Lowering Cholesterol

The goal of treatment for high cholesterol is to lower your low density lipoprotein cholesterol (LDL) enough to reduce your risk of heart disease or a heart attack. Lowering cholesterol begins with lifestyle changes, such as losing weight and changing your diet. If lifestyle changes alone are not successful in decreasing cholesterol levels, medication such as statins, bile acid sequestrants, and cholesterol absorption inhibitors may be prescribed.

 

How To Lower High Cholesterol: An Overview

It can take decades for high cholesterol to have a negative effect on your health, although it still does damage even when you don't have any noticeable cholesterol symptoms.
 
If you have high cholesterol, and nothing is done to lower it, you will be at greater risk for serious medical problems later, such as a heart attack or stroke. Therefore, lowering cholesterol is an important issue for anyone's general health. If you have high cholesterol, you will need to take steps to fight it every day, just like you would brush your teeth to fight gum disease.
 
The main goal of high cholesterol treatment is to lower your low density lipoprotein (LDL) cholesterol levels enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be.
 
(Click High Cholesterol Risk to see what your risk is and what your LDL cholesterol level should be under.)
 
Treating high cholesterol begins with lifestyle changes. If lifestyle changes alone do not lower cholesterol to a desirable level, cholesterol medication may be necessary.
 
For most people, living with high cholesterol is a lifelong journey.
 

Lowering Cholesterol Through Lifestyle Changes

Lifestyle changes are the first line of defense for a person with high cholesterol.
 
 
Lifestyle changes for lowering cholesterol include:
 
  • Changing your diet
  • Losing weight
  • Exercising
  • Quitting smoking or nicotine use.
     
It may take 3 to 6 months before you and your healthcare provider see the full benefit of lifestyle changes on your cholesterol level.
 
Changing Your Diet
In most cases, the first thing a person with high cholesterol should do is to change his or her diet. A cholesterol-lowering eating plan includes:
 
  • Limiting the amount of saturated fat and cholesterol you eat.
  • Eating only enough calories to achieve or maintain a healthy weight.
  • Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber.
  • Adding cholesterol-lowering food, such as margarines that contain plant sterol or stanol esters that lower cholesterol for some people.
     
A specific diet for lowering cholesterol (called the TLC diet) has been shown to decrease LDL cholesterol levels (see Low Cholesterol Diet). This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7 percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain.
 
If your LDL is not lowered enough by reducing your saturated fat and cholesterol intake, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanol or plant sterols (for example, cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power (see Cholesterol Lowering Food).
 
(Click Low Cholesterol Food, Cholesterol Lowering Diet, or High Cholesterol Foods for more information on lowering cholesterol through dietary changes.)
 
Losing Weight
The more weight a person gains, the more his or her cholesterol level tends to rise. For treating high cholesterol, a doctor will normally recommend that an overweight person lose weight. In fact, just a little weight loss can decrease your cholesterol level by about 10 percent. Weight management is especially important for those with several risk factors, including high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
 
Your healthcare provider will probably suggest both a low fat/low cholesterol diet and moderate exercise if you are overweight.
 
Exercising
A moderate exercise program, such as taking a brisk walk 30 to 40 minutes a day on most, if not all, days, will help you keep your heart and blood vessels in shape and lower your cholesterol. Exercise will not only lower LDL, which is the "bad cholesterol," but it also will raise high density lipoproteins (HDL), which is the "good cholesterol." Be sure to check with your doctor before starting any type of exercise program.
 
(Click Exercise and Cholesterol for more information about how moderate levels of physical activity can help in lowering cholesterol.)
 
Quitting Smoking or Nicotine Use
Nicotine in cigarettes, cigars, snuff, chewing tobacco, and pipe tobacco can make blood vessels narrow and can lower HDL.
 

Medications for Lowering Cholesterol

For some people, lowering cholesterol through diet, weight control, and exercise are not enough. However, a healthy lifestyle can keep cholesterol from getting any higher. If lifestyle changes alone are not enough, your doctor can prescribe cholesterol medications.
 
Your doctor will base his or her decision to prescribe cholesterol medication on more than just the blood cholesterol test. The doctor will also look to see if you are at risk for heart disease from other problems. The more risk factors for heart disease you have, the lower your cholesterol level needs to be.
 
(Click Heart Attack Risk to calculate your 10-year risk for a heart attack.)
 
There are many types of cholesterol medicines used to treat high cholesterol. The type your doctor recommends for lowering high cholesterol will be based on many things, like your cholesterol levels and other medical conditions. Treatment with high cholesterol medicine controls but does not "cure" high cholesterol. Therefore, you must continue taking your medicine to keep your cholesterol level in the recommended range.
 
The five major types of drugs used in treating high cholesterol are:
 
  • Statins
  • Bile acid sequestrants
  • Nicotinic acid
  • Fibrates
  • Cholesterol absorption inhibitors.
     
If you do not reach your LDL goal after 3 months on a single drug, your doctor may consider starting a second medicine along with it. Combination therapy can increase your cholesterol lowering capabilities, reverse or slow the advance of atherosclerosis, and further decrease the chance of a heart attack or related death. The use of low doses of each medicine may help reduce the side effects of the drugs.
 
Statins
Statins are effective in lowering LDL (bad cholesterol) levels and are safe for most people. Rare side effects to watch for are liver and muscle problems.
 
Example of statins used high cholesterol cholesterol include:
 
Bile Acid Sequestrants
Bile acid sequestrants help lower LDL cholesterol levels and are sometimes prescribed with statins. These cholesterol drugs are usually not prescribed as the only medicine to lower cholesterol.
 
Examples of bile acid sequestrants include:
 
Nicotinic Acid
Nicotinic acid (niacin) lowers LDL cholesterol and triglycerides, and raises HDL (good) cholesterol. These cholesterol medicines should only be used under a doctor's supervision.
 
Fibrates
Fibrates lower LDL somewhat, but are used mainly to treat high triglyceride and low HDL levels. When used with a statin, these cholesterol lowering medications may increase the chance of muscle problems.
 
An example of a fibrate medication is gemfibrozil (Lopid®).
 
Cholesterol Absorption Inhibitors
This type of cholesterol lowering medicine lowers LDL and can be used alone or in combination with statin drugs. This cholesterol medication acts within the intestine to block cholesterol absorption.
 
An example of a cholesterol absorption inhibitor used for lowering cholesterol is ezetimibe (Zetia®). This medication has also been combined with simvastatin into one ezetimibe/simvastatin tablet (Vytorin®).
 

Lowering Cholesterol: Summary

Cholesterol is not a bad thing -- it serves an important purpose in keeping the body healthy. Unfortunately, some people who have high cholesterol choose to ignore it because there are no obvious symptoms. Having high levels of cholesterol for long periods of time can greatly increase your risk of serious medical problems, like heart disease, stroke, atherosclerosis, and other heart and blood vessel problems.
 
Even though lowering cholesterol can be a challenge, commitment and care from you and your healthcare providers can make a difference. Whatever the approach you take to lowering cholesterol, making a lifelong commitment to lower your high cholesterol is a worthy goal.
 
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Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD