Understanding Cholesterol: Diagnosis and Treatment
What Are the Treatments for Cholesterol Problems? continued...
Exercise. Studies show that regular exercise improves cholesterol levels.
Medical Treatments. Drug treatment for high cholesterol centers on reducing the LDL level, and the degree of LDL lowering depends on a person's risk category (based on the LDL value and a person's risk of having a heart attack within the next 10 years). These risk factors include being older than age 45 for men and age 55 for women (unless you're a woman who has gone through premature menopause), high blood pressure, diabetes, diet high in saturated fat, smoking, obesity, sedentary lifestyle, and a family history of cardiovascular disease.
Statin drugs are among the most widely used to lower total and LDL cholesterol. Statins available in the U.S. are: Mevacor, Altocor, Pravachol, Lescol, Zocor, Crestor, and Lipitor. These drugs work by blocking the liver's ability to produce cholesterol. Though they usually don't cause problems, in rare instances, they can cause reversible damage to the liver and muscle. Because of this, your doctor will periodically perform blood tests to check your liver function.
Statins also carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects. It's important to remember that statins may also interact with other medications you take.
Niacin is an alternative for some people, but to be effective it must be taken in large doses. Unfortunately, in these amounts it often causes skin flushing and upset stomach. Newer versions of niacin made to minimize these side effects may be better tolerated. Despite its effects on cholesterol levels, an important scientific study recently found that adding niacin to statin therapy did not reduce the risk of future cardiac events.
A group of drugs called bile acid binders (cholestyramine and colestipol) may also lower total and LDL cholesterol in some people by depleting the supply of LDL cholesterol. But these drugs also have side effects -- namely bloating, gas, and constipation.
Another group of drugs called fibric acid derivatives are occasionally used to increase HDL cholesterol and lower triglyceride levels. They also mildly lower LDL.
Zetia (ezetimibe) is a drug that directly blocks the absorption of cholesterol in the small intestine. Usually it is used in combination with a statin -- getting up to an additional 25% reduction of cholesterol. Zetia is also controversial, however, because of a lack of evidence that it decreases the risk of heart attack or death from heart disease.
If your cholesterol level can't be controlled by using medication, your doctor may try to combine two drugs, most commonly a bile acid binder and a statin.
, two different medications in one pill that treat cholesterol problems and other medical conditions (such as high blood pressure),
are sometimes needed to achieve the best results. Some examples include:
A blood-cleansing procedure called LDL apheresis may help people with severe genetic cholesterol disorders. Over several hours, blood is removed from the body, chemically cleansed of LDL cholesterol, then returned to the body. Treatments every two to three weeks can reduce average LDL cholesterol by 50%-80% but are costly in both time and money.