At present, lifestyle modification—which before medicines that can lower blood cholesterol were developed, was the only approach to the treatment of persistently high blood cholesterol levels—still constitutes the first line of defense against high cholesterol. I therefore suggest that you try to adopt the following lifestyle changes first because they may be enough to bring your cholesterol down to normal: shift to a heart friendly diet; exercise; and, stop smoking (i.e., if you are a smoker).
A heart healthy diet is a diet that is rich in vegetables, fruits, whole grains, high-fiber foods, fat-free dairy products, lean meats and poultry, and fish at least twice a week.
Exercise, on the other hand, does not have to be in the form of a structured program (e.g., cycling, jogging, swimming, etc.) at all. You can get enough of it by simply taking the stairs instead of the elevator, doing household chores regularly, walking or biking in going to and from the neighborhood grocery instead of driving, etc. As long as the daily activities lead to palpable physical exertion and add up to more than 30 minutes per day.
Only if the above recommended lifestyle changes fail to lower your blood cholesterol, should you consider taking drugs. There are numerous cholesterol-lowering drugs in the market. The specific drug or combination of drugs that you or any patient needs to take depends on many factors, including individual risk factors, age, current health status and possible side effects. Hence, you need to consult a doctor to determine which drug or drugs are best for you. In any case, you should never self-medicate with cholesterol lowering drugs because they are not innocuous.
The cholesterol lowering drugs can be classified into statins, cholesterol absorption inhibitors, bile acid-binding resins and lipid-lowering drugs.
Statins include atorvastatin, fluvastatin, lovastatin, mevacor, pravastatin, rosuvastatin and simvastatin. They prevent the formation of cholesterol by the liver. They are most effective at lowering the LDL (bad) cholesterol, but also have modest effects on lowering triglycerides (blood fats) and raising HDL (good) cholesterol.
The side effects of statins are often mild and go away after a few days to weeks. But severe adverse effects involving the muscles and liver occur, albeit rarely.
Selective cholesterol absorption inhibitors, exemplified by ezetimibe, prevent the absorption of cholesterol from the intestine. They are effective at lowering the LDL cholesterol, but may also have modest effects in lowering triglycerides and raising HDL cholesterol.
Bile-acid binding resins include cholestyramine, colestipol, colesevelam. Cholesterol is used in producing bile, which is needed to absorb fat in the intestines. By binding to bile, these resins force the liver to make more bile, which means less cholesterol to circulate in blood.
Lipid-Lowering drugs include fibrates, niacin and omega-3 fatty acids. Fibrates such as gemfibrozil, fenofibrate and clofibrate lower triglycerides and in some cases increase HDL levels, but are not very effective in lowering LDL cholesterol.
Niacin and omega-3 fatty acids come in the form of prescription drugs or dietary supplements that are sold over the counter. They can lower blood cholesterol, but they should be taken only after consulting with a doctor. Niacin has many potential adverse effects while omega-3 fatty acid could interfere with other medications you may be taking.
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