High Cholesterol Treatment -- What Works?

High Cholesterol Treatment -- What Works?
Safe, effective treatment for high cholesterol isn't hard -- but it can be confusing. Get the facts.
By R. Morgan Griffin
Reviewed by Brunilda Nazario, MD

If you've just been diagnosed with high cholesterol, you may be worried. After all, along with your age, genes, and other factors, high cholesterol is a major contributor to cardiovascular disease, heart attack, and stroke. But while you can't turn back the clock or yank out unhealthy genes from your DNA, you can change your cholesterol numbers. That's because high cholesterol treatment works.

"We have good, safe treatments for high cholesterol," says Adolph Hutter, MD, a cardiologist at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. "They can directly lower your risks of heart attack, stroke, and death. So why not take advantage of them?"

For many people, making changes to their lifestyle -- eating better, losing weight, and exercising -- will be enough to lower cholesterol. Others may benefit from medicines. Often, a combination of these approaches is the right choice.

But where do you start? "People tend to be very confused about treating high cholesterol," says Nathan D. Wong, PhD, director of the heart disease prevention program at the University of California, Irvine.

WebMD talked to experts to help reduce the confusion -- and help you sort through your high cholesterol treatment options.

* Is it time to consider medication? Take this quiz for cholesterol-lowering tips.

Finding the Best High Cholesterol Treatment

There's a lot of variability in how high cholesterol treatments work in a given person. Treatment that did wonders for your spouse may do nothing for you. Some of it depends on your genes. You and your doctor will need to come up with a custom-tailored approach.

For most people, the first high cholesterol treatment to try is three lifestyle changes:

* Eating better
* Maintaining (or losing) weight
* Exercising more

Some people, if they already have other risk factors -- such as diabetes -- may immediately start medication as well.

While lifestyle changes can really help bring your cholesterol down, Wong says that not enough people give them a real chance.

"The problem is that both patients and their doctors like immediate results," he tells WebMD. "Lowering your cholesterol with exercise and diet is just not like that."

So try to give high cholesterol lifestyle treatments time to work. If they do, you can avoid the hassle of being on a daily medicine for the rest of your life.
Eating Right as a High Cholesterol Treatment

We've all heard that diet has an effect on cholesterol, but there's much confusion about what you should or shouldn't eat. Here's a rundown of the current evidence.

* Fat. If you have high cholesterol, you should cut down on saturated fat -- found in fatty meats and whole milk dairy products like cheese, ice cream, and butter. You also need to reduce your intake of trans fats, a man-made fat found in many processed foods, like stick margarine.

But the message isn't as simple as "fat is bad." There are a number of foods with healthy unsaturated fats that will actually improve your cholesterol. They include fatty fish like tuna and salmon, walnuts, and almonds. Since even good fats are high in calories, you should still eat them in moderation.
* Calories. According to Wong, the importance of counting your calories is often overlooked by people with high cholesterol. No matter how much or how little fat or cholesterol is in a food, its calories still add up. Eating too much of it can lead to weight gain, and that increases your risk of high cholesterol.

* High cholesterol foods. Experts have long urged people with high cholesterol to shun foods loaded with cholesterol, like egg yolks, shrimp, and organ meats. While some recent evidence suggests eggs may not be quite as harmful as once thought, experts still generally recommend you limit all high cholesterol foods. Also, don't assume that a food labeled "cholesterol-free" is necessarily good for you.

So what sort of diet works as a high cholesterol treatment? Ask your doctor for specific recommendations. Some experts recommend a Mediterranean-style diet, which cuts down on saturated and trans fats, while boosting intake of healthy unsaturated fats from fish and nuts.

If an improved diet doesn't help your cholesterol, don't feel like a failure. Because of their genes, some people just don't respond as well to this approach.


Weight Loss & Exercise as a High Cholesterol Treatment

Being overweight or obese ups your odds of having high LDL (bad cholesterol) and triglyceride levels and low HDL (good cholesterol) levels. It can also lead to other serious risks like high blood pressure, diabetes, and heart disease. So it's crucial to keep a healthy weight.

As a high cholesterol treatment, physical activity can have a modest effect. Exercise can lower your triglycerides (and bad LDL cholesterol to a lesser extent) and boost your good HDL cholesterol. So you should aim to get some physical activity -- even just a brisk walk -- for 30-60 minutes most days of the week.

But there are limits to what exercise can do. "For most people, exercise by itself wouldn't be an effective therapy to lower cholesterol," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga. But it can keep your weight down and reduce other cardiovascular risks.


