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.
LDL cholesterol: less than 100 mg/dLHDL cholesterol: greater than or equal to 60 mg/dLTriglycerides: less than 150 mg/dLTotal cholesterol: less than 200 mg/dL
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.
Diet
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.
Exercise and Physical Activity
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.
Tobacco Use
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.
Weight Management
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.
Statins
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:
Muscle pain and weaknessStomach painConstipationNauseaDiarrhea
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:
lovastatin (Altoprev, Mevacor)rosuvastatin (Crestor)fluvastatin (Lescol)atorvastatin (Lipitor)pitavastatin (Livalo)pravastatin (Pravachol)simvastatin (Zocor)
If you are intolerant of statins or they aren’t working to decrease your high cholesterol, your doctor may prescribe other cholesterol-lowering medications.
Bile Acid Sequestrants
colestipol (Colestid)cholestyramine (Prevalite, Questran)colesevelam (Welchol)
Cholesterol Absorption Inhibitors
PCSK9 Inhibitors
FDA-approved PCSK9 inhibitors include:
alirocumab (Praluent) a monoclonal antibody approved for use in people with heterozygous familial hypercholesterolemia, taken every two or four weeksevolocumab (Repatha) a biweekly or monthly monoclonal antibody approved for use in people with homozygous and heterozygous familial hypercholesterolemiainclisiran (Leqvio) a small interfering RNA (siRNA) therapy approved for use in people with heterozygous familial hypercholesterolemia and clinical atherosclerotic cardiovascular disease, taken twice per year
Adenosine Triphosphate-Citrate Lyase (ACL) Inhibitors
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).
Add-On Treatments for High Cholesterol
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.
Fibrates
Some commonly prescribed fibrates are:
gemfibrozil (Lopid)fenofibric acid (Trilipix)fenofibrate (TriCor)fenofibrate (Lipofen)
Niacin
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.
Combination Drugs
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:
ezetimibe and rosuvastatin (Roszet)ezetimibe and simvastatin (Vytorin)niacin and lovastatin (Advicor)niacin and simvastatin (Simcor)
Omega-3 Fatty Acid Supplements
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:
EpanovaLovazaOmtrygVascepa
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. 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.
