Conclusion: Orlistat has a cholesterol lowering efficacy independent of its weight reducing effect. Because of the limited therapeutic effectiveness, patients at high cardiovascular risk should receive rather early additional cholesterol lowering medication during weight loss programmes.

Abstract Background: Orlistat reduces energy uptake by the impairment of fat digestion and some evidence indicates it also lowers plasma cholesterol. Publication types Clinical Trial Multicenter Study Randomized Controlled Trial Research Support, Non-U.

Substances Anti-Obesity Agents Cholesterol, LDL Lactones Lipids Orlistat Cholesterol. Older adults — The decision to treat high cholesterol levels in a person over the age of 75 depends upon the individual's "chronologic age" age in years as well as their "physiologic age" which takes into account their health and fitness level.

A person with a limited life span and underlying illness may not need to receive drug therapy. On the other hand, an otherwise healthy older adult should not be denied drug therapy simply on the basis of age alone. In general, the treatment goals discussed above apply for people of all ages.

These patients often have a genetic factor that leads to a change in how cholesterol is processed in the body, and they have high levels of cholesterol from birth. As such, their risk of developing heart disease is much higher. These patients are recommended for treatment regardless of the risk score, with treatment often started in late teenage years.

You can help lower your lipid levels with lifestyle changes, medications, or a combination of both. In certain cases, a health care provider will recommend a trial of lifestyle changes before recommending a medication.

The best approach for you will depend on your individual situation, including your lipid levels, health conditions, risk factors, medications, and lifestyle. Lifestyle changes — If you have high low-density lipoprotein LDL cholesterol, you should try to make some changes in your day-to-day habits, including reducing the amount of total and saturated fat in your diet, losing weight if you are overweight or obese , getting regular aerobic exercise, and eating plenty of fruits and vegetables see "Patient education: Exercise Beyond the Basics " and "Patient education: Diet and health Beyond the Basics ".

A plant-based diet is an effective strategy to lowering LDL cholesterol. The benefits of these lifestyle changes usually become evident within 6 to 12 months.

However, the success of lipid lowering with lifestyle modification varies widely, and health care providers sometimes recommend beginning medication sooner. Medications — There are many medications available to help lower elevated levels of LDL cholesterol.

Each category of medication varies in how it works, how effective it is, and how much it costs. Your health care provider will recommend a medication or combination of medications based on your blood lipid levels and other individual factors.

Statins — Statins are one of the best-studied classes of medications and the most commonly used drugs for lowering LDL cholesterol. They are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death.

Available statins include atorvastatin former brand name: Lipitor , rosuvastatin former brand name: Crestor , and several other similar medications table 1. Statins decrease the body's production of cholesterol and increase removal of cholesterol by the liver, so they reduce LDL cholesterol levels by as much as 25 to 55 percent.

In addition, they can lower triglycerides. Statins may also reduce inflammation and may prevent heart attacks and strokes through this mechanism.

While most people tolerate statins well, there are some potential side effects, mainly muscle pain, aches, or weakness. Use of statins may also increase the risk of developing diabetes, although the risk is seen mostly in those with prediabetes, and the benefit in reduction on heart attack and stroke is about four times that of the risk of developing diabetes.

Changing statins and using low doses often can avoid these issues, but if not, non-statin medications can be used to lower LDL cholesterol. It is important to closely follow the dosing instructions for when to take statins; some are more effective when taken before bedtime while others should be taken with a meal.

In addition, some foods, such as grapefruit or grapefruit juice, can increase the risk of side effects of statins. Most manufacturers recommend that people who take lovastatin, simvastatin, or atorvastatin consume no more than one-half of a grapefruit or 8 ounces of grapefruit juice per day.

Ezetimibe — Ezetimibe brand name: Zetia blocks the body's ability to actively transport cholesterol from food as well as cholesterol that the body produces internally.

It lowers LDL cholesterol levels by 20 to 25 percent and has relatively few side effects. It is usually prescribed in combination with a statin but is also used alone in patients who cannot tolerate a statin.

