Cholesterol Treatment
High cholesterol can raise your risk of heart disease, heart attacks, or strokes, so you want to take steps to lower your cholesterol. You can treat high cholesterol with healthy lifestyle changes like diet, exercise, and weight loss and, sometimes, medications too.
Your cholesterol treatment plan is done on a case-by-case basis, based on:
- Your blood cholesterol test results
- Your age, family history of high cholesterol, or heart problems
- Current health problems like diabetes or high blood pressure, or being overweight
- Your personal preferences, like how you feel about sticking to diet changes, taking pills every day, or dealing with side effects
- Your risk of developing heart disease or having a heart attack or stroke
- If you’ve already been diagnosed with heart disease or had a heart attack or stroke before
Cholesterol treatment goals
Your personal high cholesterol treatment goals are based on your current health and cardiac risk, or risk of a heart attack or stroke within the next 10 years. Your doctor can use a formula to calculate your cardiac risk.
Your blood lipid profile or panel test results show your cholesterol levels. Your doctor can test your cholesterol to help you track how well your treatment plan is working or if it needs to be adjusted.
Normal cholesterol levels are:
- Total cholesterol: Lower than 170 mg/dL if you’re 19 or younger, and 125-200 mg/dL for men and women over 19
- LDL cholesterol: Lower than 110 mg/dL if you’re 19 or younger, and less than 100 mg/dL for men and women over 19
- HDL cholesterol: Above 45 mg/dL if you’re 19 or younger, 40 mg/dL or higher if you’re a man over 19, and 50 mg/dL or higher if you’re a woman over 19
- Triglycerides: Lower than 150 mg/dL for all adults
Based on your cardiac risk, your cholesterol goal numbers may be lower. For example:
- If you don’t have heart disease or blood vessel disease, and your overall cardiac risk is low, your LDL cholesterol treatment goal may be 100 mg/dL or lower.
- If you do have heart disease or blood vessel disease, your LDL treatment goal may be 70 mg/dL or lower.
- If you have diabetes, your LDL treatment goal may be below 70 mg/dL or at least reduced by 50%.
Lifestyle changes first
Your doctor may suggest heart-healthy lifestyle changes as the first step to lower your high cholesterol. If your cholesterol is borderline but not yet high, you should make these lifestyle changes, too. A heart-healthy diet and exercise can help lower your risk of heart attacks and strokes.
You may not need a cholesterol-lowering drug if your cardiac risk is low and your cholesterol is not above 190 mg/dL. Lifestyle changes may help you reach your goals without having to take medication.
If lifestyle changes don’t lower your cholesterol levels enough, your doctor may suggest medication. Stick with these healthy changes even if you do take meds. They can lower your cholesterol even more and may allow you to take a lower dose of medicine:
- Eat a heart-healthy diet low in saturated fats, and high in omega-3 fats and soluble fiber. Cut back on red meat, full-fat dairy foods, and sugar. Stay away from trans fats.
- Get at least 30 minutes of moderate exercise 5 days a week.
- Don’t smoke or vape. Quit smoking and try to avoid secondhand smoke.
- Limit alcohol to one drink a day for women and men over 65, and two drinks a day for men younger than 65.
- Lose weight if you need to. Even a 10% body weight loss can improve your cholesterol.
Medications
Your doctor may prescribe medication to lower your LDL cholesterol in addition to your lifestyle changes. That’s more likely if:
- Your LDL cholesterol is 190 mg/dL or higher
- You’re 45-70 years old and have diabetes, and your LDL cholesterol is 70 mg/dL or higher
- You’re 45-70 years old with a high risk of heart disease, and your LDL cholesterol is 70 mg/dL or higher
- You’ve already had a heart attack or stroke, or you have peripheral arterial disease
Statins are the most widely prescribed medication for high cholesterol. Statins reduce the amount of cholesterol made by your liver. These drugs may lower your risk of heart attacks and strokes. Statins include atorvastatin (Lipitor), rosuvastatin calcium (Crestor), simvastatin (Zocor), Fluvastatin (Lescol), Lovastatin (Mevacor, Altoprev), and Pravastatin (Pravachol), as well as combinations of statins and other cholesterol-lowering meds, atorvastatin with amlodipine (Caduet) and simvastatin and ezetimibe (Vytorin).
Ezetimibe (Zetia) is a drug that lowers your body’s absorption of cholesterol and may be prescribed with a statin.
Bile acid-binding drugs cling to acids in your digestive system and help your liver use up excess cholesterol. They include cholestyramine (Locholest, Locholest Light, Prevalite, Questran, Questran Light), Colestipol (Colestid), and Colesevelam Hcl (WelChol).
Fibrates reduce triglycerides and boost HDL cholesterol to help balance your overall cholesterol levels. They include clofibrate (Atromid-S), fenofibrate (Antara, Lofibra, Tricor, and Triglide), and gemfibrozil (Lopid).
Niacin or nicotinic acid is a vitamin that helps reduce fats produced by your liver to lower triglycerides and LDL cholesterol. Don’t take this vitamin unless your doctor tells you to do so.
Omega-3 fatty acid ethyl esters are made from fish oil. These supplements (Epanova, Lovaza, Omtryg, and Vascepa) help lower triglycerides along with a healthy diet.
PSCK9 inhibitors are newer, more targeted drugs that bind to and block a protein, PSCK9, on your liver cells to help lower your LDL cholesterol, including alirocumab (Praluent) and evolocumab (Repatha).
ACL inhibitors are another new cholesterol drug. They’re prescribed with a statin and lifestyle changes to lower your LDL cholesterol even more. ACL inhibitors, including bempedoic acid (Nexletol) or bempedoic acid and (Nexlizet), may be prescribed if you have heart disease or if your high cholesterol is caused by genetic factors.
SiRNA (small interfering RNA) therapy can treat some health conditions by changing how some of your genes work. A new medication called inclisiran (Leqvio) uses this technology to treat adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease (ASCVD) who need additional LDL lowering. 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.
How long does cholesterol treatment take to work?
When you first make lifestyle changes, plan to see your doctor for regular checkups. After 12 weeks, they may check your LDL cholesterol again to see if you need to adjust your diet or exercise even more.
After 18 weeks of lifestyle changes, if your cholesterol levels haven’t improved, they may suggest adding medication. You’ll probably see your doctor once every 4-6 months for checkups after that.
If you’re prescribed a statin or other cholesterol medication, your doctor can check your LDL cholesterol again 4-8 weeks later to see if the drugs are working. If it hasn’t lowered your numbers enough, they may adjust your prescription or add another treatment. You’ll have your cholesterol checked every year.
