Treatment & Prevention from High Cholesterol

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.
The choice of medication or combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effects.

Cholesterol Buster:

• Eat More Fiber

Diet changes offer a powerful way to fight high-cholesterol. If we've ever wondered why some cereals claim to be heart-healthy, it's the fiber. The soluble fiber found in many foods helps reduce LDL, the bad cholesterol. Good sources of soluble fiber include whole-grain breads and cereals, oatmeal, fruits, dried fruits, vegetables, and legumes such as kidney beans.

• Know Our Fats

No more than 35% of our daily calories should come from fat. But not all fats are equal. Saturated fats -- from animal products and tropical oils -- raise LDL cholesterol. Trans fats carry a double-whammy, boosting bad cholesterol, while lowering the good kind. These two bad fats are found in many baked goods, fried foods (doughnuts, fries, chips), stick margarine, and cookies. Unsaturated fats may lower LDL when combined with other healthy diet changes. They're found in avocados, olive oil, and peanut oil.  

• Smart Protein

Meat and full-fat milk offer plenty of protein, but they are also major sources of cholesterol. We may be able to reduce LDL cholesterol by switching to soy protein, such as tofu, at some meals. Fish is another great choice. Some varieties, like salmon, are rich in omega-3 fatty acids, which can improve cholesterol levels. The American Heart Association recommends eating fish at least twice a week.

• Low-Carb Diet

There's growing evidence that low-carb diets may be better than low-fat diets for improving cholesterol levels. In a two-year study funded by the National Institutes of Health, people who followed a low-carb plan had significantly better HDL (good cholesterol) levels than those who followed a low-fat plan.

• Lose Weight

If you're overweight, talk to your doctor about beginning a weight loss program. Losing weight can help you reduce levels of triglycerides, LDL, and total cholesterol. Shedding even a few pounds can also boost levels of good cholesterol -- it tends to go up one point for every 6 pounds you lose.

• Exercise

If we're healthy but not very active, starting an aerobic exercise program could increase our good cholesterol by 5% in the first two months. Regular exercise also lowers bad cholesterol. Choose an activity that boosts our heart rate, such as running, swimming, or walking briskly, and aim for at least 30 minutes on most days of the week. It doesn't have to be 30 continuous minutes; two 15-minute walks works just as well.

• Medications

If high-cholesterol runs in our family, diet and exercise may not be enough to get our numbers where we want them. In that case, medication can give cholesterol levels an extra nudge. Statins are usually the first choice. They block the production of cholesterol in the liver. Other options include cholesterol absorption inhibitors,and  bile acid resins. Our doctor may recommend a combination of these medications.
Statins are the most commonly prescribed medications for high cholesterol. They block your liver from producing more cholesterol.
Examples of statins include:

• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

Bile-acid-binding resins: Our liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts our liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in our blood.
Cholesterol absorption inhibitors: Our small intestine absorbs the cholesterol from our diet and releases it into our bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.
Injectable medications: A newer class of drugs, known as PCSK9 inhibitors, can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in our blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.

• Supplements

Certain dietary supplements may help improve cholesterol levels. These include plant sterols, barley and oats, fiber, and green tea. 

• Herbal Remedies

Some studies suggest garlic can knock a few percentage points off total cholesterol. But garlic pills can have side effects and may interact with medications. Other herbs that may reduce cholesterol include:

• Fenugreek seeds (Methi)
• Artichoke leaf extract
• Yarrow
• Holy basil (Tulsi)

How to Lower Cholesterol Naturally

In some cases, we may be able to lower our cholesterol levels without taking medications. For example, it may be enough to eat a nutritious diet, exercise regularly, and avoid smoking tobacco products.
Some people also claim that certain herbal and nutritional supplements may help lower cholesterol levels. For instance, such claims have been made about:

• garlic
• hawthorn (Nagfani)
• astragalus
• red yeast rice
• plant sterol and stanol supplements
• oat bran, found in oatmeal and whole oats
• blond psyllium, found in psyllium seed husk
• ground flax seed

However, the level of evidence supporting these claims varies. Also, the U.S. Food and Drug Administration (FDA) hasn’t approved any of these products for treating high-cholesterol. More research is needed to learn if they can help treat this condition.

How Low Should You Go?

Many people are able to lower cholesterol levels through a combination of medication and lifestyle changes. But how low is low enough? Recent guidelines do not have a target number. If we have diabetes, are at high risk of developing heart disease, or we already have coronary artery disease, we will probably be put on a drug called a statin to lower our cholesterol.

Can the Damage Be Undone?

It takes years for high cholesterol to clog the arteries with plaque. But there is evidence that atherosclerosis can be reversed, at least to some degree. Dean Ornish, MD, has published several studies showing that a low-fat vegetarian diet, stress management, and moderate exercise can chip away at the build-up inside the coronary arteries. Other research supports the idea that big drops in cholesterol can somewhat help open clogged arteries.