LDL cholesterol is the primary target of therapy to lower cardiovascular risk. Statins are medications of first choice to lower LDL cholesterol, but cannot be tolerated in up to 10% of individuals. Intermittent dosing strategies for statins can help reduce muscle symptoms in some patients. A Mediterranean-type diet supplemented with plant stanols and sterols, fiber and fish oils can help achieve cholesterol goals and reduce cardiovascular events. Caution may be needed when using supplements, such as red yeast rice, because of the concern regarding contaminants. Other lipid-lowering medications, such as intestinal agents, niacin and fibrates, can be used as alternative strategies in patients who cannot tolerate statins or in combination with low-dose statins to achieve lipid goals and reduce cardiovascular risk.
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