Cholesterol, high - Treating high cholesterol

If you've been diagnosed with high cholesterol, you will at first be advised to make changes to your diet and increase your level of exercise.

After a few months, if your cholesterol level has not dropped, you will usually be advised to take cholesterol-lowering medication.

Changing your diet, stopping smoking and doing more exercise will also help prevent high cholesterol developing. 

Diet

Eating a healthy diet that is low in saturated fats can reduce your level of LDL (bad cholesterol).

Try to avoid or cut down on the following foods, which are rich in saturated fat:

• fatty cuts of meat and meat products, such as sausages and pies
• butter, ghee and lard
• cream, soured cream, creme fraiche and ice cream
• cheese, particularly hard cheese
• cakes and biscuits
• chocolate
• coconut oil, coconut cream and palm oil

Overall:

• the average man should have no more than 30g saturated fat a day
• the average woman should have no more than 20g saturated fat a day

To get an idea of how much saturated food you are consuming, take a look at the food labels of the foods you are eating.

Read more information on how to eat good food and maintain a healthy diet.

Omega-3 fatty acids

Many experts believe that the fats found in avocados and oily fish such as mackerel, salmon and tuna are good for you.

These are known as omega-3 fatty acids and high doses can improve (lower) triglyceride levels in some patients. However, too much can contribute to obesity.

For those with a high triglyceride level, around two oily-fish based meals a week is thought to be beneficial.

However there is no evidence that taking omega-3 fatty acid supplements has the same benefit.

Cholesterol-lowering medication

There are several different types of cholesterol-lowering medication that work in different ways. Your GP can advise you about the most suitable type of treatment. Your GP may also prescribe medication to lower high blood pressure (hypertension) if it affects you.

The most commonly prescribed medications are outlined below.

Statins

Statins block the enzyme (a type of chemical) in your liver that helps make cholesterol. This leads to a reduction in your blood cholesterol level.

You will usually be started on the drug atorvastatin. Other statins include simvastatin and rosuvastatin.

When someone has side effects from using a statin, this is described as "intolerance" to it. Side effects of statins include muscle pain and stomach problems.

Statins will only be prescribed to people who continue to be at high risk of heart disease as you usually need to take statins for life. This is because cholesterol levels start to rise again once you stop taking them.

Aspirin

In some cases, a low daily dose of aspirin may be prescribed, depending on your age (children under 16 should not take aspirin) and other factors. Low-dose aspirin can prevent blood clots from forming.

Niacin

Niacin is a B vitamin found in foods and multivitamin supplements. In high doses (available by prescription), niacin lowers triglycerides and raises HDL. Niacin can be offered to people with a high triglyceride level.

High doses of niacin can cause flushing (when your skin turns red), but more recent medications significantly reduce this side effect. Avoiding spicy foods also helps to reduce flushing.

Niacin is not used in people with current indigestion, stomach ache, stomach ulcers, or those at risk of developing these symptoms.

You may also be advised to have periodic blood tests to ensure your liver is functioning well.

Read more about niacin and other B vitamins.

Other medications

Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices in your intestines into your blood. It is generally not as effective as statins, but is less likely to cause side effects.

You can take ezetimibe at the same time as your usual statin if your cholesterol levels are not low enough with the statin alone. The side effects of this combination are generally the same as those of the statin alone (muscle pain and stomach problems).

You can take ezetimibe by itself if you are unable to take a statin. This may be because you have another medical condition or you take medication that interferes with how the statin works, or because you experience side effects from statins. Ezetimibe taken on its own rarely causes side effects.

For more information on ezetimibe, read the NICE 2007 guidelines on ezetimibe for high cholesterol.