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Medications for High Cholesterol: Understanding Your Options

When lifestyle and diet changes aren’t enough, medications are the next step to manage high cholesterol.

As soon as you’re diagnosed with high cholesterol, you may worry that the rest of your life will be full of pill bottles and doctors visits. While that may be the case for some, it’s not true for everyone.

“Medicine is recommended to treat high cholesterol based on an individual’s particular set of circumstances,” says internist 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.” 

Depending on your cholesterol numbers and other heart disease risk factors, your doctor may suggest starting with lifestyle and diet changes to lower your cholesterol—such as eating less fast food, sneaking in more physical activity, and reducing stress—to bring the numbers down without medication. Here’s why exercise is one of your most powerful weapons to fight high cholesterol.

Sometimes, however, cholesterol-lowering lifestyle tweaks 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 [cholesterol is] really high or we’re worried about their increased risk because of diabetes or high blood pressure, we will immediately start them on a medication to lower their cholesterol,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. Learn more about how doctors decide to treat high cholesterol patients with medication

 

Medication Options for Treating High Cholesterol

“There are many different types of medicines that we can use to lower patient’s cholesterol levels,” says Dr. Bloom. “The main ones the patients really need to know about are called statins.”

Statins

Statins are a class of drugs that work in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol in the blood, particularly the “bad” LDL cholesterol. Learn more about the different types of cholesterol.

“In addition to helping your body produce less cholesterol, and lowering the blood levels of cholesterol, statins have an effect beyond that in terms of reducing cardiovascular disease and heart attacks,” says Dr. Knoepflmacher.  “They have an anti-inflammatory effect which we think is important and is something that helps beyond just the cholesterol lowering.”

Commonly prescribed statins include:

  • Atorvastatin (Lipitor®)
  • Fluvastatin (Lescol®)
  • Lovastatin (Mevacor®, Altoprev™)
  • Pravastatin (Pravachol®)
  • Rosuvastatin Calcium (Crestor®)
  • Simvastatin (Zocor®)

Statins are also found in the combination medications Advicor® (lovastatin + niacin), Caduet® (atorvastatin + amlodipine), and Vytorin™ (simvastatin + ezetimibe).

“Trial after trial has shown us that when we use statins appropriately in patients that we feel would benefit from them, [those patients] have a decreased risk of developing heart attack, they have decreased risk of developing stroke, and there’s a decreased risk of death,” says Dr. Bloom.

Selective cholesterol absorption inhibitors

Selective cholesterol absorption inhibitors are a newer class of drugs that work by preventing cholesterol from being absorbed in the intestine. These drugs are most effective at lowering “bad” LDL cholesterol, but also have an effect on lowering triglycerides and raising “good” HDL cholesterol.

“One of them is called ezetimibe,” says Dr. Knoepflmacher.  “It is not a statin and it works by a different mechanism; it works by blocking cholesterol absorption in the gut. It’s good for people who can’t tolerate statins for one reason or another.”

PCSK9 inhibitors

PCSK9 inhibitors work to target and inactivate a certain protein in the liver, called proprotein convertase subtilisin kexin 9. Knocking out this protein helps lower the amount of “bad” LDL cholesterol in the blood.

“PCSK9 inhibitors work by a different way than statins by injection. Some doctors are starting now to use them, particularly in patients that can’t tolerate statin therapy,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital.  

 

The Importance of Treating High Cholesterol

Untreated high cholesterol can cause plaque to build up on the arteries, which can lead to high blood pressure, chest pain, impaired kidney function, and heart attack, says Dr. Bond.

“Knowing what your cholesterol levels are and having that conversation with your doctor—whether it be lifestyle changes or starting you on a medication—is very, very important,” says Dr. Bond.

Rachel Bond, MD

This video features information from Rachel Bond, MD. 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.

Paul Knoepflmacher, MD

This video features information from Paul Knoepflmacher, MD. Dr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.

Michelle Weisfelner Bloom, MD

This video features information from Michelle Weisfelner Bloom, MD. 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.

Duration: 2:53. Last Updated On: July 25, 2018, 5:14 p.m.
Reviewed by: Preeti Parikh, MD . Review date: July 25, 2018
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