I haven't been here for a while, so bear with me if I repeat something that's already shown up in the forum.
I have genetically high cholesterol, and have been on mega doses of Lipitor (80 mg) and Niaspan (2000 mg) for over fifteen years (since bypass surgery to deal with forty years of accumulated crap in my arteries). While I have some control over levels of serum cholesterol, some of it has to be addressed by drugs, and I've done fine over the years. After my AVR last spring, I ended up on lower doses of one BP drug and eliminated another, but the statin and niacin will be part of my life forever.
Diet is one of those factors that causes some folks to jump up and down on one side of the low carb/low fat line or another. The best advice I've ever gotten, however, was to follow the ancient Greek notion of "nothing to excess." Simply eat healthfully, without completely eliminating one particular group of foods (except for allergic reactions), and get plenty of exercise. Eat healthful fats (Omega 3s especially), complex carbohydrates, and cook for nutrition density. Eat desserts and high-fat/salt dairy foods sparingly, and do indeed avoid anything that comes in a box. Become a religious about reading labels: the fewer, the better. Look for extra salt and sugars, and try to cook from scratch (learn to if you don't already know how--it's a great way to attract friends) to avoid unnecessary additives.
One factor that doesn't come under the diet rubric is stress, which can cause LDL to rise. That's why exercise is so important in so many ways--it not only burns calories and aids BP, but it helps to reduce stress as well.
If we incorporate good oils, good carbs, lots of greens, nuts, berries, seeds, vegetables and associated fibers into our diets--and moderate amounts of meat (including the occasional bit of lean cow, pig, sheep, goat, buffalo, etc.) we don't have to look too far for things that will raise HDL and lower LDL. Supplements sometimes help, but only if you're not already eating well in the first place. At the moment I'm taking fish oil, calcium/vit. D, a multivitamin, and CoQ10, but nothing else except the various heart meds. Good company, worthwhile exercise, nutritionally sound food, and enough sleep are all means by which we can feel better.
Zetia, by the way, doesn't have the side-effect potential of statins, but that's because it's a different type of drug (it goes after the dietary cholesterol, rather than cholesterol in the blood). It's also somewhat controversial at the moment because at least one study indicates that it doesn't help reduce heart attacks. It's a component of Vytorin (a combo with a statin). The downside is that it's a proprietary drug not always covered by insurance formularies, or can require a sizable co-pay. It seems to have made no difference in my levels, and I'll probably go off it after my next doc visit.
I'm not sure any of this is helpful, Rick, but I would check into the stress quotient. You might also look into the role HDL is playing in your profile. The ratio is important (if your HDL is really high, it can help to ameliorate the effects of LDL), and so is the level of triglycerides. I'd ask the doc to recommend a visit to a dietitian, who can help you take a close look at what you might be able to do food-wise after you have all the numbers together.