Medications as High Cholesterol Treatments

If lifestyle changes haven't been enough as a high cholesterol treatment -- or if you're at high risk of cardiovascular problems -- your doctor will likely turn to medications. In most cases, the first drug you will try is a statin.

Statins like Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor work by blocking the effects of an enzyme that helps make cholesterol. They can lower bad LDL cholesterol by an impressive 20-55%. They have a modest effect on triglycerides and give a mild boost to your good cholesterol, too.

But don't assume that taking a statin makes you invulnerable. They won't cancel out a diet of french fries and fondue. "Statins are a complement to dietary changes," says Hutter, "not a replacement for them."
As with any drug, there are side effects. They can cause muscle aches, an increase in liver enzymes, and other issues. But the risks are low and it's important to keep them in perspective.

"On one hand, statins can reduce your risk of death, heart attack, stroke by 30-35%," says Sperling. "On the other, they pose a 1-2% risk of generally mild side effects." The benefits are often worth the small risk, Sperling says.

Although they tend to be overshadowed by statins, other medicines are also important high cholesterol treatments instead of, or in addition to, statins. They include:

* Bile acid resins like Colestid, Lo-Cholest, Prevalite, Questran, and WelChol. They stick to cholesterol in the intestines and prevent it from being absorbed. They can lower LDL cholesterol by 15-30%.
* Ezetimibe (Zetia) blocks some of the cholesterol from being absorbed by your body. It can lower LDL levels by 18-25%.
* Fibric acid like Antara, Atromid, Lopid, and Tricor. They reduce your triglycerides and may give a mild boost to your HDL.
* Niacin, available as Niacor, Niaspan, and Nicolar. Niacin modestly lowers LDL cholesterol and triglycerides and can raise HDL cholesterol at low doses. LDL levels are usually cut by 5-15%.
* A combination medicine like ezetimibe with simvastatin (Vytorin) which uses a statin to block production of cholesterol and ezetimibe to prevent cholesterol from being absorbed.

Remember that medicines aren't right for everyone. Since they're often taken for life, you and your doctor need to carefully discuss whether you should use them.


Do Alternative High Cholesterol Treatments Work?

While lifestyle changes and medicines have been shown to lower cholesterol and reduce your risk of cardiovascular disease, the same can't always be said for many alternative treatments. Some of the various supplements and herbs that have been touted as high cholesterol treatments are garlic, policosanol, and guggul.

While a few studies of garlic have found a modest benefit, a recent study of policosanol found no effect. However, none of these studies have been large enough to be definitive, experts say.

Keep in mind that, unlike medications, herbal products are not regulated by the FDA. They are not evaluated to see if they work. They could also interact with other medicines you use.

"You just don't know what you're getting when you buy these products," says Wong. So if you want to take an alternative high cholesterol treatment, be sure to talk to your doctor.
Sticking to Your High Cholesterol Treatments

Many people find that their dedication to lowering their cholesterol fades over time. When they're first diagnosed, they're gung ho. They go on a diet and train like marathon runners. But after a few months, they get complacent. Their low-cholesterol cookbooks gather dust and their gym membership card lies in a sock drawer.
Sticking to Your High Cholesterol Treatments continued...

It is very easy to forget about high cholesterol. Even though it may still be doing damage, you can't feel it.

So how can you make healthy changes stick? The experts have some advice.

* Get tested regularly. All adults need to be tested at least once every five years. People with high cholesterol or other risk factors may need to be tested once a year or more.
* Know your numbers. "People need to know what the cholesterol numbers are and what their target numbers should be," says Sperling.
* If you've been prescribed medicine, take it. It's easy to get lax about taking a daily medicine. So do what you can to remember. Use a weekly pill box or an alarm to help you remember.
* Get help in making lifestyle changes. Changing the way you eat isn't easy -- you've probably developed some bad habits over the decades. But, unfortunately, Wong says that many doctors -- because they are so busy -- just don't give good guidance on this crucial part of treatment.

"Doctors might just tell a patient, 'Exercise more and eat less,'" Wong says. "But making these changes requires a lot more than vague advice."

So ask specific questions about what to do. If you find you're having trouble making changes to your habits, check back in with your doctor. If possible, Wong suggests having a few meetings with a dietician who can help guide you.

Perhaps most importantly, you need to stay involved. Don't be a passive about your high cholesterol treatment. Partnering with your doctor will lead to better results, says Sperling.

So whether you've been just diagnosed with high cholesterol or have known for years (and never gotten around to doing anything about it) now is the time to get serious. High cholesterol treatment is safe and it works. It could even save your life.