High cholesterol levels increase risk of heart attack and other vascular diseases. Someone with high cholesterol may benefit from dietary counseling, preferably by a dietitian, along with weight control and exercise. Many will need a lipid-lowering drug in addition. These agents fall into several classes that include statins, fibric acid derivatives, bile acid sequestrants, nicotinic acid (also known as niacin) and the cholesterol absorption inhibitors. These drugs differ in how they work and the degree and type of the lipid they lower.
Physicians usually prescribe a drug based on the underlying lipid abnormality. The most common type of cholesterol problem is a high LDL (low density lipoprotein) which is usually best treated with a statin, of which there are at least four on the market. When a patient cannot tolerate any statin, reasonable options include the use of ezetimibe (trade name Zetia); bile acid sequestrants; fenofibrate, which inhibits liver enzymes; and niacin. Referral to a lipid specialist is also very appropriate in such patients.
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