Cholesterol is a waxy, fat-like substance found in every cell of the body, which needs some of it to work properly. Too much in the blood can stick to artery walls, narrowing or even blocking them and raising the risk of coronary artery disease and other heart disease.
The liver makes cholesterol, which travels through the blood on proteins called lipoproteins:
- LDL, sometimes called “bad” cholesterol — a high level leads to cholesterol building up in the arteries
- HDL, sometimes called “good” cholesterol — it carries cholesterol from the rest of the body back to the liver, which removes it
Lifestyle first — and always
Lifestyle changes can lower high cholesterol. When they are not enough, medicine is added — but the lifestyle changes should continue alongside it.
Who needs cholesterol medicine?
A health care provider may prescribe it if you:
- have already had a heart attack or stroke, or have peripheral arterial disease
- have an LDL level of 190 mg/dL or higher
- are 40–75 years old, have diabetes, and an LDL level of 70 mg/dL or higher
- are 40–75 years old, at high risk of heart disease or stroke, with an LDL level of 70 mg/dL or higher
The types of medicine
| Medicine | How it works | Notes |
|---|---|---|
| Statins | cut the cholesterol the liver makes and boost its ability to clear LDL already in the blood | the most common treatment |
| Bile acid sequestrants | stop bile acids, which digest fats, from being absorbed; the liver makes more by breaking down LDL | for people who can’t take statins, or when statins alone aren’t enough |
| Cholesterol absorption inhibitors | block the body from absorbing cholesterol | same uses as above |
| Nicotinic acid (niacin) | a B vitamin that cuts the fats the liver makes, lowering LDL and triglycerides and raising HDL | sold without prescription, but ask your provider first — high doses can cause serious side effects |
| PCSK9 inhibitors | block the protein PCSK9, helping the liver clear LDL from the blood | may be given with a statin to people at high risk of heart attack or stroke, or with familial hypercholesterolemia |
| Fibrates | lower triglycerides, partly by cutting how much the liver makes; may raise HDL and lower LDL a little | taking them with statins may raise the risk of side effects |
| Combination medicines | combine more than one cholesterol drug; some also treat high blood pressure |
Familial hypercholesterolemia (FH) is an inherited disorder that causes very high blood cholesterol. A few medicines — lomitapide and mipomersen — are used only for people with FH.
Choosing the medicine and dose
Your provider weighs:
- your cholesterol levels
- your risk of heart disease and stroke
- your age
- any other health problems
- possible side effects — which are more likely at higher doses, especially over time
Medicine controls, it doesn’t cure
Cholesterol medicines keep levels in check but do not cure high cholesterol. Keep taking them, and have regular cholesterol checks to make sure your levels stay in a healthy range.
Sources
Based on "Cholesterol Medicines," MedlinePlus, U.S. National Library of Medicine; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from medlineplus.gov
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