When used in combination with a statin after an acute coronary syndrome eg, heart attack , ezetimibe provides a small additional reduction in the risk of having another cardiovascular event.

PCSK9 inhibitors — PCSK9 monoclonal antibody inhibitors are another class of drugs that lower LDL cholesterol levels sample brand names: Praluent, Repatha table 1 ; they are given by injection under the skin every two to four weeks.

They reduce cardiovascular events such as heart attack or stroke and potentially death. Aside from mild skin reactions at the site of injection, they have few side effects. Inclisiran brand name Leqvio is a PCSK9 inhibitor that is given by injection once, 90 days later, and then every six months.

However, they are expensive and their use is limited to patients treated with maximal tolerated statins who have persistent elevations of LDL cholesterol. Bile acid sequestrants — The bile acid sequestrants include colesevelam brand name: Welchol , colestipol brand name: Colestid , and cholestyramine sample brand names: Prevalite, Questran table 1.

These medications bind to bile acids in the intestine, reducing the amount of cholesterol the body absorbs from foods. They are used only occasionally. They lower LDL cholesterol only modestly 10 to 15 percent.

Side effects can be bothersome and may include nausea, bloating, cramping, and liver damage. Taking psyllium a fiber supplement, such as Metamucil can sometimes reduce the dose required and the side effects.

Bile acid sequestrants can interact with some medications, including as digoxin brand name: Lanoxin and warfarin brand name: Jantoven , and with the absorption of fat-soluble vitamins including vitamins A, D, K, and E.

Taking these medications at different times of day can solve these problems in some cases. Bempedoic acid — Bempedoic acid brand name: Nexletol is the newest lipid-lowering agent, and it is approved for lowering LDL cholesterol.

It works by inhibiting cholesterol synthesis at a step before the HMG-CoA reductase or the enzyme inhibited by statin therapy. Bempedoic acid alone or in combination with a statin or ezetimibe brand name: Nexlizet lowers LDL cholesterol as well as other atherogenic proteins.

Bempedoic acid can reduce the risk of cardiovascular events such as heart attacks. Side effects include an increase in the incidence of gout, gallstones, kidney damage, and small increases in liver enzymes. Early studies reported Achilles tendon rupture as a rare side effect; however, this effect was not seen in a recent large trial.

Omega-3 — Oily fish, such as mackerel, herring, bluefish, sardines, salmon, and anchovies, contain two important fatty acids called docosahexaenoic acid DHA and eicosapentaenoic acid EPA.

Eating a diet that includes one to two servings of oily fish per week can lower triglyceride levels and reduce the risk of death from coronary heart disease. Fish oil supplements, supplements with low-dose mixed fish oils usually approximately 1 gram per day of combined DHA and EPA , had been thought to provide cardiac benefit, but large trials have found no significant benefit.

As such, they are no longer recommended. A second study of a high-dose agent that had both EPA and DHA failed to provide benefit, suggesting that the EPA only preparation at the 4 g dose is important. However, the trials found that omega-3 fatty acid medications increase the risk of atrial fibrillation.

Therefore, a discussion with your cardiologist on the net benefit or harm from taking fish oil supplements including icosapent ethyl is needed before starting this treatment.

Nicotinic acid niacin — Nicotinic acid is a vitamin that is available in immediate-release, sustained-release, and extended-release formulations table 1. Nicotinic acid is rarely used for a high cholesterol. In most situations, ezetimibe or a PCSK9 inhibitor is tried before nicotinic acid.

Historically, this agent used to be used to raise HDL cholesterol levels, but that is no longer recommended. It is sometimes used for patients with high lipoprotein a levels and LDL cholesterol that is refractory to more effective and better-tolerated medications statins, ezetimibe and PCSK9 inhibitors.

Nicotinic acid is associated with many side effects, including flushing when the face or body turns red and becomes warm , itching, nausea, numbness and tingling, and worsening of gout. This medication can also cause liver damage; people who use it require regular blood tests to monitor their liver function.

