Treatment for High Cholesterol
High or abnormal cholesterol numbers can be treated by both lifestyle changes and medication.
Without treatment, high cholesterol increases your risk of severe cardiovascular disease, including heart attack and stroke.
Since high cholesterol has no symptoms, people typically find out they have high cholesterol after receiving a blood test at the doctor’s office known as a lipid panel.
If your lipid panel results show you have high total cholesterol, high LDL cholesterol, or low HDL cholesterol, your doctor may initially recommend that you make some lifestyle changes to get your cholesterol numbers back on track.
If these changes don’t result in more desirable cholesterol numbers within a few months, you may need to take medication to lower your cholesterol. For people who have already developed heart disease or who have diabetes or familial hypercholesterolemia (FH), your doctor may initially prescribe cholesterol management drugs.
Fortunately, there are plenty of lifestyle changes that can help prevent high cholesterol and lower it when it's elevated, without the need for regular medication.
RELATED: 5 Diets That Can Help Lower Cholesterol
To find a heart-healthy diet that works for you, a consultation with a registered dietitian or nurse specializing in nutrition might be helpful. Ask your doctor about a referral if you think you could benefit from professional guidance.
If you’re new to a regular exercise routine, low-impact aerobic exercise is a good way to get started. Always talk to your doctor about any long-term lifestyle changes, including increased physical activity.
Quit smoking tobacco to improve your high cholesterol. Tobacco use tends to lower HDL levels, and can damage your blood vessels, making it easier for excess cholesterol to form plaques and contribute to heart disease. It also compounds other heart disease risk factors, like high blood pressure.
Although body mass index (BMI) is not a perfect indicator of health, having a BMI in the overweight or obese range tends to be associated with elevated LDL cholesterol and lower HDL cholesterol. According to the AHA, losing as little as 5 to 10 percent of your body weight, if you’re considered overweight, can help lower your cholesterol numbers.
A waist measurement of 40 inches or more for men and 35 inches or more for women generally puts you at greater risk of high cholesterol.
If lifestyle changes alone don’t bring your cholesterol levels into the desired range, your doctor may prescribe one or more medications to lower your cholesterol. These drugs fall into a few different categories.
Most patients with high cholesterol will be prescribed statins. Statins are a class of drugs that prevent cholesterol from forming in the liver, where it is made. This then lowers the amount of cholesterol circulating in the blood. They are most effective at lowering LDL cholesterol, but can also lower triglycerides and increase HDL cholesterol.
The most common side effects of statins include:
But statin use may increase hemoglobin A1C in people who are pregnant or have diabetes, and those with certain types of liver disease should not take statins. Commonly prescribed statins in the United States include:
If you are intolerant of statins or they aren’t working to decrease your high cholesterol, your doctor may prescribe other cholesterol-lowering medications.
FDA-approved PCSK9 inhibitors include:
ACL inhibitors work by blocking the production of cholesterol in the liver. They are used as a primary prevention of high cholesterol in individuals with heterozygous familial hypercholesterolemia (FH), according to research in the journal Expert Opinion on Investigational Drugs. ACL inhibitors are also used for the secondary prevention of high cholesterol in combination with statins and dietary changes for adults who have established atherosclerotic cardiovascular disease and need additional lowering of LDL cholesterol.
To date, the only FDA-approved ACL inhibitor used to reduce LDL cholesterol is bempedoic acid (Nexletol).
Although the data doesn’t support the ability of the following drugs to directly lower LDL and total cholesterol, your doctor may also prescribe these drugs to manage your triglyceride levels.
Some commonly prescribed fibrates are:
Also known as nicotinic acid or vitamin B3, niacin is a B vitamin that can raise HDL cholesterol while lowering levels of total cholesterol, LDL cholesterol, and triglycerides by limiting your liver’s ability to produce cholesterol.
Niacin hasn’t been shown to provide any additional benefit over statins alone, and has been linked to liver damage and increased stroke risk. As a result, most doctors recommend niacin only for people who can’t take statins.
Drug manufacturers have started combining cholesterol absorption inhibitors or niacin with statins in a single formulation. Together, these combination drugs limit production of cholesterol in your liver alongside the effects of either niacin (which raises HDL cholesterol) or ezetimibe (which limits cholesterol absorption in the small intestine).
These combination drugs include:
In large doses, omega-3 fatty acids can help lower triglyceride levels. The most common supplement is OTC fish oil, but they are also available by prescription.
Omega-3 supplement prescriptions are sold under several brand names, including:
Let your doctor know if you plan to take OTC omega-3 or fish oil supplements, since they can affect how your body responds to other medications you’re already taking.
To minimize side effects of cholesterol-lowering drugs, it’s important to take them in the manner prescribed. Because some cholesterol-lowering drugs affect your liver, you may need to have your liver function tested occasionally.
Let your doctor know if you have any problems after starting a new medication. They may be able to adjust your dosage or switch you to an alternative medication.
Contact your doctor immediately if your symptoms are severe or seem life-threatening.
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