BOSTON, MA — Although statin drugs successfully lower LDL cholesterol for most people, a small subset of patients don't respond well to these medications or need to stop taking them because of side effects. "All told, the statins are the safest and best tolerated of all cholesterol-lowering medications, but the second- and third-choice drugs can have first-rate benefits, either alone or together," says Dr. Harvey Simon, editor of the Harvard Men's Health Watch.
The options include fibrate drugs, which can also help boost heart-healthy HDL cholesterol; resin-based therapies, which help keep the body from absorbing cholesterol in the gut; the relative newcomer ezetimibe (Zetia), which also interferes with the body’s absorption of dietary cholesterol; and niacin, which can improve LDL, HDL, and triglyceride levels.
Given the many medications, it may be tempting to ignore the importance of lifestyle. That's a mistake, says the Harvard Men's Health Watch. To curb cholesterol, men should also be sure to avoid tobacco in all its forms; limit saturated fats, trans fats, and cholesterol; eat more foods with heart-healthy omega-3 and monounsaturated fats; and get plenty of dietary fiber. Regular exercise and weight control are also crucial.
Lifestyle therapy can improve cholesterol levels, but even with clean living, many people need medication to achieve optimal cholesterol levels, particularly when they have to reduce their LDL levels to 100 mg/dL or less. "Don’t despair if you can’t take a statin," says Dr. Simon. "Instead, work with your doctor to find a program that’s effective. Above all, remember that even statins finish second behind lifestyle therapy. Even if you can’t take a statin, you can enjoy the many benefits — and pleasures! — of a healthful diet and regular exercise."