Treatment for high cholesterol depends on which lipid is high. In many cases, the focus of treatment is to reduce high LDL ("bad") cholesterol levels. LDL cholesterol sometimes can be lowered without medication (nonpharmacological therapy), but often, medication (pharmacological therapy) is necessary.
Standard nonpharmacological therapy consists primarily of modifying diet and lifestyle. This therapy may modestly reduce LDL cholesterol, but is not likely to lower the LDL cholesterol level more than about 30 mg/dL.
In patients without atherosclerosis who have modestly elevated LDL cholesterol levels, treatment with medication is not urgent, and an initial 6–12 month trial of nonpharmacological therapy may be advised. If the LDL cholesterol falls to an acceptable level within this time, the patient can continue with this treatment only. If the level remains high, however, pharmacological therapy should be initiated.
Lifestyle changes that may lower LDL cholesterol levels include the following:
- Diet. Minimize cholesterol and fat intake, especially saturated fat, which raises cholesterol levels more than any other substance. Cholesterol and saturated fats are found primarily in foods derived from animals, such as meats and dairy products. Dietary guidelines for reducing cholesterol and fat consumption:
- Eat lean fish, poultry, and meat. Remove the skin from chicken and trim the fat from beef before cooking.
- Avoid commercially prepared and processed food (e.g., cakes, cookies) and breaded fried foods.
- Increase the intake of fruits, vegetables, breads, cereals, rice, legumes (e.g., beans, peas), and pasta.
- Use skim or 1% milk.
- Eat no more than 2 egg yolks (or whole eggs) per week.
- Use cooking oils that are high in unsaturated fat (e.g., corn, olive, canola, safflower oils)
- Use soft margarine, which contains less saturated fat than butter.
The Food and Drug Administration (FDA) recently approved two cholesterol-lowering margarine products (Benecol® and Take Control®). These margarines contain plant-derived substances that can decrease the absorption of cholesterol in the digestive tract and may reduce cholesterol by about 7–10%. They should not be used instead of drug therapy, but may be added to a nonpharmacological treatment plan for high cholesterol.