Expert Q&A

Cholesterol Drugs: Necessary If You Eat a Good Diet?

If I follow a good diet, do I still need to take my cholesterol medicine?

So your doctor has diagnosed you with high cholesterol and to help control it, a statin or some other cholesterol medication has been prescribed. In addition, it has been recommended that a low-fat diet be followed. Perhaps the idea of taking a medication, the television ads that warn about liver damage from statins, and the high costs associated with the medicine make you wonder if it is worth it. Can you avoid taking the medication if you follow a better diet?

If your high cholesterol was caused by a poor diet, healthy eating and regular exercise will cure it, as long as these good habits are maintained for life. However, there are some people whose condition is hereditary. Just as some people inherit an affinity for drawing or math, some people just make too much cholesterol. Even worse, they may make too much of the bad Low Density Lipoprotein (LDL) and not enough of the good High Density Lipoprotein (HDL). With these people, even an excellent diet and exercise program may not lower their cholesterol to a safe level. Medication may be their only remedy.

Cholesterol-reducing medications are actually quite safe. The greatest concerns are related to liver and muscle damage. In reality, though, the danger is low. Muscle damage occurs in 1 out of 10,000 people and liver damage occurs in even fewer.

For example, take a generally healthy (normal blood pressure, non-smoker, normal weight, no other medical problems) 50-year-old man with a family history of heart disease. A slightly elevated cholesterol of 240 and a normal HDL of 40 gives him a 1 in 10 chance of a heart attack within 10 years. In other words, high cholesterol is at least 1,000 times more dangerous than the medications that are used to treat it.

Several generics are now available, so cost is less of an issue than it has been in the past. For those without prescription coverage, drug manufacturers have programs to provide the medications for a modest fee, and in some cases, for free. So the ultimate question is, how healthy do you want to be? If you want to reduce your risk of heart disease and are prescribed a cholesterol lowering medication, work with your physician to achieve the safest levels.

John Messmer, MD
Contributing Expert

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