High cholesterol is bad for your overall well-being. You should know how to lower high cholesterol level for a good heart. Treating high cholesterol is a multifaceted process aimed at reducing the risk of cardiovascular diseases (CVD) like heart attacks and strokes. The treatment strategy usually involves a combination of lifestyle modifications and medication.
Experts in cardiology and internal medicine stress the importance of a personalized approach to managing high cholesterol, as each patient’s risk factors, age, and overall health play a crucial role in treatment decisions. In this article of Tugela Wave , We are providing some easy options to control high cholesterol and keep it in lower level.
Steps to Lower High Cholesterol
Lifestyle Modifications: The Foundation of Treatment
The first line to lower high cholesterol, supported by all physicians, is lifestyle changes, which can have a profound impact on lipid levels and overall heart health. Experts agree that diet, exercise, weight management, and smoking cessation are essential components of cholesterol management.
Dietary Changes
Dr. Deepak Bhatt, a cardiologist at Harvard Medical School, emphasizes that dietary changes are crucial for controlling cholesterol. He recommends a heart-healthy diet that limits saturated fats, trans fats, and dietary cholesterol.
“Foods high in fiber, like oats, beans, and vegetables, can help lower LDL cholesterol. Omega-3-rich foods like fatty fish also play a role in lowering triglycerides,” says Dr. Bhatt.
The TLC diet recommends limiting serving sizes or replacing foods high in saturated fat and cholesterol with healthier options. Fruits, vegetables, legumes (beans and lentils), nuts, whole grains, low- or non-fat dairy products, fish, poultry without the skin, and in moderate amounts, lean meats are good options.
The Mediterranean diet, rich in healthy fats (such as olive oil and nuts), fruits, vegetables, whole grains, and lean proteins, has been shown to reduce cholesterol levels and support heart health.
Exercise
Regular physical activity is another cornerstone of cholesterol management. According to the American Heart Association (AHA), 150 minutes of moderate intensity aerobic exercise per week can help lower cholesterol and reduce high blood pressure. Exercise can help raise HDL (the “good” cholesterol) and lower LDL and triglycerides.
Dr. Cheryl Anderson, an epidemiologist and cardiologist at the University of California, San Diego says, “Exercise not only helps manage cholesterol but also supports weight loss, which can further improve lipid profiles.”
Weight Loss
High cholesterol is linked to your body weight. For individuals who are overweight or obese, losing even a small amount of weight can lead to significant improvements in cholesterol levels. Because it can reduce the amount of fat you have in your body and make you less likely to have inflammation. Lose some weight to lower high cholesterol.
Studies have shown that if you are overweight, losing just 10 pounds can reduce your overall LDL levels by as much as 8%.
Dr. John LaRosa, Director of the Cardiovascular Institute at Maimonides Medical Center, suggests that even a 5-10% reduction in body weight can result in lower LDL cholesterol and triglycerides, as well as increased HDL cholesterol.
Quitting Smoking
Smoking reduces HDL cholesterol and damages blood vessels, increasing the risk of atherosclerosis. Dr. LaRosa points out, “Cessation of smoking is critical for improving overall cardiovascular health, and it can quickly increase HDL levels”.
Dr. Adam Gepner of the University of Wisconsin School of Medicine and Public Health, in Madison says, “Some small studies have also shown that smoking lowers good cholesterol (HDL) and raises bad cholesterol (LDL).”
Medications: When Lifestyle Changes Are Not Enough
When lifestyle changes are insufficient to control cholesterol, or when a person is at high risk for cardiovascular events, medication may be necessary. The choice of medication depends on individual factors, including the severity of cholesterol elevation, existing heart disease, and other health conditions.
Below are the most common medications used to treat high cholesterol, according to experts. (We don’t advise anyone to take medications without consulting your doctor, because each individual is different and needs deferent medication.)
Statins: The Gold Standard in Cholesterol-Lowering
Statins are the most widely prescribed class of drugs for lowering LDL cholesterol. They work by inhibiting the liver enzyme responsible for producing cholesterol, thereby lowering overall cholesterol levels. Common statins include atorvastatin (Lipitor), Lescol (fluvastatin), Pravachol (pravastatin), Livalo (pitavastatin), simvastatin (Zocor), and rosuvastatin (Crestor)
Dr. Deepak Bhatt highlights statins as the first-line treatment for most patients with elevated cholesterol, especially those with a higher risk of cardiovascular events. “Statins have been proven in large studies to reduce the risk of heart attack, stroke, and death from cardiovascular disease,” he says.
