Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

High Cholesterol (Hypercholesterolemia)

Treatment

The initial treatment of high cholesterol should always be lifestyle changes. This means altering your diet and getting more exercise. Some people respond dramatically to dietary changes.

Diet

There is no consensus on the best diet. The most effective diet to lower total and LDL cholesterol is a vegetarian diet. However, this is not an easy diet to follow.

Many people prefer a "Mediterranean style" diet. There is no strict definition for what should be included in this type of diet. In general, this means

• Getting the majority of daily food calories from plant sources, especially fruits and vegetables, grains, beans, nuts, and seeds

• Using olive oil as the principal fat, replacing other fats and oils

• Having some low fat cheese and/or yogurt daily

• Eating fish a couple times per week

• Limiting processed foods

• Drinking alcohol in moderation unless medically not indicated. No more than two drinks per day for men and one per day for women.

The National Cholesterol Education Program recommends the following diet:

• Saturated fat—less than 7% of calories

• Monounsaturated fat—about 20% of calories

• Polyunsaturated fat—about 10% of calories

• Protein—about 15% of calories

• Carbohydrates—about 50% of calories

• Fiber— about 25 grams of soluble fiber per day

• Cholesterol—less than 200 milligrams per day

Avoid all trans fats.

To maintain a desirable weight, you should take in only as many calories as you burn each day. If you need to lose weight, you need to take in fewer calories than you burn.

People who aren't sure how to follow such a diet may find it useful to work with a health care professional such as a dietitian, nutritionist, doctor or nurse.

In addition to dietary changes, you should get at least 30 minutes of moderate-intensity exercise, such as brisk walking, daily.

Medications

Whether you need medication to lower your cholesterol level depends on how you respond to diet and your personal risk of heart attack and stroke.

There are five types of cholesterol-lowering medications:

• Bile acid-binding resins, including cholestyramine (Questran) and colestipol (Colestid). They are used less often today because they lower HDL (good) cholesterol as well as LDL (bad) cholesterol.

• Niacin (several brand names).

• Fibrates, including gemfibrozil (Lopid), fenofibrate (Tricor) and clofibrate (Abitrate). Fibrates are especially helpful for people with high triglyceride levels.

• Statins, also called HMG-CoA reductase inhibitors, including lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). Statins block an enzyme called HMG-CoA reductase, which is necessary for the production of cholesterol. They are the most commonly prescribed cholesterol lowering medication.

• Selective inhibitors of intestinal cholesterol absorption—There is only one available, ezetimibe (Zetia).

If your cholesterol is not controlled with diet and other lifestyle changes, your doctor may recommend that you take one or more of these medications. Each type of medication works differently and has different types of side effects.

In addition to dietary changes or medication, people with high cholesterol should try to control their other risk factors for coronary artery disease. This means keeping blood pressure at normal levels, not smoking, controlling your blood sugar, maintaining or losing weight and following a regular exercise schedule.