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How is high cholesterol treated?
Cholesterol treatment to lower cholesterol may be attained by a diet low in saturated fats and cholesterol and an exercise program. A low saturated fat/low cholesterol diet that meets recommendations for fat (total, saturated, polyunsaturated, and monounsaturated), cholesterol, carbohydrates, and plant sterol and stanol esters will reduce cholesterol levels for many people. Exercise and weight loss may improve HDL cholesterol and triglyceride levels.
A low saturated fat/low cholesterol diet, exercise, and weight loss program does not effectively reduce cholesterol levels in all people. Cholesterol medication may be prescribed in addition to a low saturated fat/low cholesterol diet, since treatment combining a low saturated fat/low cholesterol diet with exercise and cholesterol medication may reduce cholesterol levels more effectively than cholesterol medication alone.
Of the five classes of cholesterol medications, the statins most effectively reduce cholesterol. Statins reduce (LDL cholesterol) by 20-60% by inhibiting the HMG-CoA reductase enzyme that produces cholesterol in the liver. Also, triglycerides are decreased and HDL cholesterol levels are increased by statin cholesterol medications. Statins are generally well tolerated. The statins include atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®, Altocor®), pravastatin (Pravachol®), simvastatin (Zocor®), and rosuvastatin (Crestor®).
Bile acid sequestrants reduce LDL cholesterol by 10-20% by binding with bile acids in the intestines to enhance elimination of cholesterol. Certain foods, such as oat bran, also reduce LDL cholesterol by this mechanism. The bile acid sequestrants (cholestyramine (Questran®), colestipol (Colestid®), and colesevelam (Welchol®)) may be administered in combination with statins.
The newest drug class, the cholesterol absorption inhibitor drugs are designed to lower LDL cholesterol by 18-20% by decreasing absorption of cholesterol from the intestines. Ezetimibe (Zetia®) may be administered in combination with a statin to double or triple the effect of the statin alone. In fact, Vytorin® is a new combination of ezetimibe (Zetia®) and simvastatin (Zocor®) which blocks cholesterol absorption and decreases cholesterol production, reducing cholesterol levels by 45-60%.
The B vitamin nicotinic acid (niacin) effectively reduces total cholesterol, LDL cholesterol, and triglycerides and increases HDL cholesterol. A new combination of niacin and lovastatin (Advicor®) has been approved.
Lastly, the fibrate drug class is designed to reduce triglycerides and increase HDL cholesterol. Clinical data indicate that gemfibrozil (Lopid®) reduces triglycerides while fenofibrate (Tricor®) lowers triglycerides and LDL cholesterol.
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