Statins not only lower LDL cholesterol but also have anti-inflammatory effects on the arteries, which may further reduce the risk of atherosclerosis. However, some individuals experience side effects like muscle pain or liver enzyme elevation, which may require adjustments in dosage or switching to a different statin, by consulting with your physician.
Ezetimibe: Blocking Cholesterol Absorption
Ezetimibe (Zetia) is another cholesterol-lowering medication that works by reducing the absorption of cholesterol from the intestines. It is often used in combination with statins for patients who need further cholesterol reduction.
A recent study published in National Library in Medicine cited that “Ezetimibe inhibits the absorption of biliary and dietary cholesterol from the small intestine without affecting the absorption of fat-soluble vitamins, triglycerides, or bile acids. Ezetimibe localizes at the brush border of the small intestine and decreases cholesterol uptake into the enterocytes. “
Dr. Cheryl Anderson points out that ezetimibe is a good option for patients who cannot tolerate higher doses of statins or those with familial hypercholesterolemia (FH), a genetic disorder causing very high cholesterol. “For individuals with FH or those at high cardiovascular risk, combining ezetimibe with a statin can provide significant additional cholesterol-lowering benefits,” she says.
PCSK9 Inhibitors: The New Frontier
PCSK9 is a gene that plays a critical role in controlling blood LDL-C through its regulation of the LDL receptor. PCSK9 inhibitors—such as evolocumab (Repatha) and alirocumab (Praluent)—are a newer class of cholesterol-lowering drugs that target a specific protein in the liver responsible for regulating cholesterol. These injectable medications can lower LDL cholesterol by up to 60% and are typically used in patients with familial hypercholesterolemia or those who do not respond well to statins.
Dr. LaRosa explains the importance of PCSK9 inhibitors in high-risk patients: “For those with very high cholesterol or a history of cardiovascular events, PCSK9 inhibitors offer a potent option. These drugs can be used in conjunction with statins to achieve the maximum reduction in LDL cholesterol”. However, the high cost of PCSK9 inhibitors remains a barrier for some patients.
Bile Acid Sequestrants: An Older but Effective Option
Bile acid sequestrants, such as cholestyramine and colesevelam, work by binding to bile acids in the intestines, preventing their reabsorption and forcing the body to use cholesterol to make more bile acids. These medications are less commonly used today but can still be effective for certain patients, particularly those who cannot tolerate statins.
Dr. Bhatt notes, “Bile acid sequestrants are often used in combination with other medications to help lower LDL cholesterol, but they can interfere with the absorption of other medications and cause gastrointestinal side effects”.
Fibrates and Niacin: Lowering Triglycerides
For patients with high triglycerides, fibrates (e.g., fenofibrate) and niacin (vitamin B3) can be useful in reducing triglyceride levels. Fibrates primarily lower triglycerides, while niacin can raise HDL cholesterol levels. However, niacin has fallen out of favor due to its potential side effects, including flushing and liver toxicity.
Emerging Treatments: The Future of Cholesterol Management
In addition to the established therapies, there are several emerging treatments that show promise in the management of high cholesterol.
Gene Therapy and CRISPR
Experts like Dr. John LaRosa suggest that gene therapy could revolutionize cholesterol management. One area of focus is the development of gene-editing technologies, such as CRISPR, which may one day allow for targeted interventions to reduce cholesterol production at the genetic level. While this research is still in its early stages, it offers hope for more precise and durable treatments for high cholesterol.
According to American Heart Association, “A single infusion of a CRISPR-based gene-editing therapy significantly reduced low-density lipoprotein cholesterol (the bad cholesterol) in people who carry one gene for the inherited condition that results in very high LDL cholesterol levels and a high risk of heart attack at an early age.”
Bempedoic Acid: A New Cholesterol-Lowering Drug
Bempedoic acid is a newer oral medication that inhibits cholesterol production in the liver. It is typically used in combination with other cholesterol-lowering therapies, such as statins, to provide additional LDL reduction. Clinical studies suggest that it is particularly effective for patients who cannot tolerate statins due to side effects.
The treatment of high cholesterol should be individualized based on the patient’s overall health, cardiovascular risk, and response to previous treatments. Lifestyle changes, particularly diet and exercise, remain the foundation of cholesterol management, but medications are often necessary for patients with elevated cholesterol or those at high risk for cardiovascular events.
As Dr. Cheryl Anderson points out, “There’s no one-size-fits-all approach. For patients with very high cholesterol or a family history of heart disease, more aggressive treatment may be necessary, while others may manage with diet and lifestyle alone”.
Ongoing research and the development of new cholesterol-lowering therapies provide hope for more effective and personalized treatments in the future.
It is advised to consult with your physician before taking any medication.
References:
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