Treating High Cholesterol: How High-Dose Statins Work
When lifestyle changes aren’t enough, statins can help.
High cholesterol is common, affecting about 95 million adults in the United States, according to the Centers for Disease Control and Prevention. Having high cholesterol can be dangerous, but luckily, it’s treatable.
“We have several different ways to treat high cholesterol. The most commonly prescribed medications are called statins,” says Michelle W. Bloom, MD, cardio-oncologist at Stony Brook Medical Center.
What Is High Cholesterol?
“Cholesterol is a waxy, fat-like substance that is found in our blood and in all of the cells of our body, and it's actually a necessary building block to make cells healthy,” says Dr. Bloom. “It's typically produced in our liver.” Cholesterol also helps make hormones and digest fatty foods.
All living creatures, including humans, produce their own cholesterol in their bodies. This cholesterol moves through the bloodstream and is thus called blood cholesterol or serum cholesterol. However, you can also get cholesterol through food (dietary cholesterol) by eating food from cholesterol-producing animals. (Learn more about dietary cholesterol vs. blood cholesterol here.)
“The problem is that when cholesterol levels get too high, those levels can actually cause cholesterol plaques to deposit in the arteries of our body,” says Dr. Bloom. Plaque is hard and rigid, so it makes the artery lining more narrow and less flexible.
If a blood clot obstructs this narrowed artery, it can lead to a life-threatening situation. “[Plaques] can cause things like a heart attack, if it's the arteries of the heart, or a stroke when it's the arteries of the brain, or something called peripheral vascular disease, which is arteries of the legs and the limbs,” says Dr. Bloom.
How High-Dose Statins Can Help
“Statins work mainly by decreasing the body's production of cholesterol, but also [by] helping the liver to clear cholesterol from our bodies,” says Dr. Bloom.
The first step in treatment for high cholesterol might be making lifestyle changes, such as following a heart-healthy diet and increasing physical activity. However, if this doesn’t work (or is not enough) to lower cholesterol levels, medications may be necessary.
Certain risk factors will make an individual an appropriate candidate for statins, such as:
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A previous cardiac event
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Having diabetes
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Older age
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History of smoking
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High blood pressure
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Family history of heart disease
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Or a genetic predisposition to high cholesterol.
“Because we know that high-dose statins have a much higher effectiveness in lowering cholesterol, typically, in most patients that a cardiologist is seeing, we choose to use a high-dose or a moderate-dose of a statin in order to lower cholesterol levels,” says Dr. Bloom.
While statins are the mainstay treatment against high cholesterol, they’re not the only ones. Here are other medical treatments for high cholesterol.
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.
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We have several different ways to treat high cholesterol.
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The most commonly prescribed medications are called statins.
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We choose high doses of statin in patients that have
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very elevated cholesterol levels,
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or in patients that are considered to be very high risk
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of a cardiac event because of their cholesterol.
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Statins work mainly by decreasing the body's production
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of cholesterol, but also helping the liver to clear cholesterol
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from our bodies.
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Cholesterol is a waxy, fat-like substance
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that is found in our blood and in all of the cells of our body
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and it's actually a necessary building block to make cells healthy.
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It's typically produced in our liver,
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but also we get it from some of the foods that we eat,
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like meats, and other types of dairy products.
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But the problem is that when cholesterol levels get too high,
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those levels can actually cause cholesterol plaques
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to deposit in the arteries of our body,
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and sometimes those plaques become unstable.
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They can cause things like a heart attack
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if it's the arteries of the heart,
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or a stroke when it's the arteries of the brain,
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or something called peripheral vascular disease,
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which is arteries of the legs and the limbs.
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Treatment for cholesterol largely depends on risk.
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Typically, the people that we think of as high risk,
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if a person has already had a cardiac event,
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those with diabetes, older age,
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people with a smoking history, patients with high blood pressure,
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patients that have a strong family history of cardiac disease,
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or patients that have a genetic predisposition to high cholesterol.
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Because we know that high-dose statins
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have a much higher effectiveness in lowering cholesterol,
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typically, in most patients that a cardiologist is seeing,
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we choose to use a high dose or a moderate dose
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of a statin in order to lower cholesterol levels.
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In general, statins are really well tolerated by patients.
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Other than some annoying side effects,
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certainly there are not any major life-threatening side effects
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that we see from statin use, even in the highest doses of statins.
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Cholesterol medications. Dallas, TX: American Heart Association. (Accessed on March 14, 2022 at https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications.)
Control your cholesterol. Dallas, TX: American Heart Association. (Accessed on March 14, 2022 at https://www.heart.org/en/health-topics/cholesterol/about-cholesterol.)
High cholesterol facts. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on March 14, 2022 at https://www.cdc.gov/cholesterol/facts.htm.)