Managing your cholesterol

High cholesterol can increase your chances of having a heart attack. Fortunately, you can do a number of things to reduce your cholesterol level if it’s high. For some people, a better diet and more exercise will be enough to get their cholesterol to the right level. For others, medications are needed. The following information can help you understand your risk and follow a plan to reduce your cholesterol to a safer level.

What is cholesterol?

Cholesterol is a waxy substance found in your body’s cells and blood stream. Your body needs this fat-like material in the right amounts to support several important functions. Cholesterol is made by your liver, and also comes from cholesterol in animal products that you eat, such as meats, oils, butter, cheese and whole milk.

Why is cholesterol important?

Too much cholesterol can lead to heart disease, the most common cause of death in the United States. About half of all adults have at least “borderline high-risk” cholesterol (over 200 mg/dL). Studies show that lowering cholesterol reduces the chances of heart attack and death from heart disease.

Know your cholesterol level

When you have your cholesterol checked, make sure you’ve had nothing to eat or drink for 9-12 hours (water is permitted).

What does your blood test mean?

Your blood test will provide you and your doctor with information about several types of cholesterol, including LDL (the “bad cholesterol”) and HDL (the “good cholesterol”).

High levels of LDL cholesterol in the blood can lead to deposits of fat in artery walls, which can damage them. This cholesterol and fatty buildup is called atherosclerosis, or “hardening of the arteries,” and can increase your chances of having a heart attack or stroke.

If your LDL is higher than 160 mg/dL, you need to try to reduce it. Depending on your heart disease risk, your LDL goal may be much lower, as low as 100 mg/dL or even 70 mg/dL. Ask your doctor what your LDL goal should be.

The “good” HDL cholesterol carries LDL cholesterol away from the arteries and protects your heart. A high HDL (over 60 mg/dL) is good for you. But if your HDL is lower than 40 mg/dL, it increases your risk of heart disease.

Diet and exercise

If your LDL cholesterol is too high, or your HDL is too low, you can take action to improve those levels.

Exercise and weight loss are the most important places to start. They can improve your cholesterol levels and reduce your risk of heart disease. Useful recommendations about diet and exercise are on the American Heart Association website:

Reduce your intake of saturated fats and cholesterol

Saturated fats are the worst kind of fat, and should account for less than 7% of the total calories you take in. Saturated fats are found in fried foods, red meats, and high-fat dairy products, among other foods. For more information about foods to avoid, go to the USDA website:

Your diet should have less than 200 mg per day of cholesterol. Cholesterol can be found in meat, egg yolks, and dairy products.

You can also reduce your cholesterol by eating more fiber. Fiber is found in whole grains and cereals, vegetables and beans. See the USDA and American Heart Association websites for more information.

Stop smoking

If you smoke, you should quit. Smoking increases your risk of having a heart attack or stroke (and many kinds of cancer).

When are prescription drugs needed?

If diet and exercise aren’t enough to reach your LDL cholesterol goal, you may need a medication. It is very important to take your medication every day as prescribed, or it won’t work well. Call your doctor if you stop taking your medication for any reason.

Statins are the most common medications used to treat high cholesterol. Some commonly used statins include: atorvastatin (Lipitor), simvastatin (Zocor), or lovastatin (Mevacor). For many patients, an affordable generic, such as lovastatin, will be enough to reduce LDL cholesterol to goal.

For those who have a bad reaction to statins or when statins do not lower cholesterol enough, other medications, such as ezetimibe, niacin, fibrates, or bile acid sequestrants, may be combined with statins. Ask your doctor about the best medication for you.

The table below provides information about the costs of similarly effective medications to treat high cholesterol.

Rarely, statins can cause side effects such as muscle pain or liver problems. Tell your doctor if you think you may have any problems caused by your medication. Follow-up regularly after starting treatment to make sure the medication is working and that you are reaching your LDL goals.

Drug name and daily dose Brand Monthly cost
atorvastatin 10 mg Lipitor $82
fluvastatin 80 mg Lescol $96
generic n/a
lovastatin 40 mg Mevacor $123
generic $35
pravastatin 80 mg Pravachol $162
generic $4*
rosuvastatin 5 mg Crestor $94
simvastatin 40 mg Zocor $142
generic $50
simvastatin + ezetimibe 10 mg Vytorin $98
generic n/a

n/a= not currently available
*Based on the price of pravastatin 40 mg

The monthly cost for each medication was based on the lowest price available for each drug and dose, as posted on the following websites;,,,,, and The price of generic simvastatin is expected to decrease further as more generic products become available. Prices obtained November 2007.