These include:

• Nicotinic acid (niacin)-This lowers total and LDL cholesterol and raises HDL cholesterol. It also can lower triglycerides. Because the dose needed for treatment is about 100 times more than the Recommended Daily Allowance for niacin and thus can potentially be toxic, the drug must be taken under a doctor's care.
• Resins--Doctors have been prescribing Questran (cholestyramine) and Colestid (colestipol) for about 20 years. These "resins" bind bile acids in the intestine and prevent their recycling through the liver. Because the liver needs cholesterol to make bile, it increases its uptake of cholesterol from the blood.
• Fibric acid derivatives--Used mainly to lower triglycerides, Lopid (gemfibrozil) and Tricor (fenofibrate) can also increase HDL levels.
• Aspirin--Because studies have shown that aspirin can have a protective effect against heart attacks in patients with clogged blood vessels, doctors often prescribe the drug to patients with heart disease.

The decision of which drug to prescribe is one the doctor makes based on factors such as degree of cholesterol lowering desired, side effects, and cost. "If a patient has only a modest cholesterol elevation, I might prescribe Mevacor," says Johns Hopkins' Miller. "But if a more drastic reduction is needed, especially of LDL, I'll prescribe Lipitor."

The potential for drug interaction is a crucial concern, says FDA's Orloff. "Some statin drugs are known to interact adversely with other drugs, and that information may guide a decision about which statin to use." In June 1998, FDA announced the withdrawal of the drug Posicor (mibefradil), used to treat high blood pressure and stable angina, because it caused adverse reactions in patients taking various other drugs, including Mevacor and Zocor.

Though it is impossible to know yet just how many lives cholesterol-lowering therapies have saved, public health experts say awareness efforts such as the National Cholesterol Education Program are getting the word out to Americans about heart disease, its prevention and management. Reflecting on his own experience with elevated cholesterol, Hoffmann says, "Get informed [about cholesterol]. Read books, search the Internet, look at your risk factors, and, most of all, don't wait to do something about it if you have a [cholesterol] problem."