More than 100 million Americans have high cholesterol (above 200 mg/dL), which can clog arteries and cause heart attacks and strokes.

 The good news is that there are a variety of time-tested strategies you can use to lower your cholesterol and decrease your risk for heart problems.

 Some are better than others, some are easier, and some are cheaper. Here's a rundown of what's good and what's bad about cholesterol-lowering approaches.

Statins

Pros: Statins include drugs such as Lipitor, Zocor, and Crestor (all the generic names end in statin), and they can lower LDL, or “bad,” cholesterol by more than 50%. "Across the board, they are clearly a wonder drug," says Thomas Pearson, MD, PhD, the Albert D. Kaiser professor of preventive medicine at the University of Rochester Medical Center, in Rochester, N.Y.

 Cons: Side effects can be serious, including muscle inflammation and increased liver enzymes. Cost is also an issue, although several statins are available in generic form, including Lipitor, which became available as a generic at the end of 2011.

Niacin

Pros: Niacin is a B vitamin that lowers both LDL cholesterol and triglycerides, fats that can be harmful at high levels. It also raises HDL, or "good," cholesterol. "It's a powerful drug," Dr. Pearson says. It comes in tablets to be taken two or three times a day, or in an extended-release formula, which needs to be taken only once a day.

 Cons: Niacin should be administered only under the care of a physician because doses high enough to affect cholesterol can increase the risk of gout and liver problems, Dr. Pearson says. People with type 2 diabetes also need to be careful, as it can raise blood sugar. Read more about niacin.

Dietary fiber

Pros: Dietary fiber—found in beans, fruits, and other foods—binds to cholesterol, lowering LDL levels by about 5%, Dr. Pearson says. "It fills you up and often doesn't have a lot of empty calories in it," he adds. "It could be called a modest addition to the therapeutic regimen." It's also cheap and easy, available at grocery stores.

 Cons: Despite its availability, Americans seem to have a hard time getting enough fiber. Experts recommend 25 to 35 grams a day, yet most adults get only about 12 grams.

Exercise

Pros: Exercise is a great way to raise HDL. People who have had a heart attack can reduce their death risk by 25% with exercise compared with usual care, Dr. Pearson says. "Physical activity is an amazingly important behavior," he says. "You could argue that it's an absolutely essential part of either community or therapeutic regimens."

 Cons: Exercise requires more effort than popping a pill, and communities often aren't set up to make it easier. "There's no place to walk; it's unsafe; you may get run over; there are crime issues," Dr. Pearson says. "We need to engineer our environments better."

Red yeast rice

Pros: This dietary supplement is derived from a fungus that grows in rice and contains small amounts of lovastatin (Mevacor). It can be effective in people who can't take statins, says Jacob Warman, MD, chief of endocrinology at the Brooklyn Hospital Center, in New York City. Although different people see different benefits, he says, "it always works to some extent."

 Cons: Dietary supplements aren't tightly regulated in the United States the way drugs are, so there can be confusion about concentrations and proper dosages. A 2008 study found a 100-fold difference between the highest and lowest levels of monacolin among various supplement brands tested.

Bile acid sequestrants

Pros: Drugs such as Questran (cholestyramine), Welchol (colesevelam), and Colestid (colestipol) trick the body into producing extra bile, which lowers LDL cholesterol by about 15% to 20%, Dr. Pearson says.

 Cons: You have to take a lot of them to get a measurable effect, Dr. Warman says. Side effects can include constipation, stomach pain, and nausea. They can bind to other drugs, such as corticosteroids and some blood-pressure drugs, making them less effective unless you take the drugs three hours apart, Dr. Pearson says. 

Low-fat diet

Pros: Choosing healthy food such as fish and veggies over red meat and french fries is relatively straightforward, and Dr. Warman estimates it could lower cholesterol by up to 20% in some people. Societies with low-fat diets, such as Japan and parts of the Caribbean, have lower levels of heart attack and stroke.

 Cons: Much like exercise, it can be hard to eat a healthy diet consistently. Some people have to go all out—adopting a vegan diet free of animal products, for example—before they see any difference, Dr. Warman says. Diet changes may not be enough to trump genetics, so don't hesitate to switch strategies if your cholesterol won't budge.

Lovaza

Pros: Eating fish is good for the heart. This prescription drug delivers omega-3 fatty acids—the healthy fats found in fish and fish oil—in a concentrated dose. It can help lower triglycerides in people with very high levels.

 Cons: Side effects can include burping, infection, flulike symptoms, upset stomach, and change in sense of taste. Be sure to talk with your doctor before taking Lovaza if you have fish allergies or are pregnant, planning to become pregnant, or breastfeeding.

 Fibrates

Pros: These drugs include fenofibrate (Tricor and other brand names) and gemfibrozil (Lopid). They can lower triglycerides by 25% to 50% and raise HDL by 10% to 35%.

 Cons: These drugs don’t do much in terms of lowering LDL, although newer fibrates are generally better at this than Lopid. Side effects can include headache, gas, and upset stomach. 

Zetia (ezetimibe)

Pros: This medication can prevent the absorption of cholesterol in the intestines. "There's very little downside and it's very well tolerated," Dr. Warman says. It can result in about a 20% reduction in cholesterol, and it can be taken in combination with statins, which isn't true for all drugs.

 Cons: Zetia isn't as powerful as a statin, and it isn't available in a generic form.