Diet, exercise, and other lifestyle changes might not be enough to manage your high cholesterol, but it may be enough for some people. If you must take medication, you have several options to choose from.
Cholesterol levels in your body include:
- high-density lipoproteins (HDL), known as the “good” cholesterol
- low-density lipoproteins (LDL), known as the “bad” cholesterol
- non-HDL cholesterol
You’ll receive a blood test known as a lipid panel to check your cholesterol levels. It’ll also check your triglyceride levels, another type of lipid (or fat) found in your blood.
Having high cholesterol means you have high levels of LDL, non-HDL cholesterol, or both. These, and having high triglyceride levels, are risk factors for cardiovascular (heart) disease.
A balanced diet and exercise are the first line in managing high cholesterol, but management depends on the person.
Some people can use lifestyle modifications, such as diet and exercise, to lower LDL levels and increase HDL levels.
Others may find it difficult to manage high cholesterol with diet and exercise alone. This is especially true for people who have a family history of high cholesterol.
Medication is typically recommended when:
- your cholesterol levels are high enough to increase your risk of cardiovascular disease (or you already had a cardiovascular event, such as a heart attack or stroke)
- you have an LDL level greater than 190 milligrams per deciliter (mg/dL)
- you have diabetes, which makes a person 2 to 4 times more likely to develop cardiovascular disease, or otherwise considered high risk for cardiovascular disease
- you have an LDL level
greater than 70 mg/dL and history of atherosclerotic cardiovascular disease, which includes:- heart attack
- angina
- coronary artery stenosis
A doctor calculates your cardiovascular disease risk score to show your risk of developing a heart attack or stroke over 10 years. If the score is greater than 5 percent, they recommend medication.
You can calculate your cardiovascular disease risk score online using the American College of Cardiology’s risk estimator.
Having a triglyceride level greater than 200 mg/dL puts you at higher risk for cardiovascular disease.
If you have a triglyceride level of greater than 500 mg/dL, your doctor will prescribe a medication because you’re at an increased risk for pancreatitis.
Some people have a strong family history of high cholesterol, known as familial hypercholesterolemia. Lifestyle modifications may not be enough to lower your cholesterol levels if this is the case.
Some people need to lower their cholesterol levels because they’re at high risk for future cardiovascular events. They should take cholesterol-lowering medications and not rely on lifestyle modifications alone.
Statins are a type of cholesterol medication used to lower LDL cholesterol and lower the risk of cardiovascular disease.
They lower cholesterol by blocking your body’s ability to use an enzyme needed to make cholesterol.
Statins are for anyone who has high cholesterol levels, previously had a heart attack or stroke, or is at high risk for a cardiovascular event.
PCSK9 inhibitors are a newer class of cholesterol-lowering medication.
PCSK9 is a protein in the liver that prevents the liver from getting rid of LDLs. PCSK9 inhibitors block PCSK9, allowing the liver to get rid of LDL again.
The Food and Drug Administration (FDA) approved two medications, alirocumab (Praluent) and evolocumab (Repatha), in 2015. They’re injected every 2 to 4 weeks to lower LDL cholesterol levels.
If your LDL cholesterol levels aren’t responding well to a statin alone, a doctor may prescribe a PCSK9 inhibitor as well.
Small interfering RNA (siRNA) is the latest class of cholesterol-lowering medications aimed at blocking the production of PCSK9.
It stops the translation of PCSK9 messenger RNA, which can lead to lower levels of PCSK9. As a result, siRNA can lower LDL levels.
Leqvio (inclisiran) is the first drug in this class of medications. It has been shown to cause a
Inclisiran is
Statins are usually recommended to treat high cholesterol. If you’re unable to tolerate statins, your doctor may recommend other cholesterol-lowering medications, such as:
- fibrates
- niacin
- cholesterol absorption inhibitor (ezetimibe)
- citrate lyase inhibitors (bempedoic acid)
- bile acid sequestrants (cholestyramine)
- fish oil
Your doctor may also prescribe one of these medications and a statin if you have both high LDL and triglycerides (greater than 500 mg/dL).
Yes, high cholesterol medications are generally safe.
You may experience
Some people may develop liver injury with statin use. Your doctor will also check for liver damage by testing liver enzymes with a blood test.
If you show any signs of myopathy or liver damage, your doctor will lower the statin dose or prescribe a different cholesterol medication.
Statins also pose a small risk of an increase in blood sugar levels. In people with diabetes mellitus, the benefits of lowering LDL levels and reducing the risk of a heart attack or stroke with medication outweigh any risks.
Some people can manage their cholesterol with diet, exercise, and weight management and can safely come off cholesterol-lowering medications.
Others may need to stay on cholesterol-lowering medications for the rest of their lives due to a strong family history of high cholesterol or because they have a high risk of cardiovascular disease.
Even if you need to take cholesterol-lowering medication, lifestyle strategies are still important. Try to:
- increase fiber in your diet
- lower your saturated fat intake
exercise 150 minutes per week - avoid smoking, or try a smoking cessation program if you currently smoke
- avoid drinking, if you drink
Dr. Alana Biggers is an internal medicine physician. She graduated from the University of Illinois at Chicago. She is an assistant professor at the University of Illinois at Chicago College of Medicine, where she specializes in internal medicine. She also has a master’s of public health in chronic disease epidemiology.