Medication
Your health care provider may prescribe medicine if: 1 You have already had a heart attack or stroke, or you have peripheral arterial disease. 2 Your LDL cholesterol level is 190 mg/dL or higher. 3 You are 40–75 years old with diabetes and an LDL cholesterol level of 70 mg/dL or higher. More items...
Self-care
If cholesterol concentrations are very high in younger adults, it sometimes may be judicious to introduce a cholesterol-lowering drug. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.
Nutrition
In patients with severe primary hypercholesterolemia (LDL-C ≥190 mg/dL (≥4.9 mmol/L)), without concomitant ASCVD, begin high-intensity statin therapy (or moderate intensity statin + ezetimibe) to achieve in LDL-C goal of < 100 mg/dL; if this goal is not achieved, consider adding PCSK9 inhibitor in selected patients at higher risk.
When can a doctor prescribe medication for high cholesterol?
Once your cholesterol levels have improved, your health care team will monitor them to ensure they stay in a healthy range. Your treatment plan for high cholesterol will depend on your current cholesterol levels and your risk of heart disease and stroke.
When to introduce a cholesterol-lowering drug in younger adults?
When should patients with primary hypercholesterolemia begin high-intensity statin therapy?
What should I do if my cholesterol levels are high?
How to treat high cholesterol?
How it’s treated: A low- fat diet, regular exercise, and staying at a healthy weight are part of a good plan to reduce high cholesterol. People with genetic high cholesterol likely will also need to treat it with medications, usually a statin. Other medications could include nicotinic acid ( niacin) to lower your LDL and raise your HDL, bile acid-binding drugs, fibrates, or ezetimibe ( Zetia) in combination with a statin.
What causes high cholesterol?
Secondary high cholesterol is linked to health conditions like diabetes, heavy drinking, chronic kidney disease, hypothyroidism, and a high-fat diet or lack of exercise. Certain drugs for other medical conditions, like steroids, can cause high cholesterol, too.
What does it mean when your LDL is too high?
Low-density lipoprotein ( LDL ), or “bad cholesterol.” If your LDL level is too high, you’re at greater cardiac risk. LDL is the cholesterol that clumps up and clogs your arteries.
What is high cholesterol called?
Primary high cholesterol is also called familial hypercholesterolemia (FH). It’s when high cholesterol runs in your family. You may have very high levels of LDL cholesterol, which puts you at high risk of heart disease, even at a younger age.
What is the risk of cardiac arrest at age 40?
40-75, and your cardiac risk is borderline ( 5% to less than 7.5%)
Can cholesterol cause a stroke?
This can clog and narrow your arteries so blood can’t flow easily. Blood clots can form, break away, and cause a stroke or heart attack.
Do you need to take statins for high cholesterol?
You may not need to treat high cholesterol with medications like statins now if you are:
How to manage high cholesterol?
A variety of lifestyle changes can help you manage high cholesterol levels. This includes eating a heart-healthy diet, exercising regularly, and maintaining a moderate weight. If those changes aren’t enough, speak with your doctor about prescription medications that can help treat high cholesterol.
What to do if your LDL is too high?
If your LDL or total cholesterol levels are too high, your doctor can recommend lifestyle changes and medications to improve them. Here are some tips to help bring your cholesterol numbers into a healthy range.
Why is my LDL cholesterol higher?
Some people have a genetic condition called familial hypercholesterolemia, which causes higher LDL cholesterol levels. This can make it harder to address high cholesterol.
What is the average cholesterol level?
total cholesterol: less than 200 mg/dL. LDL cholesterol: less than 100 mg/dL. HDL cholesterol: 60 mg/dL or higher. Your target cholesterol levels may be slightly lower or higher depending on your age, sex, and heart disease risks.
How to get rid of excess LDL cholesterol?
A fast walk or bike ride each day can boost your HDL cholesterol, which helps sweep excess LDL cholesterol out of your bloodstream. Try to get in at least 30 minutes of moderate-intensity aerobic exercise 5 days a week. Extra fat around your middle section can increase your LDL cholesterol and lower your HDL cholesterol.
How does cholesterol absorption inhibitor work?
Cholesterol absorption inhibitors lower cholesterol by blocking the absorption of cholesterol in your intestines.
How to bring your numbers to healthy levels?
Making a few changes to your diet can help bring your numbers to healthy levels. Avoid or limit foods that contain these types of fats:
How old do you have to be to have your cholesterol checked?
If you’re 20 years or older, have your cholesterol tested and work with your doctor to adjust your cholesterol levels as needed. Often, changing behaviors can help bring your numbers into line. If lifestyle changes alone don’t improve your cholesterol levels, medication may be prescribed. Lifestyle changes include:
What does it mean when you have too much cholesterol?
