How to Lower Your Cholesterol
Here’s what happens. Ordinarily, your liver makes all the cholesterol your body needs. But you also get cholesterol from other sources. For example, you can get it from eating simple sugars as well as certain kinds of fats -- namely trans and saturated fats. You'll find these in many processed foods like donuts, frozen pizza, cookies, and crackers.You can also get it from eating certain foods, such as milk, eggs, meat, and other animal products.Over time, without your even being aware, this extra cholesterol accumulates inside your body and begins to do damage.
How Does High Cholesterol Cause Heart Disease?
When you have too much cholesterol, it builds up in the walls of your arteries, This buildup causes the arteries to harden -- a process called atherosclerosis. It also narrows the arteries, which slows and even blocks the flow of blood. That’s where the problem starts. Your blood is supposed to carry oxygen to all parts of your body, including your heart muscle. Without enough oxygen, your body’s parts won’t function the way they’re supposed to. For instance, if your heart muscle doesn’t get enough blood and oxygen you'll have chest pain. And if the blood supply to a portion of your heart is completely cut off, you’ll have a heart attack.
There are two major forms of cholesterol: Low-density lipoprotein or LDL, also known as "bad" cholesterol, and high-density lipoprotein or HDL, also called "good" cholesterol. LDL is the main source of artery-clogging plaque. HDL, on the other hand, works to clear cholesterol from your blood.
In addition to LDL and HDL, there is another kind of fat in your blood called triglycerides. Research shows that high levels of triglycerides, just like high levels of LDL, are linked to heart disease.
What Are the Symptoms of High Cholesterol?
High cholesterol does not have any symptoms. So you can be completely unaware that your cholesterol levels are getting too high. That’s why it’s important to find out what your cholesterol numbers are. If the level is too high, lowering it will lessen your risk for developing heart disease. And if you already have heart disease, lowering cholesterol can reduce your chance of a heart attack or of dying from heart disease.
How Do I Find Out What My Cholesterol Numbers Are and What They Mean?
If you’re older than 20, your doctor should measure your cholesterol levels at least once every five years. All that’s needed for this is a simple blood test called a lipid profile. The test will show you your:
Your numbers will help you and your doctor determine not only your risk for heart disease but also the best options for lowering it. For instance, an LDL level of 190 or above is considered very high, and your doctor will likely talk to you about taking medicine to lower it. And if your HDL level is 60 or above, excellent, your risk of heart disease is lowered. The goal is a lower LDL and a higher HDL to prevent and manage heart disease.
But remember, the cholesterol numbers are only one part of a larger equation. In addition to the numbers, the doctor will factor in your age, blood pressure, smoking history, and use of blood pressure medicines. All of these things plus whether you already have heart disease will give a picture of your chance of a major heart problem over the next 10 years. With that picture you and your doctor will develop a strategy to lower the risk. That strategy may involve lowering your cholesterol level with diet and possibly medicine.
What Affects Cholesterol Levels?
Lots of things can affect your cholesterol levels. They include:
- Diet. Reducing the amount of saturated fat, trans fats, and cholesterol in your diet can help lower your blood cholesterol. Eating too much sugar and too many simple carbohydrates will also increase your cholesterol levels.
- Weight. Being overweight is in itself a risk factor for heart disease. It also can increase your cholesterol. Losing weight will help lower your LDL, total cholesterol levels, and triglyceride levels. At the same time it can help you raise your HDL.
- Exercise. Regular exercise can lower LDL cholesterol and raise HDL cholesterol. You should try to be physically active for 30 minutes on most days.
- Age and Gender. As you get older, your cholesterol rises. Before menopause, women tend to have lower total cholesterol than men. After menopause, though, women's LDL levels tend to rise.
- Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
- Medical conditions. Sometimes a medical condition may cause higher cholesterol levels. Examples include hypothyroidism (an underactive thyroid gland), liver disease, and kidney disease.
- Medications. Some drugs, such as steroids and progestins, can increase the "bad" cholesterol and decrease the "good" cholesterol.
What Drugs Are Used to Treat High Cholesterol?
Cholesterol-lowering drugs include:
- Bile-acid resins
Cholesterol-lowering drugs are most effective when combined with a low-cholesterol diet and exercise program.
Statins block the production of cholesterol in the liver. They lower LDL and triglycerides and can slightly raise HDL. These drugs are the first line of treatment for most people with high cholesterol. They are associated with a lower risk of heart disease, and for people with heart disease, statins reduce the risk of future heart attacks. Side effects can include intestinal problems, liver damage, and, in a few people, muscle tenderness or weakness. If your doctor prescribes statins, you should discuss the percentage by which you should lower your cholesterol. Generally, it will be between 30% and 50%.
Examples of statins include:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol, Lescol XL)
- Lovastatin (Altocor, Altoprev, Mevacor)
- Pitavastatin (Livalo)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
Niacin is a B-complex vitamin. It's found in food, but it is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling, and headache. Aspirin can reduce many of these symptoms. Speak with your doctor first, though, before taking aspirin. Research studies suggest that even though niacin may improve your cholesterol numbers, it does not appear to lower your risk of heart disease, especially if you are already taking a statin.
Bile Acid Sequestrants
These drugs work inside the intestine, where they bind to bile and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by reducing the body's supply of cholesterol. That then lowers both total and LDL cholesterol. The most common side effects are constipation, gas, and upset stomach. Examples of bile acid resins include:
- Cholestyramine resin (Prevalite, Questran and Questran Light)
- Colesevelam (WelChol)
- Colestipol (Colestid)
Fibrates lower triglyceride levels and can increase HDL and lower LDL. It's thought that fibrates enhance the breakdown of triglyceride-rich particles and decrease the secretion of certain blood fats.
Examples of fibrates include:
- Fenofibrate (Lofibra, Tricor)
- Gemfibrozil (Lopid)
Cholesterol absorption inhibitors
Ezetimibe (Zetia) works to lower LDL by inhibiting the absorption of cholesterol in the intestines. Vytorin is a drug that combines ezetimibe and a statin. It can decrease total and LDL cholesterol and raise HDL levels. Although ezetimibe may reduce your LDL cholesterol, research studies have not found that it reduces your risk of heart disease.
Some people with high cholesterol achieve the best results with combination drugs. These are pills that contain more than one medication to treat cholesterol problems, trigylceride abnormalities, or even high blood pressure. Some examples include:
- Advicor: Lovastatin and niacin ( nicotinic acid )
- Caduet: Atorvastatin and amlodipine , a calcium channel blocker
- Liptruzet: Atorvastatin and ezetimibe
- Simcor: Simvastatin and niacin (nicotinic acid)
- Vytorin: Simvastatin and ezetimibe , a cholesterol absorption inhibitor
What Are the Side Effects of Cholesterol-Lowering Drugs?
The side effect you need to be most concerned about is muscle aches. They could be a sign of a life threatening condition. If you have muscle aches, call your doctor immediately.
Other side effects of cholesterol-lowering drugs include:
- Abnormal liver function
- Allergic reaction (skin rashes)
- Abdominal pain
- Decreased sexual desire
- Memory loss
Are There Foods or Other Drugs I Should Avoid While Taking Cholesterol-Lowering Drugs?
Ask your doctor about the other drugs you are taking, including herbals and vitamins, and their impact on cholesterol-lowering medications. You should not drink grapefruit juice while taking cholesterol-lowering drugs. It can interfere with the liver's ability to metabolize these medications.