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High cholesterol is one of the heart disease risk factors that you have control over. Here’s an overview of how to manage high cholesterol through a combination of diet, lifestyle changes, and medication.

How to Manage High Cholesterol: Diet, Medications, and More

Cholesterol isn’t inherently bad. Your body needs the waxy, fat-like substance to produce cell membranes, hormones, and nutrients like vitamin D. But too much of it — especially low-density lipoproteins (LDL) cholesterol, which accumulates in the walls of your blood vessels and is also referred to as “bad” cholesterol — can increase your risk for heart disease and stroke.

The good news? High cholesterol is one of the heart disease risk factors that you have control over. There are many changes you can make to bring down your cholesterol levels, which in turn will strengthen your overall cardiovascular health. Here’s an overview of how to manage high cholesterol through a combination of diet, lifestyle changes, and medication.

How to lower cholesterol levels with diet

There are two sources of cholesterol: your liver and the foods you eat. This means that you can begin to lower your cholesterol simply by paying attention to your diet and limiting high-cholesterol foods.

There are several categories of high-cholesterol foods to pay attention to. Saturated fats, which are typically solid at room temperature, increase levels of LDL cholesterol in your blood. You don’t have to avoid saturated fats altogether, however you should try to decrease your consumption of them. The American Heart Association suggests aiming for a diet in which 5-6% of the total calories consumed come from saturated fat. Common sources of saturated fats include red meat and full-fat dairy products.

Trans fats, also known as partially hydrogenated oils, are mainly formed through an industrial process which causes oil to become solid at room temperature. These fats are considered the least healthy to eat and should be avoided altogether as much as possible. While the Food and Drug Administration has banned food manufacturers from adding trans fats to foods, it’s still a good idea to check the label of the following foods for partially hydrogenated oils (how trans fats appear on nutrition labels): 

Cookies, cakes, and other baked goods, including frozen products

On the other hand, unsaturated fats — found in plant-based oils such as olive oil and canola oil as well as tree nuts like almonds, walnuts, and pecans — can lower high cholesterol levels. Omega-3 fatty acids — found in fish like salmon, mackerel, herring, and tuna — and soluble fiber — found in beans, peas, lentils, oats, and whole grains — will round out a low-cholesterol diet.

Other lifestyle changes can significantly lower your LDL cholesterol levels naturally, including exercising regularly, maintaining a healthy weight, avoiding cigarette smoke, and limiting your alcohol consumption.

Moderate physical activity can help lower LDL cholesterol and increase high-density lipoprotein (HDL) cholesterol, or “good” cholesterol. Aim for about 30 minutes of moderate to intense exercise per day. Everyone’s fitness needs are different, and it’s okay to start slower and work your way up to more vigorous activity.

Being overweight or obese increases your levels of LDL cholesterol, since excess body fat impacts your body’s ability to clear LDL cholesterol from your bloodstream.

Doctors may calculate your body mass index (BMI) to determine if your weight is in a healthy range. Consult your doctor about what a healthy weight is for you, and work together on a diet and fitness plan to help you reach and maintain that weight.

Smoking when you have unhealthy cholesterol levels increases your risk of heart disease even further. In addition, both smoking and vaping lower HDL cholesterol. Quitting can both lower your LDL cholesterol (bad) and increase your HDL cholesterol (good) levels.

If you currently smoke, ask your doctor for smoking cessation resources such as nicotine replacement therapy (NRT), which reduces withdrawal symptoms. If you are a nonsmoker, try to avoid exposure to secondhand smoke.

Too much alcohol can increase your cholesterol levels, so it’s important to limit your intake as you work on managing your cholesterol. The CDC recommends no more than two drinks per day for men and no more than one for women.

How to manage high cholesterol with medication

For some people, diet and exercise may be enough to manage cholesterol levels. In other cases, medication may be necessary to lower LDL cholesterol levels, increase HDL cholesterol levels, or both. There are several different classes of cholesterol medications. Your doctor can advise you on the best option for your needs.

Statins, also known as HMG CoA reductase inhibitors, act on the liver to prevent cholesterol from forming and limit the overall amount of cholesterol circulating in your bloodstream. They are most effective at lowering LDL cholesterol but can also help increase HDL cholesterol and lower triglycerides, or blood fats.

In most cases, side effects are mild and often disappear as your body adjusts to the medications. Your doctor may order tests on liver function, but liver abnormalities are rare. Statins are not safe to take if you are pregnant or you have chronic liver disease.

Ezetimibe (Zetia®) is a cholesterol absorption inhibitor and the most commonly used non-statin cholesterol medication. Potential side effects include:

This medication is not safe to take during pregnancy or while breastfeeding.

PCSK9 inhibitors bind to a protein found in liver cells to lower LDL cholesterol. They are administered as injections every 2-4 weeks. Commonly prescribed medications in this class include:

The primary side effect is itching, swelling, pain, or bruising at the injection site.

