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Lowering cholesterol can reduce a person’s overall risk of heart disease and heart attack. Many lifestyle strategies that lower cholesterol can also improve other measures of health, such as body weight. Certain medications may also help.
According to the Centers for Disease Control and Prevention (CDC), 95 million people aged 20 and over in the United States have elevated total cholesterol levels. Only about half of those whose health might improve with cholesterol medication take a cholesterol drug.
Doctors usually talk about two types of cholesterol. Low-density lipoprotein (LDL) cholesterol can accumulate in the arteries, increasing the risk of heart disease. This “bad” cholesterol is the most abundant type of cholesterol in the body.
High-density lipoprotein (HDL) cholesterol, or “good” cholesterol, helps remove LDL cholesterol from the body and transport it back to the liver. Raising HDL cholesterol can help lower LDL cholesterol.
People with high cholesterol should discuss their diet, lifestyle, and medication options with a doctor.
Keep reading to learn more about some of the drugs and remedies that may help lower total cholesterol levels.
Several prescription drugs can lower cholesterol. They include:
While several drugs may lower cholesterol, statins are the only class of drug that science has proven can lower cholesterol and reduce the risk of heart attack and stroke. They are safe for most people. However, they may present some risks to people with diabetes or a history of heart disease.
Statins lower LDL cholesterol and may also lower HDL cholesterol. In addition, they can decrease triglycerides in the blood. They work by reducing the formation of cholesterol in the liver.
Pregnant women and people with liver failure should not use statins.
Simvastatin (Zocor) and rosuvastatin (Crestor) are examples of statins.
Cholesterol absorption inhibitors
Cholesterol absorption inhibitor (CAI) drugs are relatively new and more effective in lowering LDL cholesterol than total cholesterol. Some may slightly lower triglycerides, too.
These drugs work by reducing the amount of cholesterol that the small intestine absorbs. They may work well for people who cannot use statins but are unsafe for women to use when breastfeeding or pregnant. Ezetimibe (Zetia) is one CAI drug that people may take.
PCSK9 inhibitors work in the liver to lower LDL cholesterol. They do this by binding to the PCSK9 protein. While these drugs may effectively lower cholesterol, it is unclear whether they reduce the risk of dying from heart disease.
Resins, which doctors sometimes call bile acid-binding drugs, help the intestines eliminate more cholesterol during digestion. Cholesterol makes bile. Resins attach to bile during digestion, causing the liver to produce more bile and, therefore, use up more cholesterol.
Colestipol (Colestid) and colesevelam (Welcol) are both resins. As with other cholesterol drugs that are not statins, it is not clear whether resins reduce the risk of death from heart disease. The most common side effects of resins are digestive problems, such as heartburn and diarrhea.
Fibrates can lower triglycerides and increase HDL cholesterol. However, they are not effective in lowering LDL cholesterol. Clofibrate (Atromid) and gemfibrozil (Lopid) are prescription fibrates.
Scientists have tested several natural cholesterol remedies. These include:
Niacin, or vitamin B-3, works in the liver, and it may reduce blood fats. Although it is possible to take an over-the-counter (OTC) niacin supplement, the most effective option is a prescription form of the medicine.
High doses of niacin may damage the liver. The nutrient can also cause itching, flushing, and stomach pain.
Omega-3 fatty acids
Omega-3 fatty acids, such as those present in fish oil, may lower the risk of heart disease, stroke, and heart attack. They may do this by reducing the secretion of triglycerides or helping the body remove excess cholesterol.
Eating cold-water fatty fish, such as albacore and tuna, a few times a week can help a person increase their omega-3 intake. Omega-3 supplements may also help. However, omega-3 supplements can sometimes cause bleeding, most notably in people on blood thinners or with bleeding disorders.
In some cases, a doctor may recommend a type of prescription omega-3 called omega-3-acid ethyl esters.
Eat plant sterols and stanols
Plant chemicals called sterols and stanols may help fight cholesterol and lower the risk of cardiovascular disease. Soybeans, margarine, and orange juice products that include sterols and stanols on their ingredients label are good sources.
Eat more soluble fiber
Barley, oats, and soy products, such as tofu, are also good sources of soluble fiber.
Drugs and supplements are not the only options for lowering cholesterol. People may also benefit from making the following lifestyle changes:
- avoiding trans fats, which are abundant in many fried or processed foods
- reducing saturated fat intake
- getting more exercise — strength training and aerobic exercise can both lower cholesterol while helping a person maintain a moderate body weight and reducing their overall risk of heart disease
- maintaining a moderate body weight, as people with overweight or obesity are more likely to have high cholesterol, especially if they eat foods high in trans or saturated fats
- eating a relatively low fat diet that is rich in a wide range of fruits and vegetables
- cutting visible fat off meat before serving it
- quitting smoking, if applicable
- talking to a doctor about controlling diabetes with medication and lifestyle changes
While lifestyle can strongly affect cholesterol levels, it is not the only factor. Even otherwise healthy people may have high cholesterol, particularly when it runs in the family. Cholesterol may also increase with age.
When lifestyle remedies do not work, a person may need to use prescription medications, especially if they have a high risk of heart disease.
A person can talk to a cardiologist about the best options for lowering cholesterol. If one drug is ineffective or causes serious side effects, another medication may work better.
Open communication with a doctor can help a person lower their cholesterol and attain better overall health.