Red yeast rice — Red yeast rice is a fermented rice product that can lower serum cholesterol. Red yeast rice contains naturally occurring substances called monacolins that act to reduce cholesterol by a mechanism similar to that of statins.

Although red yeast rice is effective for lowering total and LDL cholesterol, there is not evidence that it decreases rates of cardiovascular events or that it is safe to take long-term. Moreover, red yeast rice supplements are not standardized in the United States.

Different commercial preparations vary widely in the amount of the active ingredient, and some commercial preparations have been shown to contain potentially toxic substances or lovastatin, a statin medication. Soy protein — Soy protein contains isoflavones, which mimic the action of estrogen.

A diet high in soy protein can slightly lower levels of total cholesterol, LDL cholesterol, and triglycerides and raise levels of high-density lipoprotein HDL cholesterol. However, normal protein should not be replaced with soy protein or isoflavone supplements in an effort to lower cholesterol levels.

Soy foods and food products eg, tofu, soy butter, edamame, some soy burgers are likely to have beneficial effects on lipids and cardiovascular health because they are low in saturated fats and high in unsaturated fats.

Garlic — Garlic has not been proven to be effective in lowering cholesterol. Plant stanols and sterols — Plant stanols and sterols may act by blocking the absorption of cholesterol in the intestine. They are naturally found in some fruits, vegetables, vegetable oils, nuts, seeds, and legumes.

They are also available in commercially prepared products such as margarine Promise Active and Benecol , orange juice Minute Maid Premium Heart Wise , and rice milk Rice Dream Heart Wise as well as dietary supplements Benecol SoftGels and Cholest-Off. Despite lowering cholesterol levels, there are no studies demonstrating a reduced risk of coronary heart disease in people who consume supplemental plant stanols and sterols.

These products need to be studied more before they can be recommended. Although medications can rapidly lower your levels within a week , it often takes 6 to 12 months before the effects of lifestyle modifications are noticeable. Once you have an effective treatment plan and you begin to see results, it is important to stay committed to the plan.

Stopping treatment usually allows lipid levels to rise again and increases your risk for heart attack, stroke, or other cardiovascular problems.

Even while taking medications, maintaining a healthy lifestyle is crucial to obtain the most benefit from these therapies. Most people who stop treatment do so because of perceived side effects.

However, there are a wide variety of medications available today, which should make it possible for most people to find an option that works for them.

Talk with your health care provider if a specific medication is not working for you; he or she can recommend alternatives that are compatible with your lifestyle and preferences. Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site www. Related topics for patients, as well as selected articles written for healthcare professionals, are also available.

Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: High cholesterol The Basics Patient education: High triglycerides The Basics Patient education: Can foods or supplements lower cholesterol?

The Basics. Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

To avoid eating them inadvertently, scrutinize the labels on food packages before you put them in your shopping cart. If you see "partially hydrogenated" in the list of ingredients, pass that product by.

If trans fats aren't banned from restaurants in your area, ask if the cook uses partially hydrogenated oil before you order. Saturated fats and dietary cholesterol, which are derived primarily from animal products, aren't exactly heart-healthy, but it's all right to eat them in small amounts.

McManus says that because eggs are such a good source of nutrients, it's okay to have as many as four yolks a week and whites as often as you like. She also gives a nod to red meat, shrimp, lobster, high-fat cheeses, butter, and organ meats—but only to small portions of each one every couple of weeks or so.

Both polyunsaturated and monounsaturated fatty acids help lower LDL. Most plant-derived oils, including canola, safflower, sunflower, olive, grapeseed, and peanut oils, contain both. Fatty fish such as salmon, tuna, trout, herring, and mackerel , seeds, nuts, avocados and soybeans are also great sources.

Fruits and vegetables have scads of ingredients that lower cholesterol—including fiber, cholesterol-blocking molecules called sterols and stanols, and eye-appealing pigments.

