Healthy lifestyle changes alone may be enough to help some people reach healthycholesterol levels. Other people will need to take a cholesterol-lowering medicine. If you need medicine e, talk with your healthcare provider and work together to find the best option for you.
There are 7 main types of medicine:
Statins (such as atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin). These medicines lower LDL ("bad") cholesterol. They typically reduce LDL by about one-third. They can also help raise HDL ("good") cholesterol and lower triglycerides (other blood fats). Statins slow the body's production of cholesterol. They also increase the liver's ability to remove LDL from the blood. In research on people who already had heart disease, statins greatly reduced heart attacks and heart disease deaths. They may also prevent first heart attacks in people who are at high risk for heart disease.
Bile acid sequestrants (such as cholestyramine, colesevelam, colestipol). These medicines also lower LDL, although somewhat less than statins. These medicines bind with bile acids in the intestines and force them to leave the body in the stool instead of being absorbed into the blood stream. The liver needs cholesterol to make bile acids and important growth and stress hormones. So as more bile is lost, more cholesterol from your body is used up to make more bile.
Nicotinic acid (niacin). This B vitamin increases HDL and lowers LDL and triglycerides when taken at levels higher than needed in the diet. Nicotinic acid is sold as both a prescription medicine and a dietary supplement. But only the prescription form should be used to lower cholesterol. Some people don't tolerate the high doses because these medicines cause flushing or a burning or itching sensation.
Fibrates (such as gemfibrozil, fenofibrate). These drugs lower triglycerides. They may also lead to modest improvements in LDL and HDL levels.
Selective cholesterol absorption inhibitors (ezetimibe). This medicine lowers cholesterol by reducing the amount of cholesterol absorbed by the intestines. Ezetimibe, bile acid sequestrants, and nicotinic acid are sometimes combined with a statin to help people reach their LDL cholesterol-lowering levels.
PCSK9 inhibitors (alirocumab, evolocumab). These newest medicines are injected in the skin and contain antibodies that bind to an important enzyme involved in the removal of LDL from the blood stream. These medicines may lower LDL levels by almost 50% and can reduce the risk of heart attack.
Omega 3 fatty acid ethyl esters. (fish oils). This type of medicine is used along with diet and lifestyle to help people lower their triglycerides when the levels are above 500 mg/dL. This type of cholesterol medicine should not be used by anyone with a severe allergy to fish or shellfish due to the risk of a severe reaction.
Your healthcare provider can help you identify your personal risk and if you need medicine to control your cholesterol. Calculating a risk score is done looking at certain risk factors that are considered as an increased risk for atherosclerosis. The risk calculator tool looks at:
Ages between 40-79 years of age
Blood pressure (systolic and diastolic measurements)
Total cholesterol, good cholesterol (HDL), and bad cholesterol (LDL) levels
History of diabetes
Current or past smoking history
Treatment for high blood pressure
Treatment of cholesterol with a statin medicine
Current use of aspirin
If you and your provider are unsure about your risk for developing heart disease, you may have a test to look at the total amount of calcium (plaque) build-up in your arteries called a coronary artery calcium score (CAC) which is measured using a CT scan.
Discuss your treatmentgoals with your healthcare provider. Make sure you understand how your cholesterol and other factors affect your risk of heart disease or other complications. Plan to have regular monitoring and report any side effects from the medicines. Sometimes you may need more than one medicine to reach your cholesterol goals. Also make sure you also understand how to get ready for cholesterol testing. It often requires that you fast before you have the test.
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