Cholesterol treatment to lower cholesterol may be attained by a diet low in saturated fats and cholesterol and an exercise program. A low saturated fat/low cholesterol diet that meets recommendations for fat (total, saturated, polyunsaturated, and monounsaturated), cholesterol, carbohydrates, and plant sterol and stanol esters will reduce cholesterol levels for many people. Exercise and weight loss may improve HDL cholesterol and triglyceride levels.
How is high cholesterol treated?
A low saturated fat/low cholesterol diet, exercise, and weight loss program does not effectively reduce cholesterol levels in all people. Cholesterol medication may be prescribed in addition to a low saturated fat/low cholesterol diet, since treatment combining a low saturated fat/low cholesterol diet with exercise and cholesterol medication may reduce cholesterol levels more effectively than cholesterol medication alone.
Of the five classes of cholesterol medications, the statins most effectively reduce cholesterol. Statins reduce (LDL cholesterol) by 20-60% by inhibiting the HMG-CoA reductase enzyme that produces cholesterol in the liver. Also, triglycerides are decreased and HDL cholesterol levels are increased by statin cholesterol medications. Statins are generally well tolerated. The statins include atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®, Altocor®), pravastatin (Pravachol®), simvastatin (Zocor®), and rosuvastatin (Crestor®).
Bile acid sequestrants reduce LDL cholesterol by 10-20% by binding with bile acids in the intestines to enhance elimination of cholesterol. Certain foods, such as oat bran, also reduce LDL cholesterol by this mechanism. The bile acid sequestrants (cholestyramine (Questran®), colestipol (Colestid®), and colesevelam (Welchol®)) may be administered in combination with statins.
The newest drug class, the cholesterol absorption inhibitor drugs are designed to lower LDL cholesterol by 18-20% by decreasing absorption of cholesterol from the intestines. Ezetimibe (Zetia®) may be administered in combination with a statin to double or triple the effect of the statin alone. In fact, Vytorin® is a new combination of ezetimibe (Zetia®) and simvastatin (Zocor®) which blocks cholesterol absorption and decreases cholesterol production, reducing cholesterol levels by 45-60%.
The B vitamin nicotinic acid (niacin) effectively reduces total cholesterol, LDL cholesterol, and triglycerides and increases HDL cholesterol. A new combination of niacin and lovastatin (Advicor®) has been approved.
Lastly, the fibrate drug class is designed to reduce triglycerides and increase HDL cholesterol. Clinical data indicate that gemfibrozil (Lopid®) reduces triglycerides while fenofibrate (Tricor®) lowers triglycerides and LDL cholesterol.
Take Action: Management of high cholesterol
The diagnosis of high cholesterol (>160 mg/dL LDL or >200 mg/dL triglycerides) increases the risk of heart disease, and therefore, high cholesterol should be reduced by lifestyle modifications, cholesterol medication, or both, as recommended by your physician. A monitoring and treatment program should be patient tailored.
Some questions to ask your physician:
- How often should my cholesterol levels be monitored?
- How do I interpret my blood results?
- What are the best forms of exercise for me to begin/maintain?
- What are important side effects of my prescribed cholesterol medication?
- When (i.e., what time of day) should I take my prescribed cholesterol medication?
- Should I avoid certain foods or beverages while taking my cholesterol medication?
- How should my cholesterol medication be stored?
- If I miss a dose of my cholesterol medication what should I do?
Cholesterol-reducing supplements could be worth a try in the following situations:
- You have borderline-high cholesterol (total cholesterol 200 to 240 or LDL cholesterol 130 to 160) but no known heart disease. “For people with cholesterol between 200 and 240 who’ve tried diet and exercise already, these supplements are a logical alternative,” says David Heber, MD, PhD, director of UCLA’s Center for Human Nutrition. If you have heart disease symptoms with borderline or high cholesterol, see What About a Prescription Drug?.
- You’ve had side effects from taking prescription drugs for cholesterol. Side effects from these drugs are not common, says Dr. Heber, “but they do occur in some patients.” He believes the action of supplements tends to be gentler.
- You want to try a prescription drug/supplement combo. In some cases, adding a supplement may improve the preventive effects of your medication; however, always check with your doctor since there could be interactions between your supplement and a prescription drug.
- Your cholesterol is normal, but you want to try for the optimum: cholesterol under 150. As Dr. Heber notes, heart attacks are almost unheard of at cholesterol levels of 150 or lower. Not everyone can lower her cholesterol that much though. “If we could just get everyone down to 180, we’d be doing great,” he says.