The heart-healthy list spans the color spectrum—leafy greens, yellow squashes, carrots, tomatoes, strawberries, plums, blueberries. As a rule, the richer the hue, the better the food is for you.

Whole grains are another good source of fiber. Instead of refined flour and white rice, try whole-wheat flour and brown or wild rice. Old-fashioned oatmeal is also a good choice, but not the quick-cooking versions, which have had much of the fiber processed out.

And don't substitute sugar for fat. Food manufacturers may boost the sugar content of low-fat salad dressings and sauces to add flavor. If you see sugar, corn syrup, or any word ending in "ose" near the top of the list of ingredients, choose a higher-fat version without trans fats instead.

All fats , whether good or bad, have nine calories per gram—about calories a tablespoon. While you switch to a heart-healthy diet you may need to keep tabs on your calorie intake for a while. For more information, check out "11 foods that lower cholesterol.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Thanks for visiting. Don't miss your FREE gift. Niacin comes in prescription form and as a dietary supplement. Dietary supplement niacin must not be used as a substitute for prescription niacin because of potentially serious side effects.

Dietary supplement niacin is not regulated by the Food and Drug Administration and may contain widely variable amounts of niacin — from none to much more than the label states.

The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy.

These are derived from fish oils that are chemically changed and purified. Commonly referred to as omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high blood triglyceride levels. They help decrease triglyceride secretion and clear triglycerides.

The amount of marine-derived omega-3 PUFAs needed to significantly lower triglyceride 2 to 4 g is hard to get from a daily diet alone, so supplementing with capsules may be needed. These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics.

Negative interactions with other medications, herbal preparations and nutritional supplements are also possible. People with allergies to fish, shellfish or both may have a severe adverse reaction to using these supplements. Written by American Heart Association editorial staff and reviewed by science and medicine advisors.

See our editorial policies and staff. About Cholesterol. HDL, LDL Cholesterol and Triglycerides. Genetic Conditions.

Causes of High Cholesterol. How To Get Your Cholesterol Tested. Prevention and Treatment of High Cholesterol.

Cholesterol Tools and Resources. Do you have questions about cholesterol? We have answers. Our FREE cholesterol guide will help you understand and manage your cholesterol, so you can take action and live healthy!

Home Health Topics Cholesterol Prevention and Treatment of High Cholesterol Cholesterol Medications. Help to control your cholesterol levels For some people, lifestyle changes, such as a healthier diet and more exercise, may prevent or treat unhealthy cholesterol levels.

Types of cholesterol-lowering drugs Various medications can lower blood cholesterol levels. While dietary supplements can help, you might also need prescription medications to get your cholesterol numbers to a safe level.

Be sure to tell your doctor if you take any type of dietary supplement, because some can interact with medications you may be taking. There is a problem with information submitted for this request. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health.

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Show references Cholesterol management at a glance. National Center for Complementary and Integrative Health. Accessed Dec. Tangney CT, et al. Lipid management with diet or dietary supplements.

Natural Medicines. Fish oil. Green tea. Rosenson RS. Low density lipoprotein cholesterol lowering with drugs other than statins and PCSK9 inhibitors.

Adding foods that lower LDL , the harmful cholesterol-carrying particle that contributes to artery-clogging atherosclerosis, is the best way to achieve a low cholesterol diet. Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation.

Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol. An easy first step to lowering your cholesterol is having a bowl of oatmeal or cold oat-based cereal like Cheerios for breakfast.

It gives you 1 to 2 grams of soluble fiber. Add a banana or some strawberries for another half-gram. Current nutrition guidelines recommend getting 20 to 35 grams of fiber a day, with at least 5 to 10 grams coming from soluble fiber. The average American gets about half that amount. Barley and other whole grains.

Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease, mainly via the soluble fiber they deliver. Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal.

That's one reason beans are a useful food for folks trying to lose weight. With so many choices — from navy and kidney beans to lentils, garbanzos, black-eyed peas, and beyond — and so many ways to prepare them, beans are a very versatile food. Eggplant and okra.

