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Cholesterol: Latest Research

Medically Reviewed by James Beckerman, MD, FACC on June 15, 2021

High cholesterol raises your risk of heart disease, heart attack, and stroke. A healthy diet and lifestyle can improve your levels. Medication can help, too. Still, doctors and scientists keep studying cholesterol to see what else they can learn about it.

Here’s some progress they’ve made in the ways they think about, prevent, and treat high cholesterol.

A More Personal Approach

Doctors used to think everyone’s cholesterol level should be about the same. Now, your doctor will look at your numbers along with other risk factors you have for heart disease. Those factors include blood pressure, blood sugar, age, and weight. The higher your risk for heart issues, the lower your doctor may suggest you try to get your cholesterol levels.

Prescription for Exercise

If you have high cholesterol and mildly high blood pressure, but you have a low overall risk of heart disease, your doctor may not prescribe medication right away. New guidelines from the American Heart Association advise sitting less and moving more as the first treatment.

Physical activity can reduce LDL (low-density lipoprotein, or “bad”) cholesterol by 3 to 6 milligrams per deciliter (mg/dL) in your blood. It also lowers your blood pressure.

About 150 minutes of moderate exercise per week is ideal. But you could see a difference in your cholesterol levels with as few as 5 to 10 minutes of movement each day.

Beyond Statins

Doctors often prescribe statins to treat high cholesterol, but not everyone does well on these drugs. People who don’t respond to this type of medicine, or who have unpleasant side effects, now have some other options, such as:

  • PCSK9 inhibitors: PCSK9 is a protein that your liver makes. The more you have, the harder it is for your body to get rid of LDL cholesterol. A new class of drugs called PCSK9 inhibitors can block PCSK9. That way, it won’t interfere with cholesterol. You can take these medications by themselves or with statins. You get them through a shot, usually about every 2 weeks.

If you have a genetic condition called familial hypercholesterolemia, PCSK9 inhibitors may work better for you than statins do.

  • SiRNA therapy: SiRNA (small interfering RNA) therapy can treat some health conditions by changing how some of your genes work. The European Union recently approved a new medication called inclisiran (Leqvio) that uses this technology. It lowers your LDL levels by disrupting the gene that makes PCSK9. Inclisiran comes in the form of shots, taken several months apart. You can use this medication along with other cholesterol-lowering treatments or alone.

While some studies show that inclisiran could work better than statins at lowering “bad” cholesterol, it is not yet available in the U.S.

  • Bempedoic acid: Like statins, this new medication makes it harder for cholesterol to form in your body. Bempedoic acid, which is a pill you swallow, may lower your LDL levels by up to 15%. For now, you can get a prescription only if you have a family history of high cholesterol or you have atherosclerotic cardiovascular disease (ACD).

Nanotech That ‘Eats’ Plaque

Cholesterol can cause fatty deposits called plaque to form inside your arteries. Over time, it can start to block your blood flow. This condition, called atherosclerosis, raises your risk of heart problems and stroke. Scientists have recently created a nanoparticle -- a tiny object that the naked eye cannot see -- to eat away at this waxy buildup. It’s still in testing mode, but in the future, a drug that contains this nanoparticle could be part of atherosclerosis treatment.

Gut Health Could Help

Researchers have thought for some time that gut health plays a role in cholesterol levels, but it hasn’t been clear exactly how. But they now know that probiotics (“good” live bacteria) and prebiotics (which feed useful germs in your gut) can lower LDL cholesterol and triglycerides, another type of blood fat. These gut bacteria may also increase high-density lipoprotein (HDL, or “good”) cholesterol.

Talk to your doctor if you’re interested in trying probiotics or prebiotics. The amount you need in order to get results is still under review, and too much could lead to an upset stomach.

WebMD Medical Reference

Sources

SOURCES:

American Heart Association: “What Is Cholesterol?” “Prescription to sit less, move more advised for mildly high blood pressure and cholesterol,” “Making sense of cholesterol -- the good, the bad and the dietary.”

Johns Hopkins Medicine: “How to Reduce Cholesterol: New Medication.”

Harvard Health Publishing: “Are Statins Enough? When to Consider PCSK9 Inhibitors.”

Michigan State University: “Nanoparticle chomps away plaques that cause heart attacks.”

International Journal of Molecular Sciences: Cholesterol-Lowering Effects of Probiotics and Prebiotics: A Review of in Vivo and in Vitro Findings.”

Signal Transduction and Targeted Therapy: “Therapeutic siRNA: state of the art.”

Cell Host & Microbe: “Cholesterol Metabolism by Uncultured Human Gut Bacteria Influences Host Cholesterol Level.”

Mayo Clinic: “Mayo Clinic Q&A: Medications for high cholesterol.”

European Medicine Agency: “Leqvio.”

FDA: “Inclisiran.”

UC Health: “What should I know about new cholesterol guidelines?”

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