Paying close attention to what you eat and how much physical activity you get are ways to lower your high blood cholesterol. These steps are generally the first line of therapy for anyone with high cholesterol. But because you have diabetes, your risk of heart disease and stroke is much higher than for someone without diabetes. That's why your healthcare provider will encourage you to eat a healthy diet and do regular physical activity to help reach optimal values. Taking a cholesterol-lowering medication can help bring those levels to goal. Learn more about each category and the benefits, side effects and risks.

Current goal recommendations are:

• LDL — less than 100 mg/dL (an option of < 70 mg/dL in very high-risk patients)
• HDL — greater than 40 mg/dL for men and greater than 50 mg/dL for women
• triglycerides — less than 150 mg/dL

No medication should be discontinued or changed without first consulting a physician. Treatment using cholesterol-lowering medications is generally long-term. Continuing the therapy is important even when you reach a healthy cholesterol level.

Types of cholesterol medications
*Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking; however, the AHA is not recommending or endorsing any specific products.  If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information.  It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.  Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

Statins
Fibrates
Resins
Nicotinic Acid


Statins
For people with diabetes, lowering LDL (bad) cholesterol is usually the first priority. Several studies indicate that lowering LDL has significant benefits, including lowering the risk for cardiovascular disease. Statins are one of the most effective drugs for reducing elevated LDL cholesterol.

Most of statins' side effects are mild and generally go away as your body adjusts. Muscle problems and liver abnormalities are rare. If you have brown urine or muscle aches and pains, contact your doctor right away.

Side Effects:

• Upset stomach
• Abdominal pain
• Gas
• Cramps
• Constipation
• Muscle soreness, pain and weakness
• Liver abnormalities

Commonly prescribed statins include:

• Atorvastatin (Lipitor)*
• Fluvastatin (Lescol)*
• Lovastatin (Mevacor)*
• Pravastatin (Pravachol)*
• Rosuvastatin Calcium (Crestor)*
• Simvastatin (Zocor)*

Fibrates
Fibrates are best at lowering triglycerides and in some cases increasing HDL (good cholesterol) levels. These drugs are not very effective in lowering LDL (bad) cholesterol. That's why fibrates are generally used in people whose triglycerides are high or whose HDL is low, after reaching LDL goal.

For people with diabetes, it's still questionable whether increasing HDL cholesterol with fibrates in the presence of low LDL levels (lower than 3.4 mmol/L, or 130 mg/dL) will be more beneficial than statin therapy alone. Studies are ongoing.

Side Effects:

• Upset stomach or diarrhea
• Increased risk of gallstones
• Increased effect of blood-thinning medications
• Anemia

Some commonly prescribed fibrates include:

• Bezabifrate (Bezalip)*
• Fenofibrate (Lofibra, Tricor)*
• Gemfibrozil (Lopid)*

Resins
Resins are also called bile acid-binding drugs. Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so it can't be used during digestion. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. That means less cholesterol is left to circulate through your bloodstream.

The effect of bile acid sequestrants is to lower LDL cholesterol by 10 to 20 percent. Sometimes these drugs are prescribed in combination with statins. When combined, they can lower LDL-cholesterol by over 40 percent.

Side effects:

• Constipation
• Stomach irritation or diarrhea
• Gas/Bloating/Heartburn
• Dizziness

Some commonly prescribed medications include:

• Cholestyramine (Questran, Prevalite, L-Cholest)*
• Colestipol (Cholestid)*
• Colesevalam (Welchol)*

Niacin (nicotinic acid)
This drug works in the liver by affecting the production of blood fats. Niacin is prescribed to lower triglycerides and LDL cholesterol and raise HDL ("good") cholesterol.

Niacin side effects may include flushing, itching and stomach upset. Your liver functions may be closely monitored, as niacin can cause toxicity. Nonprescription immediate release forms of niacin usually have the most side effects, especially at higher doses. Niacin is used cautiously in diabetic patients as it can raise blood sugar levels.

Niacin comes in prescription form and as “dietary supplements.” Dietary supplement niacin must not be used as a substitute for prescription niacin. It should not be used for lowering cholesterol because of potential serious side effects. Dietary supplement niacin is not regulated by the U.S. Food and Drug Administration (FDA) the same way that prescription niacin is. It may contain widely variable amounts of niacin — from none to much more than the label states. The amount of niacin may even vary from lot to lot of the same brand. Consult your doctor before starting any niacin therapy.

This content is reviewed regularly. Last updated 04/10/09.