An elevated blood cholesterol level is a major risk factor for heart disease, the leading cause of death among Americans. Reducing your intake of dietary fats, increasing your level of physical activity and losing weight, if indicated, are the first steps in reducing an elevated cholesterol level. If these measures do not lower your cholesterol reading sufficiently, your doctor might prescribe medicine to alter your blood fat, or lipid, levels. Several types of medicines can help you control your cholesterol.
Statins
Statins, also known as HMG-coenzyme A reductase inhibitors, block the production of cholesterol by your liver. This action lowers your total cholesterol and LDL, or "bad" cholesterol, levels. Reducing your total cholesterol and LDL slows the formation of fat deposits, or plaques, in your arteries. The formation of plaques in the arteries that supply the heart with blood is the leading cause of heart attacks among Americans, notes the National Heart Lung and Blood Institute. As of 2010, FDA-approved statin medications include rosuvastatin, simvastatin, pravastatin, lovastatin, fluvastatin and atorvastatin. Side effects: These medications might cause elevated liver enzyme levels and, less commonly, muscle abnormalities, reports the National Cholesterol Education Program.
Bile Acid Sequestrants
Your liver combines cholesterol and other chemicals to produce bile, which is stored in your gallbladder for release into your small intestine to aid with digestion. Medicines called bile acid sequestrants bind bile in your intestines to prevent its reabsorption into the blood circulation. The bound bile passes with the stool, thereby ridding your body of the cholesterol contained in the bile. Colesevelam, cholestyramine and colestipol are FDA-approved bile sequestrants. Side effects: These medications could cause new or worsening constipation, according to the FDA-approved prescribing information.
Niacin
High doses of niacin, or vitamin B-3, can decrease your total cholesterol, LDL and triglyceride levels. Niacin, also known as nicotinic acid, is available in immediate- and slow-release forms. The usual dose of niacin for cholesterol-lowering purposes is 1,000 to 3,000 mg per day, reports the National Cholesterol Education Program. This dose far exceeds the Institute of Medicine's recommended daily allowance for niacin of 14 to 16 mg for general health purposes. Possible side effects of high-dose niacin therapy include skin flushing and itching, stomach upset, diarrhea and gout. High-dose niacin treatment may also cause elevations of liver enzymes and blood sugar.
Fibrates
Fibrates, or fibric acid derivatives, interfere with your liver's production of lipoproteins and triglycerides. The beneficial effects of fibrate medicines include decreased LDL and triglyceride levels, and increased HDL, or "good" cholesterol, notes the National Cholesterol Education Program. FDA-approved fibrates include fenofibrate, clofibrate and gemfibrozil. Possible side effects of fibrate therapy include development of gallstones and muscle inflammation.
References
- Centers for Disease Control and Prevention: Leading Causes of Death
- U.S. Food and Drug Administration: Controlling Cholesterol with Statins
- National Heart Lung and Blood Institute: Coronary Artery Disease
- The Medical Biochemistry Page: Bile Acids Synthesis and Utilization
- National Cholesterol Education Program: ATP III At-A-Glance
- Institute of Medicine of the National Academies: Dietary Reference Intakes -- Vitamins
