Lifestyle changes are the first steps you can take to improve your blood levels of cholesterol and triglycerides. These include changes in diet, regular exercise and avoiding smoking. If you've made these important lifestyle changes and your total cholesterol — especially your level of LDL cholesterol — remains high, your doctor may recommend prescription medication.

Before recommending medication, your doctor may weigh many variables — your changeable risk factors, your age, your current health and the drug's side effects. If you need a medication to improve your cholesterol levels, chances are you may need it for many years.

Your LDL cholesterol level is usually the deciding factor. If you have no other risk factors for heart disease, an LDL level greater than 190 milligrams per deciliter (mg/dL) generally warrants medication. With two or more risk factors, an LDL level greater than 160 mg/dL may require medication. If plaques have narrowed the arteries to your heart and restricted the flow of oxygen-rich blood to your heart's muscles (coronary artery disease), your doctor may suggest medication and lifestyle changes to lower your LDL to less than 100 mg/dL. And if you're considered at very high risk, you and your doctor may even discuss lowering your LDL to less than 70 mg/DL.

Medications to improve blood cholesterol levels include:

• Resins. The medications cholestyramine (Questran) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids in your intestinal tract. Your liver makes bile acids, which you need for digestion, from cholesterol. By tying up bile acids, resins prompt your liver to make more bile acids. Because your liver uses cholesterol to make bile acids, less cholesterol is available to reach your bloodstream.

  • Triglyceride-lowering drugs. These medications include fibrates such as gemfibrozil (Lopid) and fenofibrate (Tricor), and niacin (nicotinic acid). Fibrates reduce triglyceride production and remove triglycerides from circulation. They can also increase your HDL cholesterol level.

  • Statins. Statins work directly in your liver to block a substance your liver needs to make cholesterol. This depletes cholesterol in your liver cells, which causes your liver cells to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from plaques that accumulate on the walls of your arteries. This process may slowly open blocked blood vessels. Statins include fluvastatin (Lescol), lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), atorvastatin (Lipitor) and rosuvastatin (Crestor).

  • Cholesterol absorption inhibitor. Your small intestine absorbs the cholesterol from your diet. After that, dietary cholesterol enters the bloodstream. Your total cholesterol is the result of dietary cholesterol and the cholesterol the liver produces itself. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol.

  • Cholesterol absorption inhibitor-plus-statin combination. The combination drug ezetimibe/simvastatin (Vytorin) decreases both absorption of dietary cholesterol in your small intestine and production of cholesterol in your liver.

from MAYO Clinic