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 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 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.
00:00:00,000 --> 00:00:02,471
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There are many different types of
medicines that we can use to lower
00:00:06,135 --> 00:00:08,042
patients' cholesterol levels.
00:00:08,042 --> 00:00:12,531
The main ones that patients really
need to know about are called statins.
00:00:12,531 --> 00:00:17,780
00:00:17,780 --> 00:00:20,957
In addition to helping your
body produce less cholesterol and
00:00:20,957 --> 00:00:24,747
lowering the blood levels of cholesterol,
statins have an effect beyond
00:00:24,747 --> 00:00:28,800
that in terms of reducing cardiovascular
disease and heart attacks.
00:00:28,800 --> 00:00:32,490
They have an anti-inflammatory effect
which we think is important and
00:00:32,490 --> 00:00:35,821
is something that helps beyond
just the cholesterol lowering.
00:00:35,821 --> 00:00:38,356
Statins work by decreasing cholesterol
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production in the liver.
00:00:41,130 --> 00:00:45,290
Above and beyond any other class
of cholesterol lowering medicines,
00:00:45,290 --> 00:00:47,300
we know that statins work.
00:00:47,300 --> 00:00:51,835
Trial after trial has shown us that
when we use statins appropriately in
00:00:51,835 --> 00:00:55,735
patients that we feel would benefit
from them, they have a decreased risk
00:00:55,735 --> 00:00:59,470
of developing heart attack, they have
decreased risk of developing a stroke, and
00:00:59,470 --> 00:01:03,849
there's a decreased risk of death.
If a patient can't tolerate a statin or
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their levels are not where they need to
be based on what their risk factors are,
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we may then consider
initiating other medications.
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One of them is called ezetimibe,
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and that has been around for
a while and has been studied and
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has some positive outcomes.
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It is not a statin and
it works by a different mechanism.
00:01:21,170 --> 00:01:25,130
It works by blocking cholesterol
absorption in the gut.
00:01:25,130 --> 00:01:28,680
It's good for people who can't
tolerate statins for one reason or
00:01:28,680 --> 00:01:31,500
There's a new class of medicines called
00:01:31,500 --> 00:01:36,070
PCSK9 inhibitors which work by
a different way than statins and
00:01:36,070 --> 00:01:38,420
they're used by injection.
00:01:38,420 --> 00:01:43,316
Some doctors are starting now to use them,
particularly in patients that can't
00:01:43,316 --> 00:01:46,641
tolerate statin therapy.
The management of patients with high
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cholesterol again depends on the
individual and how they're being treated.
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If I have a patient that I'm just putting
on a regimen of lifestyle change, diet,
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exercise, and so on, I may have them
come back every six months, every year.
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But if I am starting medicine on them, I'm
gonna wanna check them more frequently.
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Probably after a couple of months, and
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then maybe every six months
to a year thereafter,
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assuming that they're doing well.
Untreated high cholesterol,
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depending on how long you've
been suffering from it,
00:02:13,630 --> 00:02:16,910
can cause plaque to build
up in the arteries.
00:02:16,910 --> 00:02:21,320
And eventually that plaque can ultimately
rupture and lead to a heart attack.
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It could also lead to
a narrowing in the artery,
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which could lead to chest discomfort.
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It also can affect your kidney function
because we do also have arteries
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in our kidneys.
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And with time it can cause your kidneys
to sort of not function appropriately
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which can make your blood pressure raise.
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Really knowing what your
cholesterol levels are and
00:02:39,807 --> 00:02:44,066
having that conversation with your doctor,
either it be lifestyle changes or
00:02:44,066 --> 00:02:46,980
starting you on a medication
is very very important.
00:02:46,980 --> 00:02:53,737
PCSK9 inhibitors: A new era of lipid lowering therapy. Allentown, PA: Division of Cardiology, Lehigh Valley Health Network, 2017. (Accessed on July 25, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329749)
Work With Your Doctor to Find the Right Cholesterol Meds. American Heart Association. (Accessed on July 25, 2018 at http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp#.W1iVtthKiL4)