Treatment of elevated cholesterol

August 5, 2011

Diet and Exercise

The initial step in treating high cholesterol is diet, increased physical activity, and weight loss. Reducing dietary intake of saturated fat and cholesterol is beneficial in lowering LDL cholesterol, and regular, sustained aerobic exercise increases HDL cholesterol. Weight loss in women may cause a decline in HDL cholesterol without much change in LDL cholesterol. Fat tissue in postmenopausal women produces estrogen, and therefore losing this source may reduce HDL cholesterol.


Estrogen therapy was traditionally offered to postmenopausal women as prevention for coronary artery disease. Estrogen raises HDL cholesterol and lowers LDL cholesterol. Because of this, scientists expected that estrogen would prevent heart attacks. However, the HERS study and more recently the Women’s Health Initiative found this is not true. These studies showed that using estrogen and progesterone in postmenopausal women did not reduce the risk of heart attack. The Women’s Health Initiative is continuing to study women who have had hysterectomies and take estrogen alone, to find out if the same is true.

Common side effects of cholesterol-lowering medications

HMG CoA reductase Muscle and liver inflammation
inhibitors (statins)  
Bile acid sequestrants Bloating, constipation
Niacin Flushing, high blood sugar, liver
Ezetimibe Fatigue, muscle pain, diarrhea
Fibrates Liver inflammation

Cholesterol-Lowering Medications

“Statin” drugs inhibit the major enzyme responsible for cholesterol production in the liver. These are the most effective medications for lowering LDL cholesterol, reducing it by 25-35%. Statins are proven to reduce the chance of death from heart disease in women. They are comparatively safe and have limited side effects. They also have other benefits like increasing bone density and reducing the risk of fractures. Because statins occasionally cause liver or muscle inflammation, regular blood test monitoring is required.

Other cholesterol-lowering agents include the bile acid sequestrants: cholestyramine and colestipol (Table). These are older drugs, and work by increasing the conversion of cholesterol to bile acids, which then leave the body in the stool. These medications lower LDL cholesterol by 15-20%, and increase HDL cholesterol by 3-8%. Niacin, or nicotinic acid (not related to the nicotine in tobacco), is particularly effective in raising HDL cholesterol levels by up to 30%. It also lowers LDL cholesterol. The newest drug is ezetimibe, which blocks cholesterol absorption in the intestines. It lowers LDL cholesterol by 18%. Fibrates are used to lower triglycerides, but have little effect on cholesterol.

SEE ALSO: Diabetes, Diet, Heart disease, Nutrition, Obesity

Tags: , ,

Category: Elevated Cholesterol