ACL inhibitors act on the liver to block cholesterol production. They are often taken in combination with statins to help further lower LDL in people with heart disease and people with familial heterozygous hypercholesterolemia, a genetic condition that causes high LDL cholesterol.

Commonly prescribed ACL inhibitors include:

Bempedoic acid and ezetimibe (Nexlizet®)

There are several additional medication classes which are not as commonly prescribed but do have a proven mild LDL-lowering action, including fibrates and niacin.

Fibrates are primarily used to lower blood triglyceride levels, however they may also be used to raise HDL and lower LDL cholesterol. 

Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)

Potential side effects include nausea, stomach pain, and muscle pain.

Niacin is a B vitamin that reduces the liver’s production of blood fats. It is very effective at lowering triglycerides and is sometimes prescribed to lower LDL cholesterol.

Niacin comes in prescription form and as a dietary supplement. The latter is not a replacement for a prescription, and it’s important to only take niacin if your doctor has prescribed it.

Liver function should be closely monitored while taking niacin. If you have diabetes, it’s important to discuss the potential risks and benefits of niacin with your doctor, as it can raise blood sugar levels.

There often are not any visible signs or symptoms of high cholesterol, so the only way to determine your cholesterol levels is through a simple blood test called a lipid profile.

Most adults who are in good health have their cholesterol checked every four to six years. If you have heart disease, diabetes, or a family history of high cholesterol, you will need more frequent screening. Consult with your doctor about recommended screening frequency.

Exceptional pharmacy care to strengthen your health

At Alto, we’re committed to making 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 team of pharmacists are always here to answer your questions by phone, text, or chat, and will even remind you when your medications are due for a refill.

Reach out any time via text or phone at 1-800-874-5881, or 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.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply.

What to Know About State-Funded PrEP-DAP Programs

Cost is often a barrier to starting PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. Fortunately, the HIV prevention landscape is rapidly evolving, and PrEP is now more accessible than ever.

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. In addition, many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply for state-funded PrEP drug assistance programs — also referred to as PrEP-DAP or PrEP-AP programs —  in four of the states that Alto serves.

The State of California’s PrEP Assistance Program (PrEP-AP) helps cover PrEP-related medical expenses, with different benefits for individuals without insurance, those with private insurance, and those with Medicare.

You can receive Truvada®, one of the two FDA-approved PrEP medications, free of charge through Gilead’s Advancing Access® Program. California’s PrEP-AP will also provide financial assistance with all other medications on the PrEP-AP formulary for HIV prevention and treatment of sexually transmitted infections (STIs) and the following PrEP-related medical services:

To be eligible for the assistance, you must receive all PrEP-related medical services at approved locations within the California Department of Public Health’s Office of AIDS PrEP-AP Provider Network. Search for a California PrEP-AP provider or enrollment site near you. 

Gilead’s Co-Payment Assistance Program covers up to $7,200 of Truvada® copays per calendar year. Once you’ve met this threshold, California’s PrEP-AP will cover any remaining PrEP copays for the rest of the calendar year, in addition to assistance for out-of-pocket costs for PrEP-related medical services and all other medication on the PrEP-AP formulary for HIV prevention and STI treatment. To be eligible for assistance with PrEP-related medical services, you must see a provider in your insurance plan’s network.

If you have prescription medication coverage through Medicare, you are not eligible for financial assistance from Gilead, but California’s PrEP-AP offers financial assistance with copays for all medications on the PrEP-AP formulary including Truvada®.

If you do not have prescription medication coverage through Medicare, you are eligible to enroll in Gilead’s Patient Assistance Program and receive Truvada® free of charge. In addition, California’s PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.

Anyone who has outpatient coverage through Medicare is also eligible to receive assistance from California’s PrEP-AP for PrEP-related medical services. However, you must see a provider in your plan’s network.

To be eligible for California’s PrEP-AP, you must:

Have a negative HIV test dated within six months of the PrEP-AP application

Have an annual Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level based on family size and household income

Not be fully covered by Medi-Cal or other third party payers

Be enrolled in the manufacturer's assistance program, if eligible

Colorado’s Public Health Intervention Program (PHIP) helps cover PrEP expenses for anyone living in Colorado who has an income less than 500% of the Federal Poverty Level.

If you have insurance, you must apply for the Gilead copay card to receive the assistance. If you do not have insurance, you must apply for Gilead’s Advancing Access program and see an approved PHIP-PrEP medical provider.

You can apply online or by mail. You must provide the following documents:

Proof of income (one month's worth of paystubs, award letter, etc.)

Gilead Co-Pay Card, if you have insurance

PHIP is not eligible for those with Colorado Medicaid. However, if you have Colorado Medicaid, your PrEP costs should be covered at a $1-3 copay for both medication and related medical services.

