Medical Edge Newspaper Column

High Cholesterol: Avoid Simplistic Solutions

Dec. 10, 2006
DEAR MAYO CLINIC:
I am taking omega-3 supplements each day -- two 1200-mg gel caps in the morning and the same in the evening. Will this help reduce high cholesterol? -- Ronkonkoma, N.Y.

ANSWER:
No, omega-3 fatty acids ("omega-3s") will not reduce high cholesterol.

In fact, at your total dosage -- almost 5 grams per day -- omega-3s could cause undesirable side effects, such as bleeding problems and stomach upset. Ironically, they might even slightly raise your cholesterol level.

On the positive side, omega-3s can reduce blood pressure and modestly lower the likelihood of blood clots and arrhythmias. More important, and related to the cholesterol issue, omega-3s reduce levels of triglycerides -- another type of fat in the blood -- by as much as 20 to 30 percent. Triglycerides aren't cholesterol molecules, but they do play a role in plaque formation and therefore in the health of your heart.

Keep several facts in mind. First, "cholesterol" by itself is a vague term. Do you mean low-density lipoprotein (LDL) cholesterol -- the "bad" cholesterol -- which builds up in the walls of your arteries, making them hard and narrow? Do you mean high-density lipoprotein (HDL) cholesterol -- the "good" cholesterol -- which can reduce LDL buildup by carrying it to the liver, where your body removes it? Or do you mean "total cholesterol," which is the sum of your LDL, HDL, and a fraction of the triglyceride count?

Second, lowering one measure or raising another isn't the main point. The ultimate goal is preventing a heart attack or stroke. Don't just think in terms of single risk factors or simplistic approaches en route to that objective. In other words, simply popping a pill in the absence of other important steps is not a likely path to success.

Better options for lowering your heart disease risk include lifestyle changes: losing excess weight, eating healthful foods, getting more active physically, and quitting smoking. Losing even 5 to 10 pounds can lower cardiovascular risk, and food choices make a difference. Reducing saturated fats, trans fats, and cholesterol, and increasing whole grains, fruits, vegetables, and fish, can enhance heart health.

If you've made these important lifestyle changes and your LDL cholesterol remains high, prescription medication may be appropriate.

For example, statins -- drugs that can dramatically lower LDL levels -- work by blocking a step in the cholesterol production process. They may also reduce the size of plaques in your artery walls, thereby helping to prevent further blood-vessel blockage and heart attack. Statins include such well-known medications as atorvastatin (Lipitor), simvastatin (Zocor), and lovastatin (Mevacor).

Another option is a cholesterol-absorption inhibitor -- notably, ezetimibe (Zetia) -- which helps reduce blood cholesterol by limiting the small intestine's absorption of dietary cholesterol. Zetia can also be used in combination with any of the statins.

Supplements such as plant stanol and sterol esters (in capsules or fortified foods) or the soluble-fiber psyllium (found in Metamucil) can also be taken. But because they reduce LDL levels only modestly, they should be used in conjunction with other approaches.

Whether to take medications of any kind depends on your overall cardiovascular disease risk. For example, if your LDL level is high but other factors -- family history, lifestyle, blood pressure, age, general health, weight, and diabetic or smoking status -- give no cause for concern, you may not need medication to lower your cholesterol. Your risk of heart attack and stroke is probably acceptably low. On the other hand, if you have high blood pressure and a family history of heart disease, it may make sense to treat even a moderately elevated cholesterol level aggressively. The "Heart disease risk calculator" at can be helpful in making such determinations. Diabetics are at very high risk, and generally should be treated, even if their cholesterol levels are normal.

Because managing your cardiovascular risk is complex, taking medications or supplements on your own is inadvisable. Please be sure to consult your doctor to determine your best options.

-- Sharonne N. Hayes, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.