Given that several close members of your family died at a young age of heart disease and you have a very high cholesterol level, it's likely you have an inherited condition where there are high levels of fat in the blood, known as a familial hyperlipidaemia (fats are also known as lipids). Without treatment to lower the levels of fats or lipids in the blood, you too will be at high risk of atherosclerosis (hardening of the arteries) and heart disease, and an early death.
Because you have an inherited problem, you'll have to monitor your lipid levels for the rest of your life. Although you may not always have to take lipid-lowering drugs, it's a strong possibility.
Some people manage to control fat levels by cutting down on fat in their diet, but this isn't usually enough when you have an inherited hyperlipidaemia. The basic problem isn't just that you're eating too much fat - it's in the way that your body controls fat levels and makes fat in the liver.
So diet isn't the only answer, as you may have to tackle other risk factors for heart disease such as being overweight or smoking.
How lipid-lowering drugs work
There are several different types of fat in the blood, the most important being cholesterol and triglycerides. The type of drugs you're given will depend on which fats are at a raised level, but there are two main varieties:
Drugs that act on fat production in the liver: these alter the way in which the liver makes fats, and can lower cholesterol and triglyceride levels. There are two main drug types - fibrates and statins.
Statins are the most potent cholesterol-lowering drugs, and are the most widely used treatment to tackle a high cholesterol level. Research has shown their positive effect in reducing the risk of heart disease and stroke, but they're less effective than fibrates in reducing triglyceride levels. Although statins work by stopping the body from making cholesterol, they also seem to reduce the risk of heart disease in other ways, such as keeping the lining of the blood vessels healthy and preventing the formation of blood clots.
Drugs that act on bile salts: some drugs reduce cholesterol levels by acting on bile salts. Bile is a liquid produced by the liver and released into the intestines to aid digestion. It's rich in cholesterol, which is reabsorbed into the body once it's done its job in the intestines. These drugs prevent the cholesterol from being reabsorbed, leading to it being lost from the body through the gut.
Side-effects may be a problem
Side-effects from these drugs are quite common, although usually minor. Increasing the amount of cholesterol lost through the gut, for example, can cause nausea, constipation and diarrhoea. There may also be some disruption of vitamin absorption and you might need supplements.
Statins can cause nausea, constipation and diarrhoea. They may also cause two less common but potentially serious side-effects - raised levels of liver enzymes (which may only get better if the drug is stopped) and damage to the muscles (which may result in muscle aches and pains, and, in severe cases, breakdown of the muscle cells). Fibrate drugs can increase the risk of gallstones developing.
Side-effects may be worst at the start of treatment and settle with time. Newer drugs (especially statins) may have fewer side-effects, so tend to be used in preference to other types of cholesterol-lowering drugs.
Always talk to your GP about any worries you may have about your medication, and never stop taking it without telling them. It may be possible to try different medicines until you find the one that suits you best.
This article was last medically reviewed by Dr Trisha Macnair in April 2008
