Help fight cholesterol when diet changes don’t work

Cholesterol is a naturally occurring substance in our body. It is necessary in the production of hormones, and we measure it by assessing HDL (good cholesterol), LDL (bad cholesterol) and triglyceride levels.

Healthy habits such as diet and exercise normally lead to healthy cholesterol levels. But sometimes our levels still need to be lowered.

That means that we want our LDL, or low-density lipoprotein, cholesterol level to go down, we want our HDL, or high-density lipoprotein, level to go up, and, finally, we want our triglyceride levels to go down.

If your cholesterol levels are measuring too high, your physician or primary care provider might prescribe one or more medications to help manage them.

Healthy levels include a total of less than 200 milligrams of cholesterol per deciliter of blood (mg/dL) with less than 100 mg/dL of LDL and 40 mg/dL or higher of HDL. The Centers for Disease Control and Prevention reports that 95 million U.S. adults age 20 or older have total cholesterol levels greater than recommended.

These elevated levels, which produce no symptoms, raise the risk for heart disease and strokes.

Improving diet, quitting smoking, limiting alcohol and getting regular physical exercise help maintain healthy cholesterol levels in the body. When levels remain high even with lifestyle changes, there are several medications providers can use to help manage it. Each does so in a different way:

  • Bile acid binding medications such as cholestyramine bind to the bile acid in the intestines so it cannot be reabsorbed into the blood. Because the available bile is lower, the liver consumes more cholesterol so it can produce more bile. Brand names include Colestid and Welchol.
  • Statin medications stop the production of cholesterol by blocking the enzyme that creates cholesterol. Secondly, statins help reabsorb existing cholesterol that has built up as LDL plaques (the bad cholesterol) in your arteries. Statins include the brands Lipitor, Crestor, and Zocor.
  • Cholesterol absorption inhibitors, such as Zetia, decrease LDL and triglycerides but only slightly increases the HDL. Some people experience stomach pain or fatigue side effects.
  • Omega-3 fatty acids, such as Lovaza, decrease triglycerides but may increase HDL. Side effects that you might experience include a fishy taste or indigestion.
  • Fibrates, including Antara, Tricor and Lopid, decrease LDL and triglycerides while increasing HDL. Two side effects to watch for are nausea and stomach pain.
  • Niacin decreases LDL and triglycerides while increasing HDL. Brand names include Niaspan and Niacor. Possible side effects include facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers and itching.
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