From Our 2006 Archives

4 Tips for Lower Cholesterol Fast

High cholesterol isn't inevitable as we age. Fight back four ways -- and lower cholesterol fast.

By R. Morgan Griffin
WebMD Health News

Reviewed By Cynthia Haines, MD

Deepening smile lines and silver locks may be inevitable features of growing older, but rising cholesterol doesn't have to be.

And while higher cholesterol is often a consequence of aging, young people can have it too. But no matter your age, it poses a big health risk. That's because unhealthy cholesterol levels can boost your risk of heart attacks, strokes, and other problems.

Fortunately, you can do something about it.

"Unlike your age and your genes, cholesterol levels are risk factors that you can often change," says Jorge Plutzky MD, director of the Vascular Disease Prevention Program at Brigham and Women's Hospital in Boston.

Lower Cholesterol: 4 Ways to Fast Results

According to experts, there are four basic ways to get your cholesterol where you want it:

  • Eating a healthy diet.
  • Exercising
  • Losing weight
  • Taking medicine -- in some cases

While each of these works, some people have more success with one than another. Many need a combination of approaches.

No matter what your age or the state of your health, you can reduce your risks of serious problems by controlling your cholesterol -- and it's not as hard as you think.

Know Your Cholesterol Numbers

While Plutzky says that people are often alarmed when they find out they have high cholesterol, many are also confused.

"They don't understand what the numbers mean," he tells WebMD, "They don't know the difference between total cholesterol, LDL and HDL."

So let's start with some basics. Cholesterol is a fat-like substance that circulates in your blood. Some of it is made naturally by your body, and the rest comes from foods you eat. There are two main types: HDL and LDL.

  • LDL is "bad cholesterol." It can clog your arteries, increasing the risk of heart attack and stroke. Healthy number: Less than 100mg/dL.

  • HDL is "good cholesterol." What's good about it? HDL attaches to bad cholesterol and escorts it to the liver, which filters it out of the body. So HDL reduces the amount of bad cholesterol in your system. Healthy number: 60mg/dL or higher.

  • Total cholesterol is the sum of all types of cholesterol in your blood. Although your doctor may still refer to this number, it's less significant than your HDL and LDL levels. Healthy number: Less than 200 mg/dL.

  • Triglycerides, while not cholesterol, are another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Healthy number: Less than 150 mg/dL.

Think you need to get a handle on your LDL, HDL, total cholesterol or triglycerides? Here's how to do it.

1. Lower Cholesterol by Eating Right

You've probably heard it before, but foods that are high in saturated fat and -- to a lesser extent -- high in cholesterol, boost your cholesterol levels. These include foods like egg yolks, fatty meats, and full-fat dairy products.

Plutzky recommends you also cut down on trans fatty acids as well, which are often found in processed and fried foods.

But eating a heart healthy diet isn't just about deprivation. In fact, some foods -- eaten in moderation -- can actually improve your cholesterol levels. They include:

  • Fatty fish, like tuna and salmon
  • Nuts, especially walnuts and almonds
  • Oatmeal and oat bran
  • Foods fortified with stanols, like some margarines and orange juices

How much does diet help? It depends.

"The effect of diet has a varying effect on people's cholesterol," says Roger Blumenthal MD, director of the Preventive Cardiology Center at Johns Hopkins Medical School in Baltimore. "Some people get a lot more benefit than others."

Blumenthal says diet tends to help people lower triglycerides and raise good HDL cholesterol, but it's less likely to have a big impact on bad LDL cholesterol.

2. Improving Cholesterol With Exercise

Exercise is another way to improve your cholesterol levels. Increased physical activity can have a modest effect on cholesterol, lowering triglycerides (and bad LDL cholesterol to a lesser extent), while boosting your good HDL cholesterol.

Of course, the type of exercise is up to you. Plotzky says just about any aerobic activity -- something that boosts your heart rate -- is good. Blumenthal says that walking is often the best way for people who are out of shape to get started.

"I encourage people to buy a $10 pedometer to count their steps," says Blumenthal. "It's a simple way to measure your progress, and it's easy to work in walking during the day."

3. Lose Weight: Lower Cholesterol

Being overweight tends to lead to unhealthy cholesterol levels. Losing weight can lower your bad LDL cholesterol and triglycerides. It also can raise your good HDL cholesterol.

Of course, weight loss is usually a product of a good diet and exercise. So what if you've already improved your diet and started exercising but still need to lose weight?

Then you need to make some further adjustments -- gradually. Once you've reduced your intake of saturated fats, trans fats, and cholesterol, you can focus on cutting out some calories. In the same way, once you've gotten into an exercise routine, you can step up the intensity to lose some pounds.

