Most of the cholesterol we need is produced by our liver. Cholesterol is in all of our tissues and is a component of cell membranes and nerves. Hence, raising cholesterol levels through diet increases the risk of heart disease and stroke. With cholesterol, less is better.
According to medical experts, the best way to achieve a healthier cholesterol profile is to reduce dietary intake of all fats to no more than 30 percent of daily calories. Saturated fats, found in animal products and in coconut and palm oils, are the most dangerous. No more than a third of your dietary fat should come from saturated fats. Doctors recommend that people with elevated blood cholesterol levels should get less than 300 milligrams a day of dietary cholesterol.
For daily protein, eat small portions of lean meats, skinned chicken, and fish or a bean-grain combination. Cook with polyunsaturated or monounsaturated fats, such as corn or olive oil, which won’t elevate cholesterol levels.
Consuming more soluble fiber, found in such foods as oats, beans, peas, fresh fruits, and vegetables, lowers LDL cholesterol. Dietitians say that high-fiber dietary supplements, particularly those containing psyllium, lower cholesterol levels and also improve the ratio of HDL to LDL, but they can interfere with bowel function, so take them only if a doctor recommends them.
There’s a wide array of cholesterol-lowering medications on the market, and they fall into four categories. Listed below (as per medical records) are those categories, some individual drugs within them, how they work, their side effects, and special warnings about them:
HMG-CoA reductase inhibitors, or "statins":
Included in this category are fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), atorvastatin (Lipitor), and cerivastatin (Baycol). These medications work by blocking an enzyme in the liver that is needed to produce cholesterol. This causes the body to pull cholesterol out of the blood instead. One possible side effect is a nondangerous and reversible change in liver function. Warning: This is the only class of cholesterol medications shown to reduce the risk of heart attack and stroke in those with cardiovascular disease. Higher dosages are more likely to control excess triglycerides.
Includes high potency nicotinic acid (vitamin B3). This medication works by stopping the liver from producing lipid particles. It is more effective at raising HDL, and is also effective at eliminating excess triglycerides. Possible side effects include burning sensation in the face after each dosage, loss of appetite, stomach pains, liver toxicity (particularly hepatitis) and, in rare cases, liver failure. Warning: This medication has time-release and fast-acting formulas. The time-release form of niacin generally has more side effects than the fast-acting one. An exception: the newer time-release preparation Niaspan, sold only in the United States, is reportedly easier to tolerate.
Includes gemfibrozil (Lopid). This medication works by breaking down triglycerides and raising HDL, but is less effective at lowering LDL. This medication may increase the risk of gallstones and affect liver function. It may also cause gastrointestinal distress. Warning: Because it doesn’t lower LDL efficiently, it is not recommended for treatment of heart disease. This type of medication multiplies the effects of blood-thinning drugs, increasing the risk of hemorrhage. It neutralizes the effects of antidiabetic drugs.
Bile Acid Sequestrants:
Included are colestipol (Colestid) and cholestyramine (Questran). These medications work by binding onto bile, a product of the liver that contains cholesterol, forcing the body to pull its cholesterol supply from the blood. Possible side effects include slight rise in triglycerides, constipation, heartburn, nausea, belching, and gas. These medications should not be used if you have kidney disease, gastrointestinal problems, or hemorrhoids. Warning: These drugs are not systemically absorbed, but they can decrease the absorption of other medications if taken at the same time.
Doctors maintain that improving diet, doing more exercise, and staying away from cigarettes and tobacco are still the best ways of keeping your cholesterol at a safe level. Since the cholesterol-lowering drugs are not without side effects, they should be tried only if other efforts fail.