Excessive cholesterol accumulation in our blood however, does cause degeneration of our blood vessels which results in heart attacks and strokes.  Thus, lowering the blood cholesterol is the goal of treatment.  It is now been well shown that when high blood cholesterols are lowered into the normal range, there is a dramatic decrease in the rate of heart attack and stroke.

     While some things in medicine are very complex, this problem reduces to a very simple consideration.  If one is going to lower the blood cholesterol concentration, the person either has to make less cholesterol or get rid of more of it faster.  For most people with high blood cholesterols, the basic problem is that they don't get rid of it fast enough.  One strategy on how to lower blood cholesterol would be to help the body rid itself of cholesterol faster.

    A long time ago, research had already shown that cholesterol is an essential part of our digestive process.  Every day the liver secretes about 2 grams of cholesterol into the intestine to mix with food and help the digestive process.  All of this cholesterol goes through the intestine and then is reabsorbed back into the body at the end of the small bowel.  If there was some way to block this reabsorption in the end of the small bowel, then the person would excrete extra cholesterol in the stools and maybe the blood cholesterol would come down.  This strategy resulted in the development of two products called Questran and Colestid.  These are little granules like sand that grab onto cholesterol in the small bowel and prevent the reabsorption.  Thus, the person passes the Colestid and Questran in their stool with a lot of cholesterol attached to it and the blood cholesterol levels come down because the body is getting rid of cholesterol faster.  This is perhaps the first effective treatment for high blood cholesterols.  Today, the cost of this, is around $2.50 per day and it is kind of a nuisance in that the person has to drink a glass of sandy fluid each day to make this work.  Somehow this method has never really been widely used.

     The second way to lower the blood cholesterol would be to block the liver from making it.  Every day the liver makes about 1200 mg of cholesterol.  If there was some way to cut down the rate at which the liver makes cholesterol, the blood level might drop.  This strategy resulted in the development of the "statin" family of drugs which includes Mevacor, Pravachol, Lescol,  Zocor, and Lipitor.   These drugs are the backbone of anti-cholesterolemic treatment today.  They can cut the rate of cholesterol production more than in half and drop the blood cholesterol very substantially.  The side effect profile for these medications is relatively safe.  A few people develop liver function abnormalities and a few people develop muscle aches with these drugs and don't like to use them for those reasons.  Also, they are somewhat expensive at about $2.00 per day.

     A third way to lower the blood cholesterol is to modify the diet.  On the average, as person takes in about 300 mg of cholesterol daily in their diet.  Note that humans make 1200 mg in their liver daily.  When diet gets to 200 mg of cholesterol or less, it is like eating cardboard.  A low cholesterol diet is very unpalatable and as anyone who has every tried it knows, low cholesterol diets just don't work.  There are a few vegetarians whose diets are naturally low in cholesterol but if a person eats any significant amount of meat or fatty foods, cholesterol intake goes up rather rapidly.

     Thus, the search for better ways to control the blood cholesterol is continuing.  The Merck pharmaceutical company has recently released a new product called Zetia (ezetimide).  This is a pill taken at 10 mg per day that blocks the uptake of cholesterol in the small bowel using the same strategy as Questran and Colestid above.  The difference is that Zetia is a small pill taken each day instead of a glass of sandy juice and the side effect profile is not different than that of a sugar pill.  Unfortunately, the cost is around $55.00 per month, about the same as the "statin" drugs.  At this time, it is recommended that Zetia be used in combination with one of the "statin" drugs for individuals whose cholesterols are unusually resistant to treatment.  However, it is also useful as a trial for those individuals who find the "statin" drugs having too many side effects.  For those individuals, who feel that the "statin" drugs cause muscle aches, Zetia would be worth a try to see if it would control the person's cholesterol.

     The first step in controlling blood cholesterols is to have a blood cholesterol measurement.  This can be done through your local clinics, or at health fairs.  It is strongly recommended that a person have a cholesterol measurement at age 30 and again at age 40 so that treatment of the condition can be instituted before damage has already occurred.  Know that heart attacks become much more common when people are older than 50 years of age but they occur because damage has been occurring for the previous 20 years due to the high blood cholesterol then.  Addressing the problem at an early time, prevents the degeneration of the blood vessels.