High Cholesterol

Medically reviewed by Carina Fung, PharmD, BCPPS

High cholesterol treatment

Appropriate treatment for high cholesterol takes into account not just relevant risk factors but likelihood and history of cardiovascular events as well as the specifics of an individual’s lipid profile.

First line therapy is usually lifestyle and/or dietary changes that may prevent high cholesterol or manage it, depending on the severity. After a period of 6 months or more, your provider may typically recommend getting tests done again to see if cholesterol levels are lower. If they are still high, a medication regimen may be started.

The most commonly used medications11 to treat high cholesterol are statins. They simultaneously slow the liver’s production of LDL cholesterol while speeding up the liver’s processing and clearing of LDL cholesterol, thus lowering your overall LDL-C anywhere from 22–50%. These drugs include atorvastatin (Lipitor), Fluvastatin (Lescol), lovastatin (Altroprev), pitavastatin (Livalo), pravastatin (Prevachol), rosuvastatin (Crestor), and simvastatin (Zocor).

There are also non-statin medications available for high cholesterol treatment, although they are less commonly used. Bile acid sequestrants bind to LDL cholesterol in the blood and then flush them out, which can reduce LDL-C.

Nicotinic acid—also known as niacin—is a type of B vitamin that notably can affect not just “bad” cholesterol but potentially improve cholesterol levels: LDL, HDL, and triglyceride levels. There is also a newer variety of injectable medication called PCSK9 inhibitors, which is primarily used to treat familial hypercholesterolemia.

While some of these non-statin medication options are sometimes utilized in conjunction with statins to further suppress LDL-C, statins are by far the most prevalent pharmaceutical methodology for high cholesterol treatment.

Statins are not without potential side effects. The U.S. Food & Drug Administration has reported12 that patients taking statins are at a slightly increased risk of Type 2 diabetes.

But for those whose cholesterol levels require statins, according to James P. Smith, M.D., M.S., deputy director of the Division of Metabolism and Endocrinology at the FDA, “the benefits of statins in reducing heart attacks and strokes should generally outweigh this small increased risk.”

There have also been reports13 of cognitive impairment (e.g., memory loss, forgetfulness), liver injury and, when mixed with certain other medications, muscle myopathy. But the FDA considers these to be rare.

Who needs cholesterol treatment medication?

While healthier lifestyle habits can put a dent in cholesterol levels, for some medication is required to treat high cholesterol and mitigate its harmful effects. Typically, the higher the risk for atherosclerotic cardiovascular disease14, the more necessary medication becomes — usually statins.

Calculating this risk depends on multiple factors. Healthcare providers are very likely to prescribe medication to someone who has already suffered a cardiovascular event like a heart attack or other types of conditions, such as a stroke.

Other times, whether you are prescribed medication will depend on a combination of your cholesterol levels and other commingling factors. For example, your provider may prescribe medication if you have an LDL-C of 190 mg/dL or more, or if you have an LDL-C of 70 mg/dL and have diabetes.

The likelihood of prescribing a statin increases with patient age. Younger patients, especially children, are more likely to be instructed to pursue healthier lifestyle habits, although in some rarely severe cases of familial hypercholesterolemia even children can be started on statin therapy.

It’s important to discuss your individual risk factors and medical history with your healthcare provider to determine which medication, if any, is right for you. If prescribed medication for high cholesterol treatment, listen carefully to your provider’s instructions, and ask questions is there’s anything you don’t understand. Do not stop taking any prescribed medication without consulting your provider first.

May be prescribed

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How to lower cholesterol

Besides medication, there are other ways to lower cholesterol. In addition to avoiding foods that exacerbate cholesterol levels, there are several types of foods that can improve your lipid profile.

Lower dietary cholesterol intake

Avoid red meat, and opt for leaner meats with less cholesterol and saturated fat instead. Or better yet, as the Mayo Clinic suggests15, go for fish that are high in omega-3 fatty acids.

While omega-3-rich foods like certain fish don’t directly affect LDL cholesterol, they do reduce triglycerides, blood pressure and risk of blood clot, which helps to mitigate the negative impact high cholesterol has on the body.

Foods like walnuts, flaxseed and canola oil also contain omega-3 fatty acids. You can also take omega-3 supplements, but as with any supplement you should consult your healthcare provider first.

You may consider replacing foods with high saturated fat content with options that feature healthier fats like monounsaturated fatty acids. Take avocado, for example. It’s not just a heart-healthy food, but one that has been shown to lower LDL cholesterol if you eat one a day. With a little creativity, you can replace saturated-fat heavy condiments like mayonnaise and butter with mashed avocado.

Following this pattern (replacing foods high in cholesterol and saturated fats with ones that actually combat high cholesterol) can give dietary changes an outsized effect on your efforts to lower your overall cholesterol.

Other dietary options for reducing LDL cholesterol include foods high in soluble fiber— from beans and Brussels sprouts to fruit and oatmeal—as well as whey protein and plant sterols, which have been added to some orange juices as a way to make them heart-healthier.

And while you’re ditching foods that go too heavy on cholesterol, saturated fat, and trans fat, skip or significantly reduce foods that contribute to conditions that increase risks associated with high cholesterol. These include salt (hypertension), added sugar (diabetes and obesity), and alcohol (increased cholesterol and triglycerides in blood).

Exercise helps with good cholesterol

While there are plenty of options for shrinking bad cholesterol, there are fewer for boosting the good kind. But regular physical activity does just that.

The recommended weekly amount of exercise of 150 minutes a week (just over 20 minutes a day) will not only up your HDL, but will actually increase the size of LDL particles in your body.

Exercise also helps ward off some of those other compounding risk factors for high cholesterol (obesity, diabetes, hypertension, etc.) while helping you maintain a healthy weight, one of the best ways to prevent hypercholesterolemia.

High cholesterol medication

All of these drugs are statins, the shorthand term for HMG-CoA reductase inhibitors. They reduce cholesterol in the bloodstream by blocking the liver enzyme needed to produce cholesterol, thus lowering LDL-C.

Disclaimer: The information on this site is generalized and is not medical advice. It is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. Always seek the advice of your healthcare professional with any questions you may have regarding a medical condition. Never disregard seeking advice or delay in seeking treatment because of something you have read on our site. RxSaver makes no warranty as to the accuracy, reliability or completeness of this information.

If you are in crisis or you think you may have a medical emergency, call your doctor or 911 immediately.