The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, your current health and possible side effects. Common choices include:
- Statins. Statins — among the most commonly prescribed medications for lowering cholesterol — block a substance your liver needs to make cholesterol. This depletes cholesterol in your liver cells, which causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from accumulated deposits on your artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
- Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite, Questran), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
- Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.
- Combination cholesterol absorption inhibitor and statin. The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in your small intestine and production of cholesterol in your liver. You may have heard reports that this combination medication is no more effective than taking simvastatin by itself. But, this small study didn’t find any differences in death, hospitalization or heart attacks between the two medications. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.
If you also have high triglycerides, doctor may prescribe:
- Fibrates. The medications fenofibrate (Lofibra, TriCor) and gemfibrozil (Lopid) decrease triglycerides by reducing your liver’s production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.
- Niacin. Niacin (Niaspan) decreases triglycerides by limiting your liver’s ability to produce LDL and VLDL cholesterol. Various prescription and over-the-counter preparations are available, but prescription niacin is preferred as it has the least side effects. Dietary supplements containing niacin that are available over-the-counter are not effective for lowering triglycerides, and may damage your liver.
- Combination niacin and statin. If your doctor recommends niacin in addition to a statin, you might want to discuss taking a medication that combines both niacin and a statin, such as Simcor or Advicor. These medications can reduce the number of pills you have to take, although no research studies have yet shown that the combination drugs lower cholesterol more than taking niacin and a statin separately.
Most of these medications are well tolerated, but effectiveness varies from person to person. The common side effects are muscle pains, stomach pain, constipation, nausea and diarrhea. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication’s effect on your liver.
Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol or who are obese. The American Academy of Pediatrics also recommends treatment with prescription drugs, such as statins, for children age 8 and older if a child has a high level of LDL cholesterol. However, this recommendation is controversial. The long-term effects of cholesterol-lowering drugs have not been extensively studied in children. In addition, certain cholesterol medications such as niacin are not recommended for children. Because of the disagreement in the medical community on this topic, talk to your child’s doctor about the best way to lower your child’s cholesterol.
Few natural products have been proved to reduce cholesterol, but some might be helpful. With your doctor’s OK, consider these cholesterol-lowering supplements and products:
- Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
- Blond psyllium (found in seed husk and products such as Metamucil)
- Oat bran (found in oatmeal and whole oats)
- Sitostanol (found in oral supplements and some margarines, such as Benecol)
You may have also heard of another supplement to reduce cholesterol, red yeast rice. The Food and Drug Administration released a warning regarding three brands of red yeast rice because they were found to contain lovastatin, the active ingredient in the drug Mevacor. This can be unsafe, since there’s no way to determine the quantity or quality of the lovastatin in the supplement.
If you choose to take cholesterol-lowering supplements, remember the importance of a healthy lifestyle. If your doctor prescribes medication to reduce your cholesterol, take it as directed. Make sure your doctor knows which supplements you’re taking as well.