FAQs About High Cholesterol Treatment

If you have been diagnosed with high cholesterol, you will need to begin making lifestyle changes such as eating a heart-healthy diet and getting regular exercise.

You may need to prescribed medications to help control your cholesterol if changes in lifestyle are not enough to lower your level of LDL or increase your level of HDL.

If you have never taken cholesterol medications before, you will probably have some questions about your new medication regimen. Listed below are some questions you might want to ask your doctor, along with a brief summary of what their response might be.

Cholesterol is a substance that is produced by the liver and moves through the bloodstream. It is a fatty, waxy substance. There are two types of cholesterol, and they’re about as far apart as you can get:

HDL (high-density lipoprotein) and LDL (low-density lipoprotein)

• HDL is a type of cholesterol that is often referred to as “good” cholesterol. HDL cholesterol works by grabbing up LDL cholesterol in the bloodstream and carrying it back to the liver to be processed and removed as waste.
• LDL is a type of cholesterol that can build up in artery walls if levels become too high. Over time, this buildup can lead to heart disease, heart attack, or stroke.

VLDL cholesterol is a type of cholesterol that carries triglycerides through the bloodstream. Triglycerides are fats that come from the food we eat. If there are high levels of these fats in our bloodstream, it can cause problems similar to LDL cholesterol.

The routine blood test that checks for high cholesterol, called a lipid profile or lipid panel, reports your results as four components:

• is considered borderline high when it's above 240 mg/dL. Your total cholesterol level is considered borderline high if it is above 240 mg/dL. This is because it is the sum of your LDL, HDL, and 20% of your triglyceride level.
• LDL cholesterol
• HDL cholesterol
• Triglycerides

The goal for cholesterol levels is to have the total cholesterol be below 200 mg/dL and the LDL cholesterol be below 100 mg/dL. If there are existing heart problems, then the LDL cholesterol goal should be below 70 mg/dL. When the levels are higher, it is more likely for there to be blockages in the arteries which could lead to heart disease, heart attack, or stroke.

Here are the ideal numerical ranges for each component of a cholesterol test. High cholesterol (or high triglycerides) is determined by your doctor based on your numbers.

Total Cholesterol:

• Below 200 mg/dL is the goal.
• If your blood sugar is between 200 and 239, it is time to take action.
• If your blood sugar is 240 mg/dL or higher, you need a comprehensive plan to get it under control.

LDL Cholesterol:

For people without heart disease or an elevated risk of developing heart disease:

• Below 100 mg/dL is optimal.
• 100-129 mg/dL is near optimal.
• 130-159 mg/dL is borderline high.
• 160-189 mg/dL is high.
• 190 mg/dL and above is very high.

For people with heart disease or coronary artery disease:

• Below 70 mg/dL is optimal.
• 70-99 mg/dL is near optimal.
• 100-159 mg/dL is high.
• 160 mg/dL and above is very high.

HDL Cholesterol:

• If a man's cholesterol level is below 40 mg/dL, it is considered poor. If a woman's cholesterol level is below 50 mg/dL, it is considered poor.
• In both men and women, a blood sugar level of 40-59 mg/dL is considered good.
• 60 mg/dL and above is ideal for everyone.

Triglycerides:

• Below 150 mg/dL is optimal.
• 150-199 mg/dL is borderline high.
• 200-499 mg/dL is high.
• 500 mg/dL and above is very high.

After taking into account factors such as your medical history and gender, your doctor will use your test results to determine whether you have high cholesterol and, if so, the best way to manage it.

1. What are the target levels for LDL and HDL cholesterol?

Prior to learning about the target cholesterol levels, it is beneficial to understand the different types of cholesterol. Cholesterol is a wax-like substance that is made by the liver and can also be found in particular foods. LDL is known as bad cholesterol because it can create a buildup in arteries which then increases the risk of having a heart attack or stroke. HDL cholesterol removes LDL cholesterol from arteries and carries it back to the liver where it is broken down and flushed from the body.

Cardiologists are more focused on your risk of heart disease when managing cholesterol than on numbers, according to Peter Schulman. He explains that research on LDL levels has been inconclusive and that targets for LDL and total cholesterol levels depend on your age and overall health. If your LDL and total cholesterol are above recommended targets, you should talk to your doctor about how to improve them.

2. How will I know if I need medication to treat my cholesterol?

Cardiologists now use the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator to determine a patient's need for cholesterol-lowering drugs. The calculator considers age, blood pressure, and levels of LDL, HDL, and total cholesterol, among other factors, to estimate the ten-year risk of coronary artery disease, heart attack, or stroke. A risk of 7.5 percent or higher typically prompts a recommendation for cholesterol-lowering drugs from a doctor.

3. What medications are available to treat high cholesterol? How do they work?

The American Heart Association (AHA) recommends treatment with drugs called statins for people who cannot maintain healthy cholesterol levels with diet and exercise. Statins work in the liver to prevent cholesterol from forming, which reduces the amount of cholesterol circulating in the blood, according to the AHA. They are most effective at lowering LDL levels, but they can also help reduce triglycerides and raise HDL. The AHA recommends statins for adults with a history of heart disease or stroke caused by atherosclerosis, as well as adults between 40 and 75 years of age with high cholesterol. If your LDL levels are 190 mg/dL or above while taking statins, your doctor may recommend “high-intensity” or high-dose statin treatment in order to drop your bad cholesterol by 50 percent or more.

