Treating High Cholesterol

Treating cholesterol abnormalities at Virginia Mason in Seattle

Cholesterol abnormalities are treated, first, with a combination of diet and exercise. This approach is often referred to as TLC or Therapeutic Lifestyle Change. In addition, if you use tobacco, you will be advised to stop smoking and directed to resources that can help you succeed in this endeavor. If this combined regimen fails to bring down cholesterol levels, drug treatment may be added. The overall goal of cholesterol treatment is to bring LDL, HDL and triglycerides into optimal ranges. The major rule of thumb is to lower LDL cholesterol by at least 30-40 percent when LDL is high.

Lifestyle Changes for the Patient with High Triglycerides, Diabetes or Metabolic Syndrome

Drug therapy

Drug therapy can include a number of approaches, including the following:

Statin drugs — These medications are the most common drugs prescribed for lowering cholesterol. They work by lowering the production of LDL (bad) cholesterol in the body and by increasing the liver's ability to remove cholesterol in the bloodstream. Statin medications have been shown to significantly reduce heart attacks and deaths from coronary heart disease.

Cholesterol-absorption inhibitors — These agents reduce the amount of LDL cholesterol in the body by blocking its absorption in the intestines. They may be given in conjunction with a statin medication to increase the effectiveness of lowering LDL cholesterol.
Bile acid sequestrants — This class of drug binds with cholesterol-containing bile acids in the intestines and is eliminated from the body in the stool. They may be given with a statin drug to enhance the effect of lowering LDL cholesterol.

Fibrates — These drugs improve cholesterol profiles by lowering triglycerides and raising HDL (good) cholesterol levels. Fibrates are used primarily for lowering triglycerides in people with heart disease. These medications require closer monitoring when used in combination with statins.

Niacin — This B-vitamin lowers total cholesterol, LDL cholesterol and triglyceride levels, and increases HDL (good) cholesterol. It is available with or without a prescription but its use and dose in lowering cholesterol should be monitored by a physician. "No-flush" niacin is not recommended, since it has no beneficial effect on the cholesterol profile.

Treating Cholesterol in Patients with Diabetes