In the case of patients who maintain dangerously high cholesterol levels despite their best efforts with respect to diet, weight control, and exercise, physicians can prescribe cholesterol-lowering drugs. The statins are the most popular of these drugs becuase of their powerful results in lowering cholesterol levels. Studies have demonstrated the ability of these medications to change patient profiles from high risk to normal risk, and to decrease the frequency of strokes and heart attacks. For a number of years, millions of patients worldwide have used statins, establishing their overall safety. It seems likely that statins will soon be available as over-the-counter medications in the U.S. due to their impact on coronary artery disease (CAD) and to evidence that these drugs are not being fully deployed. However, physicians should monitor patients taking statins to ensure that the medications are not creating side effects while achieving their target goals. Ideally, patients who follow a healthful diet and exercise program should be able to decrease their need for medical therapies over time, in some instances completely eliminating their use.

	Some forms of heart disease can be managed using medical therapies.

The value of aspirin as a preventive therapy for coronary and carotid artery disease and stroke has been reasonably well documented in men. Less evidence exists regarding its impact on women. Even when taken in baby doses, aspirin may slightly increase the risk of stroke from bleeding in the brain or stomach, due to the medication's effect on platelet (clotting) function. When patients are selected carefully and counseled properly about the risks involved, aspirin can provide positive changes with a very good risk-benefit ratio. At present it is generally prescribed at 81 mg daily for men over ages 30–45 and women who are over 60 years old or post menopausal.

Alternative therapies such as vitamins and herbal remedies to treat coronary disease are growing in popularity. Patients have been turning to antioxidants, such as vitamins C and E, in the hope of improving their heart disease. Based on recent research trials, it remains unclear whether these antioxidants provide any benefit; we need to collect more solid data about their potential value. While physicians still don't know a great deal about the possible influence of most alternative therapies on cardiac health, we do know that they can potentially interact with other medications.

Patients need to be forthcoming in reporting their use of alternative or supplemental remedies. For example, gingko biloba has recently become popular for improving memory. When used in conjunction with aspirin, however, the herb may create an increased risk of brain hemorrhages. Grapefruit has a documented interference with the absorption of atorvastatin (brand name Lipitor), an important statin for controlling cholesterol. Antioxidant supplements may similarly reduce statin efficacy. Patients sometimes conceal their use of nontraditional therapies from their physicians, fearing they will be perceived as not interested in conventional therapies or that they will be criticized for self-treating. Given the real potential for adverse interactions, it is extremely important that an open dialogue exist between doctor and patient.