SEPTEMBER 6, 1999 VOL. 154 NO. 9

d r u g s
When Diet Isn't Enough
By ALICE PARK

Changing your diet can only go so far in cutting cholesterol levels. And because of their genetic makeup, that's not far enough for millions. Happily, there are all sorts of cholesterol-lowering nostrums available to help make up the difference, from well-tested prescription drugs to newer (and largely untested) alternative medicines. A brief guide:

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Statins: When combined with a low-fat diet, these cholesterol-lowering drugs can cut the risk of death from heart disease 40%. Statins interfere with the liver's ability to make cholesterol, keeping LDL (bad) levels to a minimum while boosting levels of HDL (the good stuff).

Nicotinic acid: In large doses, this B vitamin cuts LDL 30%, triglyceride levels as much as 55% and increases HDL 35%. The dosage that's needed, however, is up to 70 times the recommended daily allowance, and it comes at a price. Many patients experience flushing, itching and panic attacks. Adjusting the dose, taking an aspirin 30 min. beforehand, or taking the medication on a full stomach alleviates some of the symptoms.

Arginine: This amino acid is gaining popularity as a nonprescription treatment for high cholesterol. Animal studies and preliminary studies in humans suggest that arginine may improve coronary blood flow and lower cholesterol levels by acting as an antioxidant and helping keep blood-vessel tissue elastic. Doctors have yet to show, however, that arginine can actually prevent heart disease.

Coenzyme Q10: A powerful antioxidant, this natural compound has been studied as a treatment for heart failure--with mixed results. Many Japanese and European practitioners prescribe coenzyme Q10 to keep arterial plaque at bay, but rigorous studies with a lot more patients are needed before U.S. doctors will be comfortable with it.