It has been proven that high cholesterol levels are a significant contributor to heart disease. Lowering the cholesterol level has been scientifically proven to prevent heart disease and prolongs life. This has been proven for men and women, young and old. Even people with established heart disease can slow the progression of their disease and prolong their life by lowering their cholesterol levels.

The benefit of lowering the cholesterol level is not something that takes a long time. Within six months of starting treatment for a high cholesterol level, the risk of heart disease is already reduced.

Lowering the serum cholesterol level achieves these benefits by slowing or preventing the growth of atherosclerotic plaques in the arteries. Some plaques may even get smaller with time. A lower cholesterol level also helps the arteries of the heart dilate during times of stress to provide additional blood flow to the heart muscle. The statin medications also appear to prevent inflammation in the atherosclerotic plaque. This inflammation may be what causes a plaque to rupture and cause a heart attack.

You may have heard that our bodies contain a good cholesterol (known as HDL-cholesterol) which we want to keep as high as possible and a bad cholesterol (known as LDL-cholesterol) which we want to keep as low as possible. These terms refer to the different types of protein molecules the cholesterol gets attached to in our blood stream.

The HDL protein takes cholesterol out of the lining of our blood vessels and protects against heart disease. So we like to keep the HDL (good) cholesterol as high as possible. This is accomplished by not smoking and by exercising. Some cholesterol medicines also help raise the HDL cholesterol. Post-menopausal hormones and alcohol in moderation also raises the good cholesterol.

Cholesterol attached to the LDL protein is what damages our blood vessels and significantly contributes to heart disease. Naturally, we want to keep the LDL (bad) cholesterol as low as possible. This is done by minimizing our dietary intake of cholesterol as well as the dietary intake of saturated fats which cause the liver to manufacture even more cholesterol. Often, medications are needed as well.

In many people, a high cholesterol level is at least in part due to a genetic abnormality that causes the liver to manufacture too much cholesterol. Changing the diet alone generally results in about a 11% decrease in the LDL cholesterol. The decrease may be more or less in any individual depending on their genetic background. Very severe diets such as the Ornish diet or a strict vegetarian diet can result in a 40% lowering but it is very difficult for most people to stick with those diets.

Cholesterol lowering medications are prescribed when the cholesterol level is not adequately lowered by diet alone. They are prescribed when the physician feels that the health benefits of further cholesterol lowering outweigh the risk of any potential side effects from the medications. With proper monitoring by physicians, these medications are quite safe. There had been some concern in the past that low cholesterol levels cause cancer but we now know that it is the cancer that causes the low cholesterol levels, not vice versa.

Even if medications are needed, a low fat and cholesterol diet must still be followed to get the full benefit. See Lowering Cholesterol Levels for more dietary details.

RESINS

These medications bind bile that was secreted into the intestine and prevent it from being reabsorbed. The liver makes bile out of cholesterol. Since these medications cause the body to lose bile, the liver then takes cholesterol out of the blood stream and converts it to bile, thus lowering the serum cholesterol level. These medications primarily lower the LDL-cholesterol level but not the triglyceride level. The major side effects are gastrointestinal, especially constipation.

The taste of the powders can be a problem. It is best to mix them in a noncarbonated beverage, soup or applesauce. The starting dose should be low and then slowly increased to avoid side effects. Taking them with meals also helps avoid side effects. If constipation occurs, increasing dietary fiber or taking metamucil may help.

These medications can prevent the absorption of other medications. Thus, other medications should either be taken one hour before or 4 to 6 hours after taking a bile acid sequestrant.

FIBRATES

These medications lower LDL-cholesterol and triglycerides as well as raise HDL-cholesterol levels. They do this by inhibiting the production of proteins containing fat and cholesterol by the liver and the release of trigycerides from fat stores in the body. There are no special instructions for taking these medications. Clofibrate is rarely used nowadays.

STATINS

These are the cholesterol lowering medications that have been getting a lot press lately. They have the strongest evidence (compared to the other classes of cholesterol lowering medications) that they reduce the future risk of cardiac events and death.

They work by inhibiting an enzyme in the liver that is responsible for manufacturing cholesterol. They primarily lower LDL-cholesterol but also raise HDL-cholesterol levels and sometimes, lower triglyceride levels as well. They differ from one another in terms of their potency. If a low potency statin (fluvaststatin, pravastatin) is lowering the cholesterol level adequately, there is probably no need to change to a higher potency statin (atorvastatin, simvastatin, cerivastatin). Atorvastatin and cerivastatin appear to be the best at lowering triglyceride levels.

Statins have other effects that also help prevent heart disease. These include a mild blood thinning effect and an antiinflammatory effect on the walls of the blood vessels.

The main side effect to be alert for is muscle aches and pains. These should be reported to the physician immediately. Blood tests are also monitored periodically for liver dysfunction. This complication is infrequent, readily reversable and rarely serious.

The liver makes cholesterol mostly at night. Therefore, it is recommended that these medications be taken in the evening.

NIACIN

Niacin (nicotinic acid) lowers LDL-cholesterol and triglycerides and also raises HDL-cholesterol. It accomplishes this by inhibiting the production of fat and cholesterol containing proteins by the liver.

The most common side effects of the short acting, three times a day niacins are flushing, itching and dizziness. These can be minimized by taking the following steps:

Take it with food or a cold beverage-avoid hot beverages.

One aspirin a day helps decrease these side effects. Check with your doctor before taking aspirin

Start at a low dose and slowly work your way up to the target dose.

Note: Niacinamide (nicotinamide) is not niacin and has no effect on cholesterol.

DRUG COMBINATIONS

For some unlucky people, even a low cholesterol diet and one medication is not sufficient. In these cases, combinations of 2 or sometimes 3 drugs are used.