If you cannot tolerate or statins are not effective enough, your doctor may prescribe other cholesterol lowering drugs. These include PCSK9 inhibitors to remove cholesterol from the blood; selective cholesterol absorption inhibitors to prevent cholesterol from being absorbed; and resins or bile acid-binding drugs to help the intestines eliminate cholesterol. In addition, fibrates, niacin, and omega-3 fatty acid-based medications can increase HDL and reduce triglycerides. All of these drugs can be used with or without statins. Your doctor will work with you to determine the best medication or combination of medications.

4. How often should I have my cholesterol levels tested?

The AHA advises that once you start a new treatment plan for cholesterol management, your doctor should run a fasting or non-fasting lipid test 4-12 weeks later. They advise that after that initial test, LDL levels should be monitored every 3-12 months, depending on the patient's progress. The AHA emphasizes that it is more important to monitor the percentage reduction in LDL cholesterol, rather than the levels themselves. This will give your doctor a snapshot of how your new treatment is working.

5. Are there side effects of cholesterol medication?

muscle pain is a common side effect of statin drugs, with approximately 20% of patients on statins reporting some form of pain. This pain can range from mild soreness to debilitating pain that makes everyday activities difficult. While most cases are mild, a small percentage of patients taking statins may experience more severe side effects such as muscle damage or increased liver inflammation. There is also a risk of memory loss or confusion, although this is more common in older adults.The risk of the side effects of statins generally low and differs from person to person. You should talk to your doctor about the benefits of taking these drugs, such as lowering cholesterol and helping to prevent heart attacks and strokes, to see if they are worth it.

Non-statin drugs for lowering cholesterol have some potentially unpleasant side effects, like nausea, vomiting, stomach trouble, gas, constipation, muscle pain, and headaches, but according to the Mayo Clinic, the chance of experiencing them is very low. Also, if you're pregnant or planning to be, talk to your doctor about whether it's safe to keep taking your cholesterol-lowering drugs.

6. Can I stop taking cholesterol medication once my LDL level comes down?

Your doctor will likely prescribe a statin for the rest of your life according to the National Health Service. The reason for this is that your LDL level will rise within a few weeks of stopping the medication. If you experience side effects, your doctor may adjust your dose or switch you to another statin or medication. Schulman explains that you can still get about 70 percent of the cholesterol-lowering benefits of statins even if you take them only two or three times per week instead of daily. If you develop other health conditions that make statin use risky, such as liver disease, your doctor may prescribe an alternative, including injectable PCSK9 inhibitors, which are administered using a small needle every two weeks.You should talk to your doctor before discontinuing your cholesterol-lowering medication.

7. Can certain medications, supplements, or foods interfere with cholesterol medication?

List of medications that may interfere with statins: antibiotics, antifungals, antacids, blood pressure medications, oral contraceptives. If you are taking any of these medications and are prescribed a statin, tell your doctor so they can monitor you more frequently or lower your statin dose.

Eating grapefruit or drinking grapefruit juice can have negative consequences for people taking statins, according to Schulman. These negative effects can usually be avoided by not eating grapefruit or drinking grapefruit juice at the same time as taking a dose of a statin.

8. Do I still need to exercise and watch my diet if I’m taking cholesterol medication?

You will need to exercise and eat healthy even while taking medication to help reduce your LDL levels. Quitting smoking and losing weight can also help lower cholesterol.

9. Can complementary therapies help manage high cholesterol?

There are few natural products that have been proven to lower cholesterol, but some supplements may be helpful. Just as there are drugs available to treat high cholesterol that are based on omega-3 fatty acids, so too can over-the-counter supplements containing this nutrient help you maintain healthy levels. Foods like salmon are also an excellent source of omega-3s. In addition, red yeast rice supplements have also been shown to lower LDL and total cholesterol.The Food and Drug Administration noted that you cannot be sure of how much of the supplement you are taking, and it is advised to talk to a doctor before trying a supplement or other complementary therapy.

10. Might my treatment plan change if I experience a complication, such as a heart attack?

Generally, drugs that lower cholesterol levels also reduce the likelihood of having a heart attack or stroke, but this is not guaranteed, according to the American Heart Association. If somebody taking cholesterol-lowering medication has a heart attack or stroke, it's possible that the drug by itself is not sufficiently controlling the person's cholesterol. Another possibility is that the person has developed another health condition that increases their risk of heart disease, such as high blood pressure or type 2 diabetes. In either case, it's probable that a doctor would want to reassess the treatment plan if the person's overall health changes, which could involve either changing the dose of the existing medication or prescribing a different one, Schulman says.

If unchecked, too much cholesterol will not only keep building up in the blood, but it will also start to line the artery walls with a deposit called plaque.

The plaques mentioned can cause the arteries to narrow, which can then lead to heart attacks and strokes. This is especially true when cholesterol levels are high.

The goal of high cholesterol treatment is to lower the levels of bad cholesterol while raising the levels of good cholesterol.

The best high cholesterol treatment for you will be based on a variety of personal factors. These include:

• , you have some options for lowering it. No matter the level of your cholesterol, there are ways to lower it.
• , are trying to lower your cholesterol for other reasons, or just want to eat a healthier diet, you can make changes that will have a positive effect. If you have a personal or family history of high cholesterol or heart disease, want to lower your cholesterol for other reasons, or just want to eat a healthier diet, you can make changes that will have a positive effect.
• Your weight
• Whether you smoke

There is not a single solution that will work for everyone. If your cholesterol is only slightly high and you have no other risk factors, making lifestyle changes may be enough to improve your cholesterol levels. If the lifestyle changes aren’t having the desired effect on your cholesterol levels, your doctor may start recommending cholesterol medications.

If your family has a history of high cholesterol or you have several risk factors for heart disease, your doctor may recommend a combination of medication and lifestyle changes.