The number one goal is to get LDLs down to a level that will let the lipids in your tendons “mobilize” and be dispersed through normal metabolic pathways.

What is a level that will allow lipid mobilization? Very aggressive lowering may be needed. The July 2004 NCEP (National Cholesterol Education Program) guidelines suggest an LDL goal of less than 70 mg/dL for very high risk patients. A target of 50mg/dl may even be appropriate to facilitate recovery from xanthomatosis (widespread xanthomas).

Reducing your LDLs can accomplished with drug therapy and by replacing “bad” fats with “good” fats in your diet. Certain supplements have also proven to be beneficial in lowering LDLs.

First, diet. Dietary cholesterol is not the great evil in your diet, saturated fats are. Saturated fats disrupt your liver’s ability to break down excess cholesterol, and cause it to generate more LDLs. Learning the difference between all the different kinds of fats and avoiding the bad ones is a big step (7).

Cholesterol generated (synthesized) by your liver is called “biliary cholesterol”, and is responsible for the majority of cholesterol that ends up in your blood. Each day the liver contributes about 75% of your cholesterol compared with about 25% from the diet, so even if dietary cholesterol intake were halved, it would only marginally decrease the amount of cholesterol that could potentially be absorbed by the small intestine. Blocking cholesterol absorption in the small intestine does have great value, however, since it is a pathway for both biliary and dietary cholesterol.

Plant sterols (phytosterols) can have such a blocking effect. Phytosterols make it harder for your body to absorb cholesterol from the small intestine and increase excretion of both and dietary and biliary cholesterol. Phytosterols are available as a supplement and as the primary ingredient in regular and ‘light’ spreads fortified with plant stanol ester. Flaxseed and flaxseed oil are also currently being investigated for possible heart health benefits.

Several types of medicines are used to lower high LDL cholesterol levels.

The miracle drugs of LDL reduction are the HMG-CoA Reductase Inhibitors (Statins). Statins are amazingly effective in lowering cholesterol, especially LDLs. Statins work by slowing cholesterol production in the liver and thus increasing the liver’s ability to remove the LDL-cholesterol already in the blood. All stains are very effective, but if you have to pay for them yourself, generic Lovastatin is currently the most economical alternative. Consumer reports has done an analysis of the cost and effectiveness of statins on their new web site: http://www.CRBestBuyDrugs.org

A new category of lipid lowering drug was created by Zetia (ezetimibe), which has a blocking action instead of limiting cholesterol synthesis. Vytorin is a combination of ezetimibe and simvastatin (Zocor). The statin/ezetimibe combination may be the most effective drug therapy to facilitate recovery from Tendon Xanthoma.

Increasing the dose of statins has a limited effect on reducing LDL-C. It is well established that doubling the dose of a statins only provides a 7 % reduction in LDL-C. By comparison, 80mg of Lovastatin is predicted to reduce LDL from the baseline by about 38%, about the same as Lipitor 10mg. The addition of Zetia 10mg to Lipitor 10mg is predicted to reduce LDL-C by 52% in contrast to the 38% reduction that resulted from doubling the statin dose.

Other cholesterol medicines are less effective or have worse side effects than statins, so unless you can’t tolerate or afford statins, they are the way to go.

A note about long term use of statins... if you experience muscle pain that doesn’t go away, try taking 150-200mg capsules of CoEnzyme Q10 daily.  For me, it is an absolute necessity.

Next: Treating the Symptoms

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