High Cholesterol: Cholesterol-Lowering Medication

Sometimes cholesterol medication is recommended in addition to a low-saturated fat, low-refined carbohydrate, and high-fiber diet to lower cholesterol.
Cholesterol is an important part of your cells and also serves as the building block of some hormones. The liver makes all the cholesterol the body needs. But cholesterol also enters your body from dietary sources, such as animal-based foods like milk, eggs, and meat. Too much cholesterol in your blood can increase the risk of coronary artery disease.
The first line of treatment for abnormal cholesterol is usually to eat a diet low in saturated and trans fats, and high in fruits and vegetables, nuts, and seeds, and to increase exercise. But for some, these changes alone are not enough to lower blood cholesterol levels. These people may need medicine, in addition to making lifestyle changes, to bring their cholesterol down to a safe level.
Cholesterol-lowering drugs include:

• Statins
• Niacin
• Bile-acid resins
• Fibric acid derivatives
• Cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a healthy diet and exercise.

How Do Statins Work?

Statins block the production of cholesterol in the liver itself. They lower LDL, the "bad" cholesterol, and triglycerides, and have a mild effect in raising HDL, the "good" cholesterol. These drugs are the first line of treatment for most people with high cholesterol. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness.  Statins have been shown in multiple research studies to reduce the risk of cardiovascular events like heart attacks and death from heart disease.
Examples of statins include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)

How Does Nicotinic Acid Work?

Nicotinic acid is a B-complex vitamin. It's found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling and headache. A recent research study suggested that adding nicotinic acid to statin therapy was not associated with a lower risk of heart disease. Examples of nicotinic acid medication include:

• Nicolar and Niaspan

How Do Bile Acid Resins Work?

These drugs work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's supply of cholesterol. The most common side effects are constipation, gas and upset stomach. Examples of bile acid resins include:

• Questran and Questran Light
• Colestid
• WelChol

How Do Fibrates Work?

Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples of fibrates include:

• Atromid
• Tricor
• Lopid

Ezetimibe lowers bad LDL cholesterol by blocking cholesterol absorption in the intestine. Research studies have not found that ezetimibe is associated with a lower risk of heart disease.

What Are the Side Effects of Cholesterol-Lowering Drugs?

The side effects of cholesterol-lowering drugs may include:

• Muscle aches*
• Abnormal liver function
• Allergic reaction (skin rashes)
• Heartburn
• Dizziness
• Abdominal pain
• Constipation
• Decreased sexual desire
• Flushing with nicotinic acid

*If you have muscle aches, call your doctor immediately. This could be a sign of a life-threatening condition.

Are There Foods or Other Drugs I Should Avoid While Taking Cholesterol-Lowering Medicine?

You should limit grapefruit juice and fresh grapefruit consumption while taking statins, as grapefruit can interfere with the liver's ability to metabolize these medications. Talk with your doctor about your other medications, as it may be appropriate to adjust the dosing of your cholesterol medication depending on interactions.