Medications for Cholesterol: What You Need to Know
Maintaining healthy amount of cholesterol in your body is one of the most important ways to decrease the risk of heart disease and other health issues. Cholesterol is a waxy, fat-like substance that can build up in almost any area of the body but is most dangerous in the heart arteries that supply blood containing oxygen to the heart. This buildup can occur without warning until you have chest pain, a heart attack or cardiac arrest.
Adopting a lifestyle of exercise, a low-cholesterol diet, getting enough sleep, and limiting alcohol is the first step to having healthy cholesterol levels. But sometimes these measures are not enough, and your doctor may tell you that you need to take medication to reduce your cholesterol levels.
How do I know if I have high levels of cholesterol?
Your doctor will order a blood test to measure the amount of cholesterol in your body. You will probably need to fast (not eat or drink anything except water and your medications) for 9 – 12 hours before you go to the laboratory to have a blood sample drawn.
Your doctor will review the test results when they are available.
What makes up my cholesterol score?
Your cholesterol score is made up of several numbers. It includes several types of lipoproteins which are a combination of fat (lipid) and protein.
| Lipid type | Definition |
|---|---|
| LDL (low density lipoprotein) | “bad” cholesterol that can cause fatty buildup in your arteries. |
| HDL (high density lipoprotein) | “good” cholesterol that can remove cholesterol from blood and artery walls. |
| VLDL (very low-density lipoprotein, mostly triglycerides) | Another type of “bad” cholesterol that can cause fatty buildup in your arteries. |
| Total cholesterol | LDL, HDL, and 20% of the VLDL (triglyceride) score added together |
Generally, total cholesterol levels under 200 are considered healthy and those greater than 240 places you at risk. Total cholesterol results in between 200-240 are of concern and should be addressed.
What other factors affect the decision to start medication treatment?
Your cholesterol score is not the only factor your doctor uses to determine if medication treatment is needed to reduce your cholesterol to healthier levels. Other conditions and risk factors such as diabetes, high blood pressure, and smoking will be considered. Your age, race, sex, and other medical conditions such as cardiovascular disease or a recent heart attack are also important in making the decision to start treatment. These factors are put into a calculator that is used to calculate your risk of having a heart attack or stroke in the next 10 years. If your risk is considered high enough, your doctor will likely start you on medications. If your cholesterol level is high but you do not qualify yet to take medicines, your doctor will talk to you about making diet and lifestyle changes to help reduce your cholesterol.
What types of medications are used to treat cholesterol?
A class of medications called “statins” are the recommended treatment for high cholesterol. More information on statins can be found in the article titled "What You Should Know About 'Statin' Medications." Medications other than statins are available to treat cholesterol, especially if:
- you have an inherited condition (familial hypercholesterolemia) that increases cholesterol levels,
- continue to have increased LDL levels while taking statins,
- or have side effects and can’t take statins.
These are non-statin medications are used to manage cholesterol:
- Cholestyramine, colesevelam, colestipol: These drugs bind to bile acids (byproducts of cholesterol) and remove them from the body. They may be used in addition or in place of statins to help decrease LDL cholesterol.
- Ezetimibe (Zetia®): May be used in addition or in place of statins to help decrease LDL cholesterol or to manage familial hypercholesterolemia. It works by preventing the absorption of cholesterol in the intestine.
- Bempedoic Acid (Nexletol®): May be used along with statins to help decrease LDL cholesterol to manage familial hypercholesterolemia or alone or in combination with statins to prevent heart disease. It works by blocking the production of cholesterol in the liver.
- Alirocumab (Praluent®), Inclisiran (Leqvio®): These are injectable drugs that block the production of LDL cholesterol in the body. They are used alone or in combination with other medications to manage familial hypercholesterolemia or to treat people with cardiovascular disease.
How will I know if my medications are working?
Your doctor will order blood tests periodically to check how well your medication treatment is working to lower your cholesterol levels, particularly your LDL levels. If your levels are not as low as desired to reduce health risks, your doctor may increase your dose of your current medication, change to another medication, or add another medication to your current therapy. Always take your medication as prescribed and do not miss any doses.
Summary
Managing high blood cholesterol is an important part of maintaining your heart health. Medication therapy may be necessary to treat high LDL cholesterol. Be sure to ask your pharmacist if you have any questions about these medications or how to take them.