One type of hyperlipidemia, hypercholesterolemia, means you have too much non-HDL cholesterol and LDL (bad) cholesterol in your blood. This condition increases fatty deposits in arteries and the risk of blockages.
Why is my cholesterol out of balance?
Another way your cholesterol numbers can be out of balance is when your HDL (good) cholesterol level is too low. With less HDL to remove cholesterol from your arteries, your risk of atherosclerotic plaque and blockages increases. If you’re diagnosed with hyperlipidemia, your overall health and other risks such as smoking or high blood pressure will ...
What to do if you have high LDL?
If you have high low-density lipoprotein (LDL) cholesterol, your health care provider may prescribe medicine in addition to lifestyle changes to control your LDL cholesterol level.
How old do you have to be to have a high LDL?
You are 40–75 years old with diabetes and an LDL cholesterol level of 70 mg/dL or higher. You are 40–75 years old with a high risk of developing heart disease or stroke and an LDL cholesterol level of 70 mg/dL or higher. Talk with your health care team about how you can lower your risk for heart disease.
What is the name of the drug that lowers LDL cholesterol?
A newer type of medicine called PCSK9 inhibitors lowers cholesterol. These medicines are primarily used in people who have familial hypercholesterolemia, a genetic condition that causes very high levels of LDL cholesterol.
How does statin medicine lower cholesterol?
Cholesterol Lowering Medications. Type of Medicine. How It Works. Statins. Statin drugs lower LDL cholesterol by slowing down the liver’s production of cholesterol. They also increase the liver’s ability to remove LDL cholesterol that is already in the blood.
What is the best vitamin for lowering cholesterol?
The body needs bile acids and makes them by breaking down LDL cholesterol. Niacin, or nicotinic acid. Niacin is a B vitamin that can improve all lipoprotein levels.
What is the purpose of bile acid chelators?
Bile acid chelators prevent bile acids from the stomach from being absorbed into the bloodstream. In order to make more of these digestive substances , the liver must extract cholesterol from the blood and lower cholesterol levels.
How to get LDL cholesterol out of blood?
Daily brisk walking or bicycling can help raise HDL cholesterol, thereby removing excess LDL cholesterol from the blood. Try to get at least 30 minutes of moderate-intensity aerobic exercise five days a week.
What is the most influential cholesterol management program in the United States?
The most influential guidelines for cholesterol management in the United States have been those developed by the NECP. This program was sponsored by the National Heart, Lung and Blood Institute and included many health-related organizations in the United States (28). Between 1987 and 2004, three major Adult Treatment Panel (ATP) reports (3; 30; 31) and one update were published (31) (Table 4).
What is the relationship between cholesterol and ASCVD?
A relationship between cholesterol levels and ASCVD risk is observed in both developing and developed countries (2; 3). Populations with the lowest cholesterol levels have the lowest rates of ASCVD. Within populations, individuals with the lowest serum cholesterol carry the least risk. In other words, “the lower, the better” for cholesterol levels holds, both between populations and for individuals within populations.
How much does statin reduce LDL?
Meta-analysis has shown that for every mmol/L (39 mg/dl) reduction in LDL-C with statin therapy there is an approximate 22% reduction in ASCVD events (8, 4, 9, 10, 11). Another report (12) showed that an almost identical relationship holds when several different kinds of LDL-lowering therapy were analyzed together. This response appears to be consistent throughout all levels of LDL-C. Individual statins vary in their intensity of cholesterol-lowering therapy at a given dose (1) (Table 2). For example, per mg per day, rosuvastatin is twice as efficacious as atorvastatin, which in turn is twice as efficacious as simvastatin. Statins are best classified according to percentage reductions in LDL-C. As shown in Table 2, moderate- intensity statins reduce LDL-C by 30-49%, whereas high-intensity statins reduce LDL-C by >50%. On average, a 35% LDL-C reduction by moderate-intensity statin reduces risk by approximately one third, whereas high-intensity statins lower risk by about one-half. But, in fact, absolute reductions vary depending on baseline levels of LDL-C. For example, for a baseline LDL-C of 200 mg/dL, a 50% reduction in LDL-C equates to a 100 mg/dL (2.6 mmol/L) decline; this translates into a 59% reduction in 10-year risk for ASCVD events. In contrast, in a patient with a baseline LDL-C a 100 mg per dL, a 50% reduction in LDL-C equates to a 50 mg/dL (1.3 mmol/L) decline, which will reduce ASCVD risk by about 30%. Thus, at lower and lower levels of LDL-C, progressive reductions of LDL-C produce diminishing benefit from cholesterol-lowering therapy. This modifies the aphorism "lower is better". Whereas the statement is true, it must be kept in mind that there are diminishing benefits from intensifying cholesterol-lowering therapy when LDL-C levels are already low.
