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Lower cholesterol for better overall well-being -

The benefits of these lifestyle changes usually become evident within 6 to 12 months. However, the success of lipid lowering with lifestyle modification varies widely, and health care providers sometimes recommend beginning medication sooner.

Medications — There are many medications available to help lower elevated levels of LDL cholesterol. Each category of medication varies in how it works, how effective it is, and how much it costs.

Your health care provider will recommend a medication or combination of medications based on your blood lipid levels and other individual factors. Statins — Statins are one of the best-studied classes of medications and the most commonly used drugs for lowering LDL cholesterol.

They are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death. Available statins include atorvastatin former brand name: Lipitor , rosuvastatin former brand name: Crestor , and several other similar medications table 1. Statins decrease the body's production of cholesterol and increase removal of cholesterol by the liver, so they reduce LDL cholesterol levels by as much as 25 to 55 percent.

In addition, they can lower triglycerides. Statins may also reduce inflammation and may prevent heart attacks and strokes through this mechanism. While most people tolerate statins well, there are some potential side effects, mainly muscle pain, aches, or weakness.

Use of statins may also increase the risk of developing diabetes, although the risk is seen mostly in those with prediabetes, and the benefit in reduction on heart attack and stroke is about four times that of the risk of developing diabetes.

Changing statins and using low doses often can avoid these issues, but if not, non-statin medications can be used to lower LDL cholesterol. It is important to closely follow the dosing instructions for when to take statins; some are more effective when taken before bedtime while others should be taken with a meal.

In addition, some foods, such as grapefruit or grapefruit juice, can increase the risk of side effects of statins. Most manufacturers recommend that people who take lovastatin, simvastatin, or atorvastatin consume no more than one-half of a grapefruit or 8 ounces of grapefruit juice per day.

Ezetimibe — Ezetimibe brand name: Zetia blocks the body's ability to actively transport cholesterol from food as well as cholesterol that the body produces internally.

It lowers LDL cholesterol levels by 20 to 25 percent and has relatively few side effects. It is usually prescribed in combination with a statin but is also used alone in patients who cannot tolerate a statin.

When used in combination with a statin after an acute coronary syndrome eg, heart attack , ezetimibe provides a small additional reduction in the risk of having another cardiovascular event.

PCSK9 inhibitors — PCSK9 monoclonal antibody inhibitors are another class of drugs that lower LDL cholesterol levels sample brand names: Praluent, Repatha table 1 ; they are given by injection under the skin every two to four weeks.

They reduce cardiovascular events such as heart attack or stroke and potentially death. Aside from mild skin reactions at the site of injection, they have few side effects. Inclisiran brand name Leqvio is a PCSK9 inhibitor that is given by injection once, 90 days later, and then every six months.

However, they are expensive and their use is limited to patients treated with maximal tolerated statins who have persistent elevations of LDL cholesterol. Bile acid sequestrants — The bile acid sequestrants include colesevelam brand name: Welchol , colestipol brand name: Colestid , and cholestyramine sample brand names: Prevalite, Questran table 1.

These medications bind to bile acids in the intestine, reducing the amount of cholesterol the body absorbs from foods. They are used only occasionally. They lower LDL cholesterol only modestly 10 to 15 percent. Side effects can be bothersome and may include nausea, bloating, cramping, and liver damage.

Taking psyllium a fiber supplement, such as Metamucil can sometimes reduce the dose required and the side effects.

Bile acid sequestrants can interact with some medications, including as digoxin brand name: Lanoxin and warfarin brand name: Jantoven , and with the absorption of fat-soluble vitamins including vitamins A, D, K, and E. Taking these medications at different times of day can solve these problems in some cases.

Bempedoic acid — Bempedoic acid brand name: Nexletol is the newest lipid-lowering agent, and it is approved for lowering LDL cholesterol. It works by inhibiting cholesterol synthesis at a step before the HMG-CoA reductase or the enzyme inhibited by statin therapy.

Bempedoic acid alone or in combination with a statin or ezetimibe brand name: Nexlizet lowers LDL cholesterol as well as other atherogenic proteins. Bempedoic acid can reduce the risk of cardiovascular events such as heart attacks.

Side effects include an increase in the incidence of gout, gallstones, kidney damage, and small increases in liver enzymes.

Early studies reported Achilles tendon rupture as a rare side effect; however, this effect was not seen in a recent large trial. Omega-3 — Oily fish, such as mackerel, herring, bluefish, sardines, salmon, and anchovies, contain two important fatty acids called docosahexaenoic acid DHA and eicosapentaenoic acid EPA.

Eating a diet that includes one to two servings of oily fish per week can lower triglyceride levels and reduce the risk of death from coronary heart disease.

Fish oil supplements, supplements with low-dose mixed fish oils usually approximately 1 gram per day of combined DHA and EPA , had been thought to provide cardiac benefit, but large trials have found no significant benefit. As such, they are no longer recommended.

