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The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL) level enough to reduce your risk of having a heart attack or diseases caused by hardening of the arteries.

In general, the higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. (A risk factor is a condition that increases your chance of getting a disease.)

There are two main ways to lower your cholesterol:

  • Therapeutic Lifestyle Changes (TLC)�includes a cholesterol-lowering diet (called the TLC Diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
  • Drug Treatment�if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

The higher your risk for heart disease, the lower your LDL goal will be. Your doctor will set your LDL goal.

Lowering Cholesterol With TLC

TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main parts of TLC are:

  • The TLC Diet, which recommends:
    • Limiting the amount of saturated fat and cholesterol you eat.
    • Eating only enough calories to achieve or maintain a healthy weight.
    • Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber.
    • Adding cholesterol-lowering food, such as margarines that contain plant sterol or stanol esters that lower cholesterol for some people.
  • Weight management:
    • Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
  • Physical activity:
    • Regular physical activity is recommended for everyone. It can help raise HDL levels and lower LDL levels, and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

Cholesterol-Lowering Medicines

Along with suggesting that you change the way you eat and exercise regularly, your doctor may prescribe medicines to help lower your cholesterol. Even if you begin drug treatment, you will need to continue TLC. Drug treatment controls but does not "cure" high blood cholesterol. Therefore, you must continue taking your medicine to keep your cholesterol level in the recommended range.

The five major types of cholesterol-lowering medicines are:

  • Statins
    • Very effective in lowering LDL (bad) cholesterol levels
    • Safe for most people
    • Rare side effects to watch for are liver and muscle problems
  • Bile Acid Sequestrants
    • Help lower LDL cholesterol levels
    • Sometimes prescribed with statins
    • Not usually prescribed as the only medicine to lower cholesterol
  • Nicotinic Acid
    • Lowers LDL cholesterol and triglycerides, and raises HDL (good) cholesterol
    • Should only be used under a doctor's supervision
  • Fibrates
    • Lower triglycerides
    • May increase HDL (good) cholesterol levels
    • When used with a statin, may increase the chance of muscle problems
  • Ezetimibe
    • Lowers LDL cholesterol
    • May be used with statins or alone
    • Acts within the intestine to block cholesterol absorption

When you are under treatment, you will be checked regularly to:

  • Make sure your cholesterol level is controlled
  • Check for other health problems

You may take medicines for other health problems. It is important that you take ALL medicines as your doctor prescribes. The combination of medicines may lower your risk for heart disease or heart attack.

When trying to lower your cholesterol or keep it low, it is important to remember to follow your treatments for other conditions you may have, such as high blood pressure. Get help with quitting smoking and losing weight if they are risk factors for you.


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