Treatment for high cholesterol varies by individual. While some people are able to manage their cholesterol levels with lifestyle changes like exercise and diet alone, others need medication to lower their risk for heart health issues.
It’s common to have concerns about beginning treatment with medication, but remember that taking cholesterol-lowering medication is normal: more than 40 million U.S. adults take statins, the first-line medication for high cholesterol. And if you have high cholesterol, the most important thing is working with your doctor to determine what you need to live your healthiest life.
Below, we explain more about different cholesterol treatment options and when it may be necessary to take medication.
Key facts about cholesterol
Before we dive in, let’s review the basics about cholesterol.
Defining high cholesterol
Cholesterol is a lipid — a soft, waxy, fat-like substance that’s found in your bloodstream and in your cells. There are two types: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is also called “bad cholesterol” because it can build up on the walls of your blood vessels, increasing your risk of a heart attack or stroke. HDL is considered “good cholesterol” because it can help remove LDL cholesterol from your body. When we say high cholesterol, we are typically referring to a person’s levels of LDL cholesterol.
Triglycerides are another type of lipid that your doctor will monitor. Like LDL cholesterol, they can accumulate in your blood vessels and are associated with heart health issues. Total cholesterol is a measure of all three components: LDL cholesterol, HDL cholesterol, and triglycerides.
While the exact definition of “healthy” cholesterol may vary by individual, these are some general guidelines.
A healthy range for total cholesterol is typically considered to be less than 200 milligrams per deciliter (mg/dL).
A healthy range for HDL cholesterol is typically considered to be higher than 40 mg/dL for men and higher than 50 mg/dL for women.
A healthy range for LDL cholesterol is typically considered to be less than 100 mg/dL.
A healthy range for triglycerides is typically considered to be less than 150 mg/dL.
It is possible to have high triglycerides without having high LDL cholesterol levels. There are medications that specifically target triglycerides while high-intensity statins can lower both LDL cholesterol and triglyceride levels.
Lifestyle changes that support healthy cholesterol levels
The following lifestyle practices can help you manage your cholesterol and triglycerides and are important even for those who take cholesterol-lowering medication.
Regular exercise: Moderate physical activity can help lower LDL cholesterol and increase HDL cholesterol. The American Heart Association recommends 150 minutes of moderate-intensity aerobic exercise per week, or about 30 minutes of moderate to intense exercise each day.
Diet: Certain types of food can increase your LDL cholesterol. Try to limit your consumption of saturated fats (common sources include red meat and full-fat dairy products) and avoid trans fats, also known as partially hydrogenated oils, as much as possible. On the other hand, unsaturated fats (olive oil, canola oil, and tree nuts); omega-3 fatty acids (salmon, mackerel, herring, and tuna); and soluble fiber (beans, peas, lentils, oats, and whole grains), can support healthy cholesterol levels.
Smoking cessation: If you have high cholesterol, quitting smoking can help lower both your cholesterol levels and your overall risk for heart disease.
Healthy alcohol consumption: If you drink, limiting your alcohol intake can help you manage your cholesterol, as heavy drinking can increase your cholesterol levels. The CDC recommends two alcoholic drinks per day for men and one for women.
When does a doctor prescribe cholesterol-lowering medication?
High cholesterol is one of the most common risk factors for heart disease. Effective cholesterol treatment can lower your risk for cardiovascular health issues, including a heart attack or stroke.
While statins were once considered exclusively cholesterol-lowering medications, we have learned more about their overall heart health benefits in recent years, and they are increasingly prescribed as a heart disease risk-reducing medication. Your doctor may prescribe a medication from this class even if your overall cholesterol numbers are in a healthy range.
When developing recommendations for cholesterol treatment, your doctor will consider a variety of health factors to assess your overall heart health, including the following.
Your cholesterol levels
While the exact definition of “healthy” cholesterol levels may vary by individual, a healthy range for LDL cholesterol is typically considered to be less than 100 mg/dL. If your LDL cholesterol is over 190 mg/dL, your doctor may recommend medication.
Overall heart health
Treatment plans account for other heart disease risk factors in addition to high cholesterol. For example, if you have diabetes — which can double your risk for heart disease and stroke — or another key risk factor, you may need to supplement lifestyle changes with medication even if your cholesterol is below the 190 mg/dL threshold.
Genetics
There are a variety of causes of high cholesterol, including lifestyle and health factors as well as genetics. People with a family history of high cholesterol often need medication, since lifestyle changes alone are less likely to lower cholesterol levels.
When making recommendations for treatment, your doctor may use a tool called a cardiac risk calculator, which assesses your chances of developing heart health issues based on your personal health history. Those with a higher score may be more likely to need cholesterol-lowering medication.
Is medication always a first-line treatment?
In some cases, a doctor will recommend cholesterol-lowering medication after first exploring lifestyle changes. Other times, medication is the best option for first-line treatment based on an individual’s health history and risk for heart disease. If your provider decides to start treatment with medication first, it doesn’t mean that you have failed to take care of your health on your own. Rather, it gives you an opportunity to keep your heart as strong as possible.
How will my doctor pick the right medication for me?
Treatment for high cholesterol and/or triglycerides varies by individual, and there is no one best medication. Your doctor will consider several factors when recommending a medication, including:
Your overall heart health and risk for cardiovascular issues
Other medications you take and potential interactions or side effects
The medication’s lowest effective dose — higher-intensity statins can reduce lipid levels at a lower dose than other medications
Whether you’re targeting LDL cholesterol, triglycerides, or both
There are a variety of medications for high LDL cholesterol and/or triglycerides, and it may take time for you and your doctor to determine the best treatment for your needs. Keep in mind that each person’s response to medication is unique. If you know someone who had side effects from one medication, it doesn’t mean that you will have the same experience.
What if my cholesterol medication causes side effects?
Like most medications, many commonly prescribed cholesterol-lowering medications have the potential for side effects. They are typically mild. Fortunately, there are a variety of medication options to consider. Remember, too, that in most cases, the benefits of a cholesterol medication far outweigh the potential risks.
Statins, the most common cholesterol medication, are often the starting point of cholesterol treatment with medication. Commonly prescribed statins include:
Atorvastatin (Lipitor®)
Fluvastatin (Lescol®)
Lovastatin (Mevacor®, Altoprev®)
Pravastatin (Pravachol®)
Rosuvastatin Calcium (Crestor®)
Simvastatin (Zocor®)
A small percentage of people who take statins experience muscle aches and elevated liver enzymes, two of the most common side effects. There are many alternatives for those who can’t take statins, including the following:
Ezetimibe (Zetia®), a cholesterol absorption inhibitor and the most commonly used non-statin cholesterol medication
PCSK9 inhibitors such as alirocumab (Praluent®) and evolocumab (Repatha®) - administered as injections every 2-4 weeks
Niacin (nicotinic acid)
Fibrates such as gemfibrozil (Lopid®) and fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide®) specifically target high triglycerides and are often used to lower triglyceride levels.
Will I need to take medication for the rest of my life?
This also varies by individual. Some people with high cholesterol need to take medication for the rest of their life. Others transition off of their medication if they have achieved healthy cholesterol levels and their doctor recommends a new treatment plan. Never stop taking medication without consulting your provider.
The pharmacy care you deserve
At Alto, we make it as simple as possible to stay on top of your cholesterol-lowering medications. We offer same-day delivery and medication management tools like reminders and auto refills in our app. And our expert pharmacists are always just a message away!
To learn more, reach out via in-app messaging.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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