Medications to lower blood cholesterol levels are reserved for people at high risk for heart disease
or those with known vascular disease (stroke, myocardial infarction, peripheral vascular disease). Middle aged and older men and women with vascular disease or diabetes are helped from a drug class known as the ‘statins’, no matter what their cholesterol levels are. Patients with diabetes are at a greater risk of vascular disease, and need strong treatment.
Most often, patients without vascular disease who have high cholesterol with or without other risk factors should try diet, exercise, and weight loss (if overweight) prior to using medications. Those with high cholesterol or high triglycerides, overweight, diabetes,
and any vascular disease should see a nutritionist before starting medications. Patients with known vascular disease may need medications right away. Even so, lifestyle changes are still very vital lowering your risk.

Lowering cholesterol with medication
Several types of drugs are available for cholesterol lowering, including statins, bile acid sequestrants, niacin, and fibric acids. Based on the different types of medications available, your doctor can help decide which one is best for you.
• Statins. Proven to be highly effective and well tolerated in most patients, statins are now regarded as the treatment of choice for lowering“bad” cholesterol levels. These include atorvastatin (Lipitor®), fluvastatin
(Lescol®), lovastatin (Mevacor®), pravastatin (Pravachol®), and simvastatin (Zocor®). While the frequency of side effects with these medications is generally very low, nausea, gas, constipation, and abdominal cramping may occur. Headache, muscle pain, and liver problems have been reported in some cases.
• Bile acid sequestrants. These drugs also lower LDL levels and can be used alone or in combination with statin drugs. This type of drug includes cholestyramine (Questran®), colestipol (Colestid®), and colesevelam (Welchol®). Bile acid sequestrants can cause intolerable gastrointestinal effects (such as bloating,
gas, abdominal pain, and constipation) at the level of dosage required to lower LDL cholesterol levels. Because of these potential side effects, these drugs are
mostly added to statins when further lowering of total cholesterol or LDL cholesterol is needed. They also can be used alone for patients who cannot take statins.

• Niacin (nicotinic acid). Niacin, a B vitamin, lowers LDL and triglyceride levels, and raises HDL cholestero levels. It is the most effective drug available for raising HDL cholesterol levels. Side effects include hot flashes, nausea, indigestion, gas, and high blood sugar. A few years ago, the Food and Drug Administration approved a new prescription medication called Advicor® that combines niacin to boost “good” cholesterol and lovastatin to lower “bad” cholesterol.
• Fibric acids. These medications lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Three fibrates are currently available in the United States: gemfibrozil (Lopid®), fenofibrate (Tricor®), and clofibrate (Atromid-S®). Fibrates are generally well tolerated but can occasionally cause some side effects such as nausea, bloating, gas, and the formation of gallstones.
Since these drugs are only somewhat effective in lowering “bad” cholesterol levels, fibrates are often used in conjunction with another drug, such as statins, to reduce LDL levels.
What about estrogens?
It is true that estrogen helps to decrease LDL cholesterol levels in postmenopausal women. For a long time, experts in the field of women’s health and heart disease considered estrogen replacement therapy (or hormone replacement therapy) an effective way to reduce a postmenopausal woman’s risk of developing future heart disease. However, a number of large, well-designed studies published in the medical literature in the last few years have failed to find that estrogen replacement helps prevent future risks of heart disease. For some women, hormone replacement therapy may even increase the risk for developing future manifestations of heart disease. Until we learn more about what types of women, if any, receive cardiovascular benefit from taking hormone replacement therapy, estrogen taken alone or in combination with progesterone should not be used for treating high cholesterol levels. The other medications (e.g. statins) currently available for lowering LDL cholesterol levels appear as equally effective for women as men.
Other steps
In addition to medication to lower your “bad” (LDL) cholesterol goal has been reached, your doctor may prescribe other measures to lower your triglycerides,
increase your level of “good” (HDL) cholesterol, or both. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and a low fat — high fiber diet.