Some, but not all, patients can treat cholesterol problems med-free.
Hearing a diagnosis like high cholesterol may make you immediately think of pill bottles and prescription forms, but here’s the thing: Not every patient requires medication, especially at first.
“Depending on the [cholesterol] level and depending on your risk factors, sometimes we can have a patient change their lifestyle,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. Heart-healthy lifestyle changes—like sneaking in more physical activity and reducing stress—might be enough to bring the numbers down without medication.
“Medicine is recommended to treat high cholesterol based on an individual’s particular set of circumstances,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital. “If a person just has high cholesterol, and they don’t have any other risk factors—they don’t have a family history, they don’t have high blood pressure, they don’t smoke, they don’t have diabetes—then cholesterol may not need to be treated with medicine.”
And in some cases, cholesterol-lowering lifestyle tweaks just aren’t enough. Having high cholesterol puts you at risk of developing heart disease or having a stroke, so taking control over those numbers is essential to preventing a more serious heart problem.
“If your cholesterol is very, very high, we know that diet alone and exercise alone are unlikely to lower the numbers to the degree we need it to be lowered to,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital.
To determine each patient’s need for medication, doctors assess a risk score based on several key factors, according to Dr. Bond:
Other medical conditions, such as high blood pressure
Taking medication for high cholesterol doesn’t have to be a permanent sentence. With the combined power of lifestyle changes and medication, you may get to a point when you can maintain a healthy cholesterol level on your own. (Here are the heart-smart ways to lower cholesterol that doctors recommend.)
“If you have the ability to have a conversation with the doctor, really focus in on, ‘Well what are foods that I need to remove from my diet? What are foods I need to add to my diet? Do I need to exercise a little bit more?’” suggests Dr. Bond. “All of these lifestyle changes could ultimately get you off of the medication.”
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.Paul Knoepflmacher
Dr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.Rachel Bond
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
00:00:00,000 --> 00:00:02,304
00:00:02,304 --> 00:00:06,345
Not everybody that has elevated
cholesterol levels necessarily needs to be
00:00:06,345 --> 00:00:07,300
on a medication.
00:00:07,300 --> 00:00:10,581
Depending on the level and
depending on your risk factors,
00:00:10,581 --> 00:00:13,743
sometimes we can have a patient
change their lifestyle.
00:00:13,743 --> 00:00:19,089
00:00:19,089 --> 00:00:23,217
Medicine is recommended to treat high
cholesterol based on an individual's
00:00:23,217 --> 00:00:25,180
particular set of circumstances.
00:00:25,180 --> 00:00:29,380
So if a person just has high cholesterol
and they don't have any other risk
00:00:29,380 --> 00:00:32,760
factors, they don't have a family history,
they don't have high blood pressure,
00:00:32,760 --> 00:00:36,710
they don't smoke, they don't have
diabetes, then cholesterol may not need to
00:00:36,710 --> 00:00:40,644
be treated with medicine.
If your cholesterol's very, very high,
00:00:40,644 --> 00:00:45,584
we know that diet alone and exercise alone
are unlikely to lower the numbers to
00:00:45,584 --> 00:00:48,019
the degree we need it to be lowered to.
00:00:48,019 --> 00:00:51,240
So you would be started on
a medication in that situation.
00:00:51,240 --> 00:00:54,350
We also know that if you have conditions,
for example, you're
00:00:54,350 --> 00:00:59,110
diagnosed with high cholesterol, but you
also have heart disease, you should be put
00:00:59,110 --> 00:01:03,850
on a medication regardless of if you make
lifestyle changes, which we'll encourage.
00:01:03,850 --> 00:01:07,195
But we know that the importance
of those medications are not just
00:01:07,195 --> 00:01:11,130
that lowering your cholesterol,
but also lowering inflammation.
00:01:11,130 --> 00:01:15,760
Your doctor is gonna use a series of
measures to figure out if you should be
00:01:15,760 --> 00:01:18,920
started on a medication to
lower your cholesterol or not.
00:01:18,920 --> 00:01:21,061
One measure they do is a risk score.
00:01:21,061 --> 00:01:25,080
And that helps you to determine if you
should be put on a medication or not.
00:01:25,080 --> 00:01:29,690
What comprises a risk score,
typically consists of what your age is,
00:01:29,690 --> 00:01:31,410
what your gender is, what your race is.
00:01:31,410 --> 00:01:35,250
If you have other medical conditions
that could put you at a high risk for
00:01:35,250 --> 00:01:37,450
such as high blood pressure.
00:01:37,450 --> 00:01:41,598
If you're a smoker, if you have extra
amounts of weight, if you're overweight or
00:01:41,598 --> 00:01:42,738
obese, for example.
00:01:42,738 --> 00:01:46,345
If you do have high cholesterol and
your doctor starts you on a medication,
00:01:46,345 --> 00:01:49,778
it doesn't mean, again, that you're
gonna be on that medication for
00:01:49,778 --> 00:01:51,000
the rest of your life.
00:01:51,000 --> 00:01:54,610
If you have the ability to have
a conversation with the doctor,
00:01:54,610 --> 00:01:59,490
really focus in on, well, what are foods
that I need to remove from my diet or
00:01:59,490 --> 00:02:01,700
foods that maybe I need to add to my diet?
00:02:01,700 --> 00:02:03,950
Do I need to exercise a little bit more?
00:02:03,950 --> 00:02:09,300
All of these life style changes can
ultimately get you off of the medication.
00:02:09,300 --> 00:02:14,909
Causes of high cholesterol. Dallas, TX: American Heart Association. (Accessed on April 13, 2021 at https://www.heart.org/HEARTORG/Conditions/Cholesterol/CausesofHighCholesterol/Causes-of-High-Cholesterol_UCM_001213_Article.jsp.)Cholesterol medications. Dallas, TX: American Heart Association. (Accessed on April 13, 2021 at https://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp.)