Medication for High Cholesterol: When Is It Necessary?
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:
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.”
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 KnoepflmacherDr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.
Rachel BondDr. 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.
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Not everybody that has elevated
cholesterol levels necessarily needs to be
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on a medication.
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Depending on the level and
depending on your risk factors,
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sometimes we can have a patient
change their lifestyle.
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[MUSIC]
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Medicine is recommended to treat high
cholesterol based on an individual's
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particular set of circumstances.
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So if a person just has high cholesterol
and they don't have any other risk
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factors, they don't have a family history,
they don't have high blood pressure,
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they don't smoke, they don't have
diabetes, then cholesterol may not need to
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be treated with medicine.
If your cholesterol's very, very high,
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we know that diet alone and exercise alone
are unlikely to lower the numbers to
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the degree we need it to be lowered to.
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So you would be started on
a medication in that situation.
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We also know that if you have conditions,
for example, you're
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diagnosed with high cholesterol, but you
also have heart disease, you should be put
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on a medication regardless of if you make
lifestyle changes, which we'll encourage.
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But we know that the importance
of those medications are not just
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that lowering your cholesterol,
but also lowering inflammation.
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Your doctor is gonna use a series of
measures to figure out if you should be
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started on a medication to
lower your cholesterol or not.
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One measure they do is a risk score.
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And that helps you to determine if you
should be put on a medication or not.
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What comprises a risk score,
typically consists of what your age is,
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what your gender is, what your race is.
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If you have other medical conditions
that could put you at a high risk for
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high cholesterol,
such as high blood pressure.
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If you're a smoker, if you have extra
amounts of weight, if you're overweight or
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obese, for example.
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If you do have high cholesterol and
your doctor starts you on a medication,
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it doesn't mean, again, that you're
gonna be on that medication for
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the rest of your life.
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If you have the ability to have
a conversation with the doctor,
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really focus in on, well, what are foods
that I need to remove from my diet or
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foods that maybe I need to add to my diet?
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Do I need to exercise a little bit more?
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All of these life style changes can
ultimately get you off of the medication.
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Causes of high cholesterol. Dallas, TX: American Heart Association, 2018. (Accessed on February 20, 2018 at https://www.heart.org/HEARTORG/Conditions/Cholesterol/CausesofHighCholesterol/Causes-of-High-Cholesterol_UCM_001213_Article.jsp.)
Cholesterol medications. Dallas, TX: American Heart Association, 2017. (Accessed on February 20, 2018 at https://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp.)