1. The Good, the Bad and the Statins
High cholesterol is bad, but cholesterol alone is not to blame. Cholesterol becomes attached to lipids called lipoproteins. Exactly hich lipoproteins it attaches to is where the real problem lies. High-density lipoproteins (HDL) carry cholesterol out of the blood; low-density lipoproteins (LDL) carries it throughout our bodies. Basically, we want more HDL and less LDL. There are medications that lower LDL cholesterol. The most commonly-used are statins (simvastatin, lovastatin and atorvastatin, among others) sold under brand names like Zocor or Lipitor. Statins lower LDL cholesterol by suppressing the enzyme that produces cholesterol.
2. Other Soldiers in the War Against LDL Cholesterol
Statins may not be for everyone (such as pregnant women or those with liver disease). There are, however, other agents which work to lower LDL cholesterol. Drugs like Colestid or LoCholest bind with bile acid to eliminate cholesterol from the intestines (these drugs may raise triglyceride levels, so should not be used for those with high triglycerides). Prescribed niacin, not supplements, can also lower LDL cholesterol and can be used when bile acid sequestrants cannot be used. Fibrates like Tricor or Lopid do not work as effectively at lowering LDL cholesterol and work better to lower triglycerides.
3. Throwing Some Combination Punches at Bad Cholesterol
Sometimes, one type of LDL cholesterol-lowering medication may not be ample for certain conditions. Since some of these medications act on triglycerides and others on LDL, a combination of medications might work best. Drug combinations are usually considered for those with severely high levels of cholesterol (hypercholesterolemia) that cannot be controlled by diet or a single medication. A statin combined with a bile acid sequestrant, or a bile acid sequestrant combined with niacin, seems to be effective to substantially lower LDL cholesterol levels.
4. No Drug Is Without Some Potential Side Effects
Each type of medication prescribed for lowering LDL cholesterol is not without side effects, but they are generally well-tolerated. Statins are safest ("safer than aspirin" says Dr. Jennifer Robinson, of the University of Iowa Hospitals and Clinics), though they may cause mild gastrointestinal problems; these should lessen the longer you take these medications. Side effects of bile acid sequestrants are also mild, mostly joint pain or aches, but they are rare. Niacins may run the risk of liver side effects. Some fibrates have not yet been approved by the FDA for specifically treating high LDL cholesterol; side effects are mostly minimal.
5. Some Simple Lifestyle Changes
Taking medications to lower LDL cholesterol don't necessarily need to be the first step. A low-fat diet and exercise may be enough to get LDL levels down without ever having to pop a single pill. Stopping smoking and maintaining a healthy weight will also help. A study by the founder of the Preventive Medicine Research Institute in California has shown that diet, exercise and reducing stress can lower LDL by nearly 40 percent, and even reduce plaque already built up in the arteries, something even statins have not been shown to do.