How do statins lower cholesterol?
Statins were discovered in the 1970s by Endo of Japan (6). These drugs lower cholesterol by inhibiting cholesterol synthesis in the liver. They block HMG CoA reductase, a key enzyme in cholesterol synthesis. This inhibition enhances the liver’s synthesis LDL receptors. The latter, discovered by Brown and Goldstein (7), remove LDL and VLDL from the bloodstream, which lower serum cholesterol. Statin have proven to be highly efficacious with few side effects. The development of statins as a cholesterol-lowering drug has been actively pursued by the pharmaceutical industry. Several statins have been approved for use in clinical practice by the FDA. Over the past three decades, a series of RCTs have been carried out that documents the efficacy and safety of statin therapy. In these RCTs, statin therapy has been shown to significantly reduce morbidity and mortality from ASCVD. Although individual RCTs produced significant results, the strongest evidence of benefit comes from meta-analysis. i.e., by combining data from all the trials (4).
How does cholesterol affect atherosclerosis?
The first evidence for a connection between serum cholesterol levels and atherosclerosis came from laboratory animals. Feeding cholesterol to various animal species raises serum cholesterol and causes deposition of cholesterol in the arterial wall. The latter recapitulates early stages of human atherosclerosis. Subsequently, in humans, severe hereditary hypercholesterolemia was observed to cause premature atherosclerosis and ASCVD. Later, population surveys uncovered a positive association between serum cholesterol levels and ASCVD (2, 3). Finally, clinical trials with cholesterol-lowering agents documented that lowering of serum cholesterol levels reduces the risk for ASCVD (4). These findings have convinced most investigators that the cholesterol hypothesisis proven. Moreover, the relationship between cholesterol levels and ASCVD risk is bidirectional; raising cholesterol levels increases risk, whereas reducing levels decreases risk (Figure 1).
What drugs lower LDL?
Other LDL-lowering drugs include microsomal triglyceride transfer protein (MTP) inhibitors (21) and RNA antisense drugs that block hepatic synthesis of apolipoprotein B (22). Both of these drugs inhibit secretion of atherogenic lipoproteins into the circulation. At present their use is restricted to patients with severe hypercholesterolemia. Another class of drugs inhibits cholesterol ester transfer protein (CETP); these agents lower LDL-C levels as well as raising HDL-C (23; 24). RCTs show their benefit is small, if any, so the pharmaceutical industry shows little interest in further development. Finally, a new class of drugs inhibits a circulating protein called proprotein convertase subtilisin/kexin type 9 (PCSK9); the PCSK9 protein promotes degradation of LDL receptors and raises LDL-C levels. Inhibition of PCSK9 markedly lowers LDL-C concentrations (25). Recent reports indicate that PCSK9 inhibitors reduce risk in ASCVD patients at very high risk when combined with statins (26, 27). However, absolute risk reductions are limited because LDL-C levels usually are already low in patients who are treated with high-intensity statins. PCSK9 inhibitors, however, could be useful for patients who are statin intolerant or those with very high baseline LDL-C, such as familial hypercholesterolemia.
Is there a correlation between cholesterol and atherosclerotic cardiovascular disease?
The Cholesterol Hypothesis. Between the years 1955 and 1985, many epidemiologic studies showed a positive relation between cholesterol levels and atherosclerotic cardiovascular disease (ASCVD) events. Over the next 30 years, a host of randomized controlled clinical trials has demonstrated that lowering cholesterol levels will reduce risk for ASCVD. This bidirectional relationship between cholesterol levels and ASCVD provides ample support for the cholesterol hypothesis.
What to do if you take a medicine with high cholesterol?
If you take medicine to treat high low-density lipoprotein (LDL) cholesterol, heart disease, stroke, or diabetes, follow your health care team’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist.
What to do if you are concerned about your cholesterol?
Managing High Cholesterol. If you are concerned about your cholesterol, talk to your health care team about steps you can take to manage your cholesterol.
How to lower LDL cholesterol?
You can take steps to lower your high LDL cholesterol levels by making healthy changes to your lifestyle, such as choosing foods lower in saturated and trans fats and maintaining a healthy weight.
What is the first choice for CVD?
As with people who already have known CVD, when the decision is made to start medication, the first choice is usually a statin. (See 'Statins' below.)
How to reduce LDL cholesterol?