The New York State Department of Health’s AIDS Institute has a PrEP assistance program for individuals without insurance. The program covers the cost of PrEP-related medical services including HIV testing, counseling, STI testing, and primary care services. The cost of PrEP itself will be covered through manufacturer-sponsored patient assistance programs, to which healthcare providers affiliated with the program can help you apply.

Eligibility is based on financial and medical need. Learn more about how to apply and search for a New York State PrEP-AP provider near you.

Washington State’s PrEP Drug Assistance Program (PrEP-DAP) provides financial assistance with  PrEP and related medical services.

The program covers the cost of Truvada®. The Washington Department of Public Health contracts with Ramsell Corp® to provide pharmacy benefits for program participants. You must use a pharmacy contracted with Ramsell for PrEP-DAP to receive the financial assistance (Alto is contracted with Ramsell).

In addition, Washington’s PrEP-DAP also covers many of the PrEP-related lab and medical services including baseline and monitoring tests for STIs, kidney function, and Hepatitis B. If you have insurance, the program covers your portion of insurance deductibles, copays, and coinsurance up to a certain limit. To confirm the current maximum amount of financial assistance for individuals with insurance, call 360-236-3412 or 877-376-9316 (toll free) or email PrEPDAP@doh.wa.gov.

If you do not have insurance, the program will cover all of the costs up to the maximum amount of covered services.

To be eligible for Washington’s PrEP-DAP, you must live in Washington State, test negative for HIV, and meet one of several defined risk factors, described in more detail here.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and Emtricitabine 200 mg/Tenofovir 300 mg (generic Truvada, which became available in October 2020). PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

A negative HIV test is required before starting PrEP. Your doctor or pharmacist may also recommend additional tests to ensure that it’s safe for you to use PrEP. Initial baseline testing may include:

You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:

Pregnancy testing and discussion of pregnancy plans every 3 months

HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B

We’ll help you get PrEP at the most affordable price

Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. We offer discrete, private packaging and free, same-day delivery along with in-app reminders to stay on track. And our pharmacists — who have deep expertise in many clinical areas, including HIV treatment and prevention — are directly available through phone, text, or within the Alto app to answer any questions.

Reach out any time to get started via text or phone at 1-800-874-5881, or in-app messaging.

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Learn more about the fertility considerations specific to TGNB individuals.

Fertility Options for Transgender, Gender-Queer, and Nonbinary (TGNB) Individuals

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Transgender, gender-queer, and nonbinary (TGNB) inidviduals have multiple options for starting a family, including fertility preservation treatment and using a donor or surrogate for several or more of the components of biological conception. Below, we explain more about the fertility considerations specific to TGNB individuals and potential paths to explore as you plan to start a family.

Each person’s journey to parenthood looks different. Transgender, gender-queer, and nonbinary individuals have specific factors to consider in planning for a family, as the biological process of transitioning may affect your ability to conceive.

Many transgender and nonbinary individuals take hormones like testosterone, estrogen, and testosterone blockers, or anti-androgens, while transitioning. Testosterone suppresses feminine physical traits and induces masculine ones in transgender men and some nonbinary individuals, such as facial and body hair and a deeper voice. Estrogen increases feminine characteristics like breast development and facial and body hair reduction in transgender women and some nonbinary individuals.

Researchers are still learning about the impact of testosterone and estrogen therapy on long-term reproductive function. While prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, some evidence, like a 2019 study on transgender fertility from Boston IVF, suggests that these effects are reversible upon discontinuation of the treatment.

Based on eight years of patient data, the Boston IVF study found that transgender men who underwent egg freezing for fertility preservation had similar egg yields as cisgender women, or women whose sex assigned at birth was female. More than half of the study’s transgender male participants had taken testosterone before pursuing ovarian stimulation treatment, all of whom had discontinued use of the hormone for an average of four months prior to starting their egg freezing cycle.

While the study’s results affirm that hormone therapy may not necessarily prevent you from having children biologically, every person’s situation is different. If you are considering hormone therapy and want to have children in the future, consult with your doctor about the possibility of freezing your eggs or sperm for future use, a process we explain in more detail below.

In addition, there is currently no definitive evidence that testosterone therapy will prevent individuals assigned female sex at birth from becoming pregnant. Depending on your ideal timeline for starting a family, you may also want to discuss contraception options with your healthcare provider.

For many transgender and nonbinary individuals, gender confirmation surgery is an important aspect of transitioning. It plays a crucial role in addressing gender dysphoria, the distress caused by the disconnect between your gender identity and the sex you were assigned at birth.

Depending on the circumstances, gender confirmation surgery may permanently affect your reproductive function. For instance, hysterectomies are performed in some female-to-male transitions, which prevents the possibility of carrying a child in the future. The removal of testicles during a male-to-female transition may also impact your ability to have biological children.

