Reducing High Cholesterol Levels
When a patient without heart disease is first diagnosed with high cholesterol levels, doctors often prescribe a program directed towards lifestyle changes (e.g. diet, exercise and weight loss). By closely following your diet and being more physically active, you can lower your blood cholesterol levels.
Eating less fat, especially saturated fat, may help lower cholesterol levels. To cut back on saturated fats, choose:
- Poultry, fish, and lean cuts of meat. Remove the skin from chicken and trim the fat from meat.
- Skim milk instead of whole milk.
- Low-fat cheeses (like low-fat cottage cheese). Cut down on full-fat processed, natural, and hard cheeses (like American, brie, and cheddar).
- Liquid vegetable oils high in unsaturated fat (these include canola, corn, olive, and safflower oil). Use tub or liquid margarines that list liquid vegetable oil as the first ingredient (instead of lard and hydrogenated vegetable shortening which are high in saturated fat). Choose products whose label descriptions show that they are lower in saturated fat.
- Fewer commercially prepared and processed foods made with saturated or hydrogenated fats or oils (like cakes, cookies, and crackers). Read food labels to choose products low in saturated fats.
- Foods high in starch and fiber, such as whole grain breads and cereals, pasta, rice, dry peas and beans.
- More vegetables and fruits.
To reduce dietary cholesterol intake you should:
- Eat less organ meat (such as liver, brain, and kidney).
- Eat fewer egg yolks as whole eggs, or in prepared foods (try substituting two egg whites for each whole egg in recipes, or using an egg substitute).
Sometimes doctors will prescribe a diet recommended by the American Heart Association and National Cholesterol Education Program (NCEP).
Step I Diet -- On this program, patients should eat 8 to 10 percent of the day's total calories from saturated fat, 30 percent or less of total calories from fat, less than 300 milligrams of dietary cholesterol a day, and just enough calories to achieve and maintain a healthy weight. A doctor or a registered dietitian can suggest a reasonable calorie level. Food labels also are very helpful in determining how much saturated fat, cholesterol, and calories are in various foods. If the Step I Diet does not result in desirable cholesterol levels, the Step II Diet may be recommended.
Step II Diet -- This limits the daily saturated fat intake to below 7 percent of daily calories and dietary cholesterol to below 200 milligrams. The Step II Diet is recommended for people with heart disease.
Blood cholesterol levels should begin to drop a few weeks after starting on a cholesterol-lowering diet, although by how much is dependent on the individual. If the desired response is not obtained after a reasonable period of time, and LDL levels are still high, drug therapy may be required to lower cholesterol to a safe level.
Regular physical activity may help reduce deaths from heart disease by lowering LDL levels, raising HDL levels, lowering high blood pressure, lowering triglyceride levels, reducing excess weight and improving the fitness of your heart and lungs.
If you have been inactive for a long time, start with low to moderate level activities such as walking, taking the stairs instead of the elevator, gardening, housework, dancing, or exercising at home. Begin by doing the activity for a few minutes most days, then work up to a longer program at least 30 minutes per day, 3 or 4 days a week. This can include regular aerobic activities such as brisk walking, jogging, swimming, bicycling, or playing tennis.
If you have heart disease or have had a heart attack, talk with your doctor before starting an activity to be sure you are following a safe program that works for you. Otherwise you may experience chest pain or further heart damage. If you have chest pain, feel faint or light-headed, or become extremely out of breath while exercising, stop the activity at once and tell your doctor as soon as possible.
There are two important steps:
- Eat fewer calories (cutting back on the fat you eat will really help)
- Burn more calories by becoming physically active
Cholesterol lowering drugs are often prescribed when LDL levels remain high after successfully following a cholesterol-lowering diet for at least 6-12 months. Some people may start drug therapy at the beginning of treatment because of very high LDL levels, or due to the presence of heart disease.
Drugs that lower blood cholesterol work in different ways. Some may achieve better results than others. It is important to let your doctor know all the other medicines you are taking before a cholesterol lowering medicine is prescribed. Tell your doctor immediately if you experience any side-effects from a cholesterol lowering drug.
To gain maximum benefit from medicines prescribed to lower cholesterol levels, it is important to follow a cholesterol-lowering diet, lose excess weight, exercise regularly and quit smoking if you smoke.
HMG-CoA Reductase Inhibitors (statins) work by interfering with the cholesterol-producing mechanisms of the liver and by increasing the capacity of the liver to remove cholesterol from circulating blood. Statins can lower LDL cholesterol by as much as 60 percent, depending on the drug and dosage.
The different statin drugs can cause different responses in different patients. Some patients may have fewer side effects with one drug than with another. Some statin drugs are also known to interact adversely with other drugs, and this may influence prescribing. Statin drugs can also produce intestinal side effects, as well as damage to the liver itself, and, in a few patients, muscle tenderness.
- Baycol (cerivastatin) was withdrawn from the U.S. market as of August 8, 2001. Bayer Pharmaceutical Division voluntarily withdrew Baycol after reports of potentially fatal muscle damage apparently caused by the drug.
- Lescol (fluvastatin)
- Lipitor (atorvastatin)
- Mevacor (lovastatin)
- Pravachol (pravastatin)
- Zocor (simvastatin)
Fibric Acid Derivatives are used to lower triglycerides and cholesterol, and can also increase HDL levels. Side effects may include gastrointestinal discomfort, aching muscles, sensitivity to sunlight, and skin rashes.
Nicotinic Acid (niacin or vitamin B3) lowers total and LDL cholesterol and raises HDL cholesterol. It can also lower triglycerides. Nicotinic acid is found in food, but is available in high doses by prescription. The main side effects are flushing, itching, tingling and headache.
Bile-Acid Sequestrants work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulation. Bile is made largely from cholesterol, so these drugs deplete the body's supply of cholesterol. The most common side effects from these drugs are constipation, bloating and upset stomach.
National Cholesterol Education Program
NHLBI Information Center
P.O. Box 30105
Bethesda, Maryland 20824-0105
American Heart Association
Phone 1-800-AHA-USA1 (1-800-242-8721)
Last updated: 2013-04-09 by L. Anderson, PharmD