A second study of a high-dose agent that had both EPA and DHA failed to provide benefit, suggesting that the EPA only preparation at the 4 g dose is important.

However, the trials found that omega-3 fatty acid medications increase the risk of atrial fibrillation. Therefore, a discussion with your cardiologist on the net benefit or harm from taking fish oil supplements including icosapent ethyl is needed before starting this treatment.

Nicotinic acid niacin — Nicotinic acid is a vitamin that is available in immediate-release, sustained-release, and extended-release formulations table 1. Nicotinic acid is rarely used for a high cholesterol.

In most situations, ezetimibe or a PCSK9 inhibitor is tried before nicotinic acid. Historically, this agent used to be used to raise HDL cholesterol levels, but that is no longer recommended. It is sometimes used for patients with high lipoprotein a levels and LDL cholesterol that is refractory to more effective and better-tolerated medications statins, ezetimibe and PCSK9 inhibitors.

Nicotinic acid is associated with many side effects, including flushing when the face or body turns red and becomes warm , itching, nausea, numbness and tingling, and worsening of gout. This medication can also cause liver damage; people who use it require regular blood tests to monitor their liver function.

Red yeast rice — Red yeast rice is a fermented rice product that can lower serum cholesterol. Red yeast rice contains naturally occurring substances called monacolins that act to reduce cholesterol by a mechanism similar to that of statins.

Although red yeast rice is effective for lowering total and LDL cholesterol, there is not evidence that it decreases rates of cardiovascular events or that it is safe to take long-term. Moreover, red yeast rice supplements are not standardized in the United States. Different commercial preparations vary widely in the amount of the active ingredient, and some commercial preparations have been shown to contain potentially toxic substances or lovastatin, a statin medication.

Soy protein — Soy protein contains isoflavones, which mimic the action of estrogen. A diet high in soy protein can slightly lower levels of total cholesterol, LDL cholesterol, and triglycerides and raise levels of high-density lipoprotein HDL cholesterol. However, normal protein should not be replaced with soy protein or isoflavone supplements in an effort to lower cholesterol levels.

Soy foods and food products eg, tofu, soy butter, edamame, some soy burgers are likely to have beneficial effects on lipids and cardiovascular health because they are low in saturated fats and high in unsaturated fats.

Garlic — Garlic has not been proven to be effective in lowering cholesterol. Plant stanols and sterols — Plant stanols and sterols may act by blocking the absorption of cholesterol in the intestine.

Most plant-derived oils, including canola, safflower, sunflower, olive, grapeseed, and peanut oils, contain both. Fatty fish such as salmon, tuna, trout, herring, and mackerel , seeds, nuts, avocados and soybeans are also great sources.

Fruits and vegetables have scads of ingredients that lower cholesterol—including fiber, cholesterol-blocking molecules called sterols and stanols, and eye-appealing pigments. The heart-healthy list spans the color spectrum—leafy greens, yellow squashes, carrots, tomatoes, strawberries, plums, blueberries.

As a rule, the richer the hue, the better the food is for you. Whole grains are another good source of fiber. Instead of refined flour and white rice, try whole-wheat flour and brown or wild rice.

Old-fashioned oatmeal is also a good choice, but not the quick-cooking versions, which have had much of the fiber processed out. And don't substitute sugar for fat. Food manufacturers may boost the sugar content of low-fat salad dressings and sauces to add flavor.

If you see sugar, corn syrup, or any word ending in "ose" near the top of the list of ingredients, choose a higher-fat version without trans fats instead.

All fats , whether good or bad, have nine calories per gram—about calories a tablespoon. While you switch to a heart-healthy diet you may need to keep tabs on your calorie intake for a while. For more information, check out "11 foods that lower cholesterol.

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Such diets can be adapted based on your cultural and food preferences. A sedentary lifestyle lowers HDL cholesterol. Physical activity is important. At least minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure.

And you have lots of options: brisk walking, swimming, bicycling or even yard work can fit the bill. Worse still, when a person with unhealthy cholesterol levels also smokes, risk of coronary heart disease increases more than it otherwise would.

Smoking also compounds the risk from other risk factors for heart disease, such as high blood pressure and diabetes. By quitting, smokers can lower their LDL cholesterol and increase their HDL cholesterol levels. It can also help protect their arteries. Nonsmokers should avoid exposure to secondhand smoke.

Learn more about quitting smoking. Being overweight or obese tends to raise bad cholesterol and lower good cholesterol. Your health care professional can help you reach your health goals, including keeping your cholesterol at healthy levels.

Written by American Heart Association editorial staff and reviewed by science and medicine advisors. See our editorial policies and staff. About Cholesterol. HDL, LDL Cholesterol and Triglycerides.

Genetic Conditions. Causes of High Cholesterol. How To Get Your Cholesterol Tested.

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