a standalone drug, or when combined with other cholesterol-lowering medications.  The most common combination is colesevelam hydrochloride and a statin (typically atorvastatin, simvastatin, or lovastatin). Depending on the exact combination, one can expect different results:

• Lovastatin and colesevelam hydrochloride can decrease LDL levels with up to 34 percent.
• Simvastatin and colesevelam hydrochloride results in LDL levels lowered with about 42 percent.
• Atorvastatin and colesevelam hydrochloride can lower LDL levels with any value in between 12 and 53 percent, with the average percentage being 48.

Resins and coronary heart disease

Resins were used in the treatment of coronary heart disease way before statins were a thing. As with other applications of bile acid sequestrants, in the care of coronary heart disease, the side effects are mostly of gastrointestinal nature as well.

This happens because resins are a class of drug without any systemic absorption. However, they are known to cause stomach pain, diarrhea, and even nausea and vomiting.

Resins: Possible side effects

Since bile acid sequestrants aren’t actually absorbed by the body, and instead work by binding to bile acids and eliminating them from your organism, their side effects are mostly experienced at a gastrointestinal level.

A lot of experts suggest that these side effects are only at the beginning, until the body gets adjusted to how the drug works. Some of the most common side effects include an upset stomach, flatulence, constipation, and nausea.

Doctors suggest increasing your liquid intake while you’re on a resins-based treatment. Eating more fibers can also help, as they soften your stool and make bathroom trips easier.

There are also people who have their gag reflex triggered almost immediately when trying to take the pills, because they can’t get adjusted to the taste. This happens more frequently in people who have to take resins more than once per day.

Who should avoid resins?

While resins are a good way to deal with high cholesterol levels, they should never be taken unless they are prescribed by the doctor. There are also a few categories of people who do not respond well to bile acid sequestrants treatment, such as:

• Resins are known to interact with different types of medication, so it’s always important to let your doctor know whatever other meds of supplements you’re taking before starting a resin-based treatment. Resins can make some drugs less effective, such as thiazide diuretics, digoxin, thyroid hormones, or warfarin. Resins can also reduce the absorption of certain vitamins, such as A, D, E, or K. This means that if you are on a resin-based treatment for a long time, you may have a deficiency of either of these vitamins.
• People with gastrointestinal problems should also avoid taking resins, as they may worsen hemorrhoid or gastrointestinal issues.
• There are no studies that can inform doctors on the impact of resins on women who are pregnant or breastfeeding. Researchers suspect that these drugs can alter the way the fetus absorbs certain vitamins that are important to their development.

Conclusion

Bile acid sequestrants have a rather unique way of pushing the body to get rid of extra cholesterol. Since they bind to bile acids and are then eliminated from the body, they are not absorbed by the organism, but that doesn’t mean they don’t have any side effects.

Most people with high cholesterol that have started a treatment based on resins drugs have reported gastrointestinal problems that can be quite uncomfortable. Usually, these drugs are more efficient in lowering cholesterol when they are paired with other similar drugs, such as statins.