The general feeling among doctors is that people with angina should take their own action, such as eating healthily, stopping smoking, and exercising regularly, to lower their blood cholesterol levels, and that very few actually need drugs to do the job for them.
This is not because the drugs do not work. They do, very successfully, lower blood lipid (fat) levels. However, there is little proof that they actually benefit patients, because the trials of lipid-lowering drugs have had equivocal results. Due to this, there are guidelines for doctors about prescribing such drugs for people with higher than normal levels of cholesterol and other related lipids in the blood.
Cholesterol-lowering drugs should not be considered until other risk factors for atherosclerosis have been controlled or eliminated. They list the most important of them as being smoking, alcohol consumption, obesity, diabetes, hypertension, and physical inactivity.
Those with cholesterol levels above 250 mg/dl but below 300 mg/dl should be given a thorough diet overhaul. If they do not respond with a good reduction in cholesterol, especially if they have other risk factors such as hypertension and a previous heart attack, then drug treatment should be considered.
For those with cholesterol levels above 300 mg/dl, diet is still essential, but the majority will need drugs. Most people with this level of blood cholesterol have inherited their condition (familial hypercholesterolemia); they may need two drugs with different actions to lower their levels satisfactorily.
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