By planning for the future and discussing your reproductive options with your healthcare provider before undergoing gender confirmation surgery, you may be able to preserve your fertility options.

Fertility preservation treatment for TGNB individuals

Many transgender and nonbinary individuals choose to preserve their eggs or sperm for future use before beginning the biological process of transitioning. Sperm freezing helps transgender women plan for a future family before starting estrogen therapy. 

This is a fairly simple process in which a sperm sample is either surgically retrieved or collected by the person freezing their sperm. Doctors will then analyze that initial sperm sample to determine if additional samples are needed. Your sperm will then be stored in vials with cryoprotectant agents that will help ensure its long-term viability.

In egg freezing, transgender men take fertility medications to stimulate egg production. Once the eggs are developed, your doctor will retrieve them from you in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, you may have to undergo more than one cycle of egg freezing.

Read our previous blog to learn more about what to expect during egg freezing.

Fertility treatment and conception options

Transgender and nonbinary individuals and families have multiple options for having children biologically, including intrauterine insemination (IUI) and in vitro fertilization (IVF).

In IUI, transgender women can use their frozen sperm and have it placed into their partner’s or a surrogate’s uterus. If you elect to use a surrogate, they will also take on the role of egg donor, meaning that they will be the biological mother of your child.

In IVF, eggs and sperm are combined in a laboratory. The fertilized eggs, or embryos, are then placed into the uterus with the potential outcome of a pregnancy. As with IUI, transgender individuals have multiple options with IVF. 

Transgender men can use their own eggs or those of their partner or a donor to have the fertilized embryo implanted into their own uterus. The sperm may come from their partner or a donor. Alternatively, their partner or a gestational carrier may have the embryos implanted into their uterus. (A gestational carrier carries and delivers a child for an individual or couple and is not genetically related to that child whereas a surrogate offers both her eggs and uterus.)

Transgender women can have their sperm fertilized with eggs from their partner or a donor. Then, their partner or a gestational carrier may have the embryos implanted into their uterus.

IVF is a more complicated process than IUI from a medical standpoint, as it involves more fertility medications and an egg retrieval process. However, IUI can be more emotionally and legally complicated if you are using a surrogate. Take time to research all of your options so that you can determine the best one for your needs and know what to expect going in.

If you are exploring using a donor or surrogate, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. In some states, a surrogate may automatically receive parental rights after your child’s birth since she is the biological mother, which will have to be legally terminated. Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.

Learn more about these paths to parenthood, including the related legal aspects.

Fertility treatment is a significant investment, both financially and emotionally. Determining how to pay for these expenses is an important part of planning your family. There are many resources such as EMD Serono’s financial assistance programs for fertility medications. Family Equality council also has a list of family-building grants that help LGBQ+ families afford fertility treatment. Be sure to ask your fertility clinic about available financial assistance programs and payment plans.

At Alto, we’re committed to doing whatever we can to minimize stress during fertility treatment, including supporting your financial well-being. If fertility medications are a part of your path to parenthood, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible.

Read our previous post on managing the costs of fertility treatment.

A fertility pharmacy partner you can rely on

Alto is here to support your journey with starting a family. We know that there are many paths to parenthood and that each individual or family’s needs are different. Our team of patient care pharmacists has experience working with the TGNB community, and we’ll be here at every step of the way if you choose to pursue any of the fertility treatments described above. We also offer discrete, private packaging and free, same-day delivery to keep stress at minimum during this special time in your life.

Starting Monday, August 16, residents of the San Diego metro area can now choose Alto's same-day doorstep delivery for their pharmacy needs.

Hello, San Diego!

Alto's launch in San Diego extends our free, same-day pharmacy delivery model to even more Californians.

Starting today, August 15th, residents of the San Diego metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts or in our mobile app. 

Starting a new medication or doing an injection for the first time? Message a pharmacist with your questions, even in the evenings and on weekends. And we’re a full service pharmacy - we stock all major brand, generic, over-the-counter and specialty medications, meaning your entire family’s pharmacy needs can be managed in the Alto app and coordinated into one delivery.

Courier delivery windows
Monday - Friday: 6 - 9 pm PT (6:30 - 9:30 pm PT for outlying areas)
Saturday - Sunday: 2 - 5 pm PT (2:30 - 5:30 pm PT for outlying areas)

Walk-in hours
Monday - Friday: 9 am – 7 pm PT
Saturday - Sunday: 10 am - 6 pm pT

San Diego residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax). 

Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch. 

Need to pick up? Our pharmacy is located at 4240 Kearny Mesa Road, Suite 107.

General customer support hours are Monday - Friday 6 am - 9 pm PT and Saturday - Sunday 7 am - 6 pm PT. Patients can reach out to Alto via phone/text at 1 (800) 874