Treatments for High Cholesterol

Treatment list for High Cholesterol: The list of treatments mentioned in various sources for High Cholesterol includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Cholesterol medications
- Hormone Replacement Therapy - for menopausal women.
- Statins
  - Lovastatin
  - Simvastatin
  - Pravastatin
  - Fluvastatin
  - Atorvastatin
- Bile Acid Sequestrants - also called Bile acid resins
  - Cholestyramine
  - Colestipol
- Nicotinic Acid (niacin)
  - Immediate release nicotinic acid
  - Timed release nicotinic acid
- Fibric acid derivatives - also called Fibrates
  - Gemfibrozil
- Probucol
- Hormone replacement therapy - for menopausal women; has been shown to improve cholesterol.
Other treatments - there are various treatments that are not for cholesterol reduction but often given to people with high cholesterol.
- Low-dose aspirin - may help avoid heart attacks and blood clots.
- Beta-blockers - also reduces heart attack risk.
- Anti-hypertensives - if the person has high blood pressure.
Lifestyle treatments
- Low-cholesterol diet
- Low saturated fat diet
- TLC Diet - low cholesterol low saturated fat.
- Control weight
- Regular exercise
- Physical activity
- Moderate alcohol - in small amounts may help HDL cholesterol.
- Control stress
- Cholesterol Logbook - tracking the results helps to control it.

Treatment of High Cholesterol: medical news summaries: The following medical news items are relevant to treatment of High Cholesterol:

Treatments of High Cholesterol discussion: Although some red meat is high in saturated fat and cholesterol, which can raise your blood cholesterol, you do not need to stop eating it or any other single food. Red meat is an important source of protein, iron, and other vitamins and minerals. You should, however, cut back on the amount of saturated fat and cholesterol that you eat. One way to do this is by choosing lean cuts of meat with the fat trimmed. Another way is to watch your portion sizes and eat no more than 6 ounces of meat a day. Six ounces is about the size of two decks of playing cards.¹

Fish oils are a source of omega-3 fatty acids, which are a type of polyunsaturated fat. Fish oil supplements generally do not reduce blood cholesterol levels. Also, the effect of the long-term use of fish oil supplements is not known. However, fish is a good food choice because it is low in saturated fat.¹

Eating less fat, especially saturated fat, and cholesterol can lower your blood cholesterol level. Generally your blood cholesterol level should begin to drop a few weeks after you start on a cholesterol-lowering diet. How much your level drops depends on the amounts of saturated fat and cholesterol you used to eat, how high your blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your blood cholesterol level by 10-50 mg/dL or even more.¹

Saturated fats raise your blood cholesterol level more than anything else. So, the best way to reduce your cholesterol level is to cut back on the amount of saturated fats that you eat. These fats are found in largest amounts in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats. They are also found in some vegetable oils--coconut, palm, and palm kernel oils.¹

Most vegetable oils--canola, corn, olive, safflower, soybean, and sunflower oils--contain mostly monounsaturated and polyunsaturated fats, which help lower blood cholesterol when used in place of saturated fats. However, a few vegetable oils-- coconut, palm, and palm kernel oils--contain more saturated fat than unsaturated fat. A special kind of fat, called "trans fat," is formed when vegetable oil is hardened to become margarine or shortening, through a process called "hydrogenation." The harder the margarine or shortening, the more likely it is to contain more trans fat. Choose margarine containing liquid vegetable oil as the first ingredient. Just be sure to limit the total amount of any fats or oils, since even those that are unsaturated are rich sources of calories.¹

Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products. Also, look for the list of ingredients. Here, the ingredient in the greatest amount is first and the ingredient in the least amount is last. So to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first, or that list many fat and oil ingredients.¹

ATP III recommends a multifaceted lifestyle approach to reducing cholesterol. This approach is termed therapeutic lifestyle changes (TLC) and includes the TLC diet, weight management, and physical activity. TLC is for anyone whose LDL is above their goal level. The TLC diet is a low saturated fat, low cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and to avoid weight gain. Increased amounts of viscous (soluble) fiber as well as food products containing plant stanols/sterols (such as cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power. The other TLC components are weight management (especially for those who are overweight or obese) and increased physical activity.²

While TLC alone may lower the LDL to goal in many persons, others (especially those with multiple risk factors and those with CHD or a CHD risk equivalent) may need a combination of TLC and drug therapy to lower their LDL cholesterol to goal. The choice of drug or drugs used will depend on the individual's lipid profile. The statins are a frequently prescribed group of drugs that effectively lower LDL cholesterol and are safe for most users. In clinical trials, LDL cholesterol lowering with statins has been shown to decrease the rate of heart attacks and deaths from CHD by approximately 30%. Statins have been shown to be effective in persons with or without CHD. Bile acid sequestrants also lower LDL cholesterol and can be used alone or in combination with statin drugs. Nicotinic acid (or niacin) lowers LDL cholesterol and triglycerides and raises HDL cholesterol. Nicotinic acid in doses large enough to lower cholesterol can cause side effects and should only be used under the supervision of a physician. Fibric acids are used mainly to treat high triglycerides and low HDL. Regardless of the type of drug therapy used, individuals should take an active part in their health care. In order to maximize cholesterol lowering, TLC should always be maintained when drug therapy is prescribed. ²

If your blood cholesterol levels are too high, your doctor may recommend a specific treatment program for you. For most people, cutting back on foods high in saturated fat and cholesterol will lower LDL cholesterol, which is the main goal of treatment. Regular physical activity and weight loss for overweight persons also will lower blood cholesterol levels.

