There are seven statin drugs currently approved for use in the United States: Mevacor, Pravachol, Zocor, Lipitor, Lescol, Crestor and Livalo. All of these are available in more than one dose, so the first step is to read the label to see the current dose, and to ask a physician or pharmacist if that same statin drug is available in a lower dose. A lower dose may still provide adequate control of blood cholesterol, either alone or in combination with approved non-statin treatments.
Step 1
Research the non-statin approaches to lowering cholesterol. As statins function by reducing cholesterol synthesis in the liver, they work well in combination with cholesterol absorption blockers such as soluble fiber foods, phytosterol foods or prescription absorption blockers such as ezetimibe or cholestyramine.
Step 2
Consult your physician. Your doctor will need to review your plan and timeline for implementing non-statin methods before cutting back on the statin dose.
Step 3
Start first with the non-prescription changes. These include adding two to three servings per day of foods with soluble fiber. Examples are oatmeal and whole oat muffins. Cut back on foods with saturated fat and cholesterol. Increase exercise to four to six times a week, and change diet to lose weight.
Step 4
Reduce your prescription statin to the dose approved by your physician once the nonprescription changes have been in place for at least two months. Your doctor should plan to remeasure blood cholesterol six to eight weeks after the statin is lowered.
Step 5
Evaluate whether you are on target for managing cholesterol and low-density cholesterol levels. If not, consider adding two to three servings of phytosterol-containing foods or dietary supplements. According to a review by T. Miettinen, in the January 2009 issue of "Current Atherosclerosis Reports," patients already using a statin drug achieved 7 to 20 percent additional reduction of LCL-cholesterol when adding phytosterols to their treatment.
Step 6
Consider a prescription non-statin if nonprescription approaches are not enough. Prescription niacin, either Niacor or Niaspan, lowers cholesterol and has the additional benefit of lowering triglycerides. The downside is the hot flash side effect. Prescription ezetimibe, brand-name Zetia, blocks cholesterol absorption. Combining ezetimibe with a low-dose statin has proven more effective than raising the dose of the statin.
Tips and Warnings
- Ask your doctor what your last cholesterol values were, and what your targets are. Understand that half the dose provides more than half the benefit; for example, for Crestor, the top dose of 40 mg/day resulted in a 63% decrease in LDL-cholesterol, but the lowest dose of 5 mg/day resulted in 45% decrease. Your doctor can recommend a Registered Dietitian for diet advice.
- Alternative medicine products claim to lower cholesterol. These include red yeast rice, policosanol, garlic, guggul and nonprescription niacin. The scientific evidence for all of these is inconclusive. None are recognized by the Food and Drug Administration as approved means of controlling cholesterol. Fish oil is mistakenly thought by many to be a cholesterol-lowering agent. Fish oil can reduce risk of heart disease, but the mechanism is not via lowering cholesterol.
Things You'll Need
- Phytosterol foods
- Soluble fiber foods
- Prescription niacin
- Prescription ezetimibe