4. Controlling Cholesterol With Medication

So what happens if diet, exercise and weight loss aren't enough to bring your cholesterol under control? Your doctor might recommend medicine.

Medicine may also be a first choice for people who have other risk factors. "If you have high cholesterol and heart disease or diabetes," says Blumenthal, "the evidence is pretty clear that you should be on medication."

Medicine can have a dramatic effect both on your cholesterol levels and your overall health. "People need to understand that using medicine can lower your risk of heart attack and stroke by 30-40%," says Blumenthal.

Several types of medication can help, including:

  • Statins, like Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor. Statins are usually the first choice for medicine. They block the effects of an enzyme that helps make cholesterol. They also lower bad cholesterol by a whopping 20-55%. They have a modest effect on triglycerides and give a mild boost to your good cholesterol.

  • Ezetimibe (Zetia) is a newer cholesterol-reducing medication that decreases how much cholesterol the body absorbs. It can lower bad cholesterol by up to 25%. Ezetimibe may be combined with a statin to boost the cholesterol lowering effects. Vytorin is ezetimibe combined with the statin Zocor.

  • Niacin, available as Niacor, Niaspan, and Nicolar (among others), lowers LDL cholesterol and triglycerides and raises HDL cholesterol. LDL levels are usually cut by 5-15% and may be reduced up to 25%.

  • Bile acid resins like Colestid, Lo-Cholest, Prevalite, Questran, and WelChol. They stick to cholesterol in the intestines and prevent it from being absorbed. They can lower LDL cholesterol by 15-30%.

  • Fibric acid like Atromid, Lopid, and Tricor. They mainly reduce your triglycerides and may also give a mild boost to your HDL. LDL is affected to a lesser extent.

Like any medicines, drugs to lower your cholesterol can have side effects. Talk to your health care provider about the risks.

If you wind up needing a medicine, don't feel like your lifestyle changes have failed. Some people have high cholesterol that just doesn't respond as well to exercise and diet, but keeping up your lifestyle changes may allow you to take lower doses of medicine.

Four Cholesterol Treatments: Which Is Best?

The best treatment varies from person to person. People at low risk may try lifestyle changes first and only move on to medication if they need it. Others who are at severe risk may need a medicine, like a statin, right away.

Admittedly, lifestyle changes may not be enough to drastically lower your bad LDL levels.

"Physical activity and improved diet can lower your triglycerides and raise your [good] HDL cholesterol," says Plutzky. "But it's pretty hard to eat or exercise your way to better LDL levels."

But that doesn't make lifestyle changes any less important or give you a free pass to loll about the house eating ice cream. You still need to keep eating well and exercising.

"Exercise and dietary changes have a lot of cardiovascular benefits that won't show up on a cholesterol test," says Plutzky. Exercise, eating well, and losing weight can lower blood pressure, lower your heart rate, and decrease your risk of diabetes and other diseases. And remember that your real goal is not merely better cholesterol numbers, but a lower risk of cardiovascular disease.

If your doctor does prescribe a statin, you may have mixed feelings. You may not like the idea of being on a medicine for the rest of your life. But Blumenthal and Plutzky urge people to think about the benefits.

"The safety and efficacy of statins is superb," says Plutzky. "They may be one of the greatest medical advances we've had in recent years."

And Blumenthal predicts that soon they may be taken like preventative aspirin is now -- even in people who don't have high cholesterol by today's standards.

Plutzky says that we've come a long way in our understanding and treatment of high cholesterol.

"We have excellent, safe treatments for high cholesterol now," says Plutzky, "Treatments that people in the past with high cholesterol would have given absolutely anything to have. So if you need them, it's a shame not to take advantage of them."

Published August 21, 2006.


SOURCES: American Heart Association web site, "Cholesterol Lowering Drugs." Roger Blumenthal MD, director of the Preventive Cardiology Center at Johns Hopkins Medical School, Baltimore, Md. Bruznell J., "Diagnosis and Treatment of dyslipidemia," ACP Medicine; April, 2005. Kris-Etherton, P. Circulation, Nov. 19, 2002; vol 106: pp 2747-2757. National Heart, Lung, and Blood Institute web site, "National Cholesterol Education Group: The Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)," "High Blood Cholesterol: What You Need to Know," "Your Guide to Lowering Cholesterol with TLC: Therapeutic Lifestyle Changes." National Institutes of Health: Medline Plus web site, "Niacin for High Cholesterol." Jorge Plutzky MD, director, Vascular Disease Prevention Program, Cardiovascular Division of Brigham and Women's Hospital; assistant professor of medicine, Harvard Medical School, Cambridge, Mass. Tapsell L. Diabetes Care, December 2004; vol 27: pp 2777-2783.

©2006 WebMD Inc. All rights reserved.





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