Sources of soluble fiber, such as psyllium , can help clear cholesterol from the blood and eliminate it through the bowels, according to a review. The authors stated that people should introduce fiber supplements gradually to avoid side effects, such as bloating or cramping.

They also suggested that individuals should speak with a doctor before taking fiber supplements if they are taking medication or have an existing condition affecting their digestive system. According to a review of 31 trials, green tea lowered LDL cholesterol and total cholesterol in study participants who had moderate weight or were overweight.

Green tea contains active compounds called catechins, which may help reduce the risk of cardiovascular disease, although more research is necessary. People can purchase green tea extracts as a supplement in tablet form or consume green tea as a drink.

However, green tea contains caffeine , so individuals sensitive to the substance should be mindful of how much they consume. In addition, some products may not have undergone regulation by the FDA. Therefore, people should speak with a doctor or another healthcare professional before taking supplements, especially if they have a health condition or are taking medication.

Additionally, many supplements are unsuitable for use during pregnancy or while chestfeeding. Furthermore, if someone has concerns about their cholesterol levels, they can consult a doctor about diet and lifestyle strategies that could manage cholesterol, improve overall health, and lower their risk of heart disease.

Learn more about lowering cholesterol through diet and exercise. Several supplements, such as red yeast rice, phytosterols, and beta-glucans, may help people lower their cholesterol.

A person can get advice from a doctor about whether supplements are suitable for taking either alone or with cholesterol-lowering medication such as statins. In addition, people can help improve their cholesterol profile by maintaining a moderate weight, eating a nutritious diet, and participating in regular exercise or activity.

Natural ways to lower cholesterol include replacing trans fats and saturated fats, eating more soluble fiber, and exercising regularly. Learn more…. Eating a healthy diet is one way to keep cholesterol levels in check.

Learn which foods to avoid and which to prioritize to maintain healthy…. Learn about lifestyle strategies and drugs that may help. Fish oil does not appear to lower cholesterol. In some cases, it may raise it.

Find out more about taking fish oil for cholesterol. People can lower their cholesterol levels by taking medications and making lasting changes to their diet and lifestyle. Learn more. My podcast changed me Can 'biological race' explain disparities in health?

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Medical News Today. Health Conditions Health Products Discover Tools Connect. What are the best supplements for lowering cholesterol? Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — By Louisa Richards on May 31, Fibrates are especially good for lowering triglyceride blood fat levels and have a mild LDL-lowering action.

Niacin is a B vitamin that limits the production of blood fats in the liver. Take this only if your doctor has prescribed it. It lowers triglycerides and has mild LDL-lowering action. Niacin side effects may include flushing, itching and upset stomach.

Your liver functions may be closely monitored because niacin can cause toxicity. Nonprescription immediate-release forms of niacin usually have the most side effects, especially at higher doses.

Niacin is used cautiously in diabetic patients because it can raise blood sugar levels. Niacin comes in prescription form and as a dietary supplement. Dietary supplement niacin must not be used as a substitute for prescription niacin because of potentially serious side effects.

Dietary supplement niacin is not regulated by the Food and Drug Administration and may contain widely variable amounts of niacin — from none to much more than the label states.

The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy. These are derived from fish oils that are chemically changed and purified. Commonly referred to as omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high blood triglyceride levels.

They help decrease triglyceride secretion and clear triglycerides. The amount of marine-derived omega-3 PUFAs needed to significantly lower triglyceride 2 to 4 g is hard to get from a daily diet alone, so supplementing with capsules may be needed.

These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics. Negative interactions with other medications, herbal preparations and nutritional supplements are also possible.

People with allergies to fish, shellfish or both may have a severe adverse reaction to using these supplements. Written by American Heart Association editorial staff and reviewed by science and medicine advisors.

See our editorial policies and staff. About Cholesterol. HDL, LDL Cholesterol and Triglycerides. Genetic Conditions. Causes of High Cholesterol.

How To Get Your Cholesterol Tested.