Medication for High Cholesterol: When Is It Necessary?

Some, but not all, patients can treat cholesterol problems med-free.

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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:

  • Age

  • Sex

  • Race

  • Other medical conditions, such as high blood pressure

  • Smoking status

  • Weight

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.”