Lifestyle changes — If you have high low-density lipoprotein (LDL) cholesterol, you should try to make some changes in your day-to-day habits, including reducing the amount of total and saturated fat in your diet, losing weight (if you are overweight or obese), getting regular aerobic exercise, and eating plenty of fruits and vegetables (see "Patient education: Exercise (Beyond the Basics)" and "Patient education: Diet and health (Beyond the Basics)" ). A plant-based diet is an effective strategy to lowering LDL cholesterol.
What is the LDL cholesterol level after statins?
After starting statin therapy, the LDL cholesterol is rechecked; a second medication may be suggested if the level is higher than 70 mg/dL (1.81 mmol/L). Studies have found that if the LDL cholesterol is reduced to less than 70 mg/dL, the size of the plaques can get smaller.
What is familial hypercholesterolemia?
Familial hypercholesterolemia — Some patients have extremely high levels of LDL cholesterol, eg, >190 mg/dL and a family history of others with such high levels. These patients often have a genetic factor that leads to a change in how cholesterol is processed in the body, and they have high levels of cholesterol from birth. As such, their risk of developing heart disease is much higher. These patients are recommended for treatment regardless of the risk score, with treatment often started in late teenage years.
What is the medication for heart attack?
People who have been hospitalized following a heart attack (also called a "myocardial infarction" or MI) or after a coronary intervention procedure (eg, stent placement or bypass surgery) are started on cholesterol-lowering medication (usually a high-dose statin) before going home from the hospital; they are also advised to make lifestyle changes related to improving their diet and exercise habits, reduce their weight if overweight, regardless of their LDL cholesterol level. (See "Patient education: Heart attack recovery (Beyond the Basics)" .)
How to lower lipids?
You can help lower your lipid levels with lifestyle changes, medications, or a combination of both. In certain cases, a health care provider will recommend a trial of lifestyle changes before recommending a medication. The best approach for you will depend on your individual situation, including your lipid levels, health conditions, risk factors, medications, and lifestyle.
How to lower triglycerides?
Dietary interventions and exercise are usually effective in lowering triglycerides. The dietary interventions include limiting intake of refined carbohydrates, excess calories, and alcohol.
What is the best treatment for high cholesterol in children?
Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol, or who are obese. Children age 10 and older might be prescribed cholesterol-lowering drugs, such as statins, if they have extremely high cholesterol levels.
What is the first degree of family to be checked for hypercholesterolemia?
If you are diagnosed with familial hypercholesterolemia, doctors usually recommend that your first-degree relatives — such as siblings, parents and children — be checked for the disorder. This will allow treatment to begin early, if needed.
How much LDL cholesterol is familial hypercholesterolemia?
Adults who have familial hypercholesterolemia usually have LDL cholesterol levels over 190 mg/dL (4.9 mmol/L). Children who have the disorder often have LDL cholesterol levels over 160 mg/dL (4.1 mmol/L). In severe cases, LDL cholesterol levels can be over 500 mg/dL (13 mmol/L).
What medications can lower triglycerides?
If you also have high triglycerides, your doctor may prescribe: 1 Fibrates. The medications fenofibrate (Tricor) and gemfibrozil (Lopid) decrease triglycerides by reducing your liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides. 2 Niacin. Niacin (Niaspan) decreases triglycerides by limiting your liver's ability to produce LDL and VLDL cholesterol. But niacin doesn't usually provide any additional benefit than using statins alone. Niacin has also been linked to liver damage and stroke, so most doctors now recommend it only for people who can't take statins. 3 Omega-3 fatty acid supplements. Omega-3 fatty acid supplements can help lower your triglycerides. They are available by prescription or over-the-counter. If you choose to take over-the-counter supplements, get your doctor's OK first. Omega-3 fatty acid supplements could affect other medications you're taking.
What foods can help with familial hypercholesterolemia?
Good sources include oats, peas, beans, apples, citrus fruits and carrots. Increasing physical activity. Maintaining a healthy body weight. With familial hypercholesterolemia, your doctor likely will also recommend that you take medication to help lower your LDL cholesterol levels.
What is the name of the drug that helps the liver absorb more LDL cholesterol?
PCSK9 inhibitors. These newer drugs — alirocumab (Praluent) and evolocumab (Repatha) — help the liver absorb more LDL cholesterol, which lowers the amount of cholesterol circulating in the blood. They're injected under the skin every few weeks and are very expensive.
What is the best medication for high LDL?
The Food and Drug Administration recently approved alirocumab (Praluent) and evolocumab (Repatha) for people who have a genetic condition that causes very high levels of LDL. These drugs may also be used for people who have had heart attacks or strokes and need additional lowering of their LDL levels.
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