Losing extra weight, as well as quitting smoking and becoming more physically active, also may help boost your HDL cholesterol level.

If your new diet and other lifestyle changes do not lower your blood cholesterol level enough, your doctor may suggest that you take cholesterol-lowering medications. If you have other risk factors for heart disease, you will need to lower your cholesterol more than someone without risk factors.³

A variety of things can affect cholesterol levels. These are things you can do something about:

Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up. Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of saturated fat and cholesterol in your diet helps lower your blood cholesterol level.
Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as raise your HDL and lower your triglyceride levels.
Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.

⁴

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, see the boxes below for your risk category. There are two main ways to lower your cholesterol:

Therapeutic Lifestyle Changes (TLC)--includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.

Drug Treatment--if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

If you are in...

Category I, Highest Risk, your LDL goal is less than 100 mg/dL. If your LDL is 100 or above, you will need to begin the TLC diet. If your LDL is 130 or higher, you will need to start drug treatment at the same time as the TLC diet. If your LDL is 100 to 129, you may also need to start drug treatment together with the TLC diet. Even if your LDL is below 100, you should follow the TLC diet on your own to keep your LDL as low as possible.
Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.
Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans.
Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the heart-healthy diet for all Americans.

To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.⁴

TLC is a set of things you can do to help lower your LDL cholesterol. The main parts of TLC are:

The TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines and salad dressings) can also be added to the TLC diet to boost its LDL-lowering power.
Weight Management. Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
Physical Activity. Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

Foods low in saturated fat include fat free or 1% dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats, egg yolks, and full-fat dairy products.
Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans.

Drug Treatment

Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of drugs available for cholesterol lowering including statins, bile acid sequestrants, nicotinic acid, and fibric acids. Your doctor can help decide which type of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people. Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid lowers LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels.

Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.⁴

Reducing your blood cholesterol level can greatly lessen the chances of developing coronary heart disease. Most people can lower their blood cholesterol by changing their diet, losing excess weight, and increasing physical activity. To lower your blood cholesterol through diet, eat fewer foods high in saturated fat, total fat, and cholesterol. The total fat in your diet should average no more than 30 percent of your daily calories. Cholesterol should be held below 300 milligrams per day. If you follow these guidelines for about 6 months and your blood cholesterol does not drop to a goal level set with you by your doctor, you may need to cut back still more on saturated fat and cholesterol. ⁵

Choose fish, poultry, and lean cuts of meat and remove the fat and skin before eating. Eat no more than about 6 ounces per day. Broil, bake, roast, or poach foods rather than frying them. Cut down on high fat processed meats including sausage, bacon, and cold cuts such as salami and bologna. Limit organ meats such as liver, kidney, and brains. Use skim or low-fat milk and cheeses, and low- or nonfat yogurt. Instead of butter, use liquid or soft margarine or vegetable oils high in unsaturated fats. Use all fats and oils sparingly. Eat egg yolks only in moderation. Egg whites contain no fat or cholesterol and can be eaten often. Eat plenty of fruits and vegetables (5 a day is recommended), as well as cereals, breads, rice, and pasta made from enriched or whole grains (such as rye bread or whole wheat spaghetti). Many packaged and processed foods are high in saturated fats. Get in the habit of reading food labels. Look for the "Nutrition Facts" on the label and choose products that are lowest in fat. Also read product labels for cholesterol content. ⁵

Regular physical activity can help improve your cholesterol profile. Even low to moderately intensive activity, if done daily, can provide benefits. Examples of such activity are pleasure walking, gardening, yard work, moderate-to-heavy housework, dancing, and home exercise. More vigorous exercise can raise HDL cholesterol levels (the so-called "good" cholesterol) and will improve the overall fitness of your heart. This kind of activity is called "aerobic" and includes jogging, swimming, jumping rope, or brisk walking or bicycling. Regardless of the type of activity you choose, be sure to build up your activity level gradually over a period of several weeks. Also, check with your doctor first if you have any health problems, of if you are over 50 and are not used to energetic activity and plan a fairly strenuous program. ⁵

Footnotes:
1. excerpt from CHECK YOUR CHOLESTEROL AND HEART DISEASE I.Q: NHLBI
2. excerpt from Drop-in Article (2001 National Cholesterol Education Month Kit): NHLBI
3. excerpt from NHLBI Heart Disease & Women Are You At Risk: NHLBI
4. excerpt from NHLBI, High Blood Cholesterol What You Need to Know: NHLBI
5. excerpt from High Blood Cholesterol: NWHIC

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