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Treatments for Elevated Cholesterol

If you have elevated cholesterol, rest assured you are not alone. I see people daily with elevated cholesterol (many of whom never knew until I checked it). Of the many types of lipids, elevated Low Density Lipoprotein (LDL-C) is always on a doctor’s radar due to its cardiovascular risk. It is considered a cardiovascular risk because when in the blood, it can get into the blood vessels and oxidize, which can lay the foundation for plaque buildup (atherosclerosis).


Even the healthiest of eaters can have high cholesterol though because a majority of LDL is made in the body. As I tell my patients, thank your parents because it is genetic. However, a small portion of LDL is from “dietary cholesterol”. Since dietary cholesterol is only found in animal products (meat, eggs, dairy), eating a more plant-based diet rich in plant sterols and fiber can help decrease cholesterol. You can also take plant sterols in supplement form. Research has suggested that there may be a genetic component as to who responds to plant sterols and who does not.


Other supplement treatments for high cholesterol include bergamot (a citrus fruit native to Europe) and berberine (found in a variety of plants). Another supplement with great potential to lower cholesterol is red yeast rice (product of fermenting rice with yeast). The mechanism of action of red yeast rice is comparable to the lipid lower prescription medication Lovastatin but may be better tolerated in people who do not tolerate statin medications. These supplements can be used alone, or in combination, to help lower cholesterol.


Many patients I see have an automatic aversion to the word “statin”. For some reason, statin medications have developed a bad reputation in the integrative medicine world. I fully support patients in treating their high cholesterol with dietary modifications and supplements, but for some, statins deserve consideration. There are certainly some concerns with statins. Statins carry a real risk of myopathy, a side effect of muscle aches that can become unbearable. This is where the term “statin intolerance” comes from. There is also a slight risk of temporarily elevated liver enzymes. Statin medications have also been linked to increased risk of new-onset diabetes. And in patients who have had a stroke, there is an increased risk of non-fatal hemorrhagic stroke. As scary as these potential side effects sound, most research has suggested that the benefits of statin medications still outweigh the risks.


Beyond being powerful cholesterol lowering medications, statin medications have proven in numerous studies to decrease the risk of cardiovascular events both as primary prevention (those who have not had a heart attack or stroke), and as secondary prevention (those who have had a heart attack or stoke and want to prevent another event). They also decrease the risk of cardiovascular and all-cause mortality. Additionally, statins have anti-inflammatory properties. There was some concern that statin medications negatively affect cognition, but it is now believed that statins may reduce the risk of dementia and Alzheimer's Disease. For many people with persistently elevated cholesterol despite best dietary efforts and supplements and/or significant cardiovascular risk, statin medications may be a good option.


There are several other prescription medications used to treat high cholesterol, but I will not dive into them, as statins are considered first-line therapy and by far the most prescribed medication for high cholesterol.


If you have high cholesterol, talk to your doctor about all treatment options and devise a plan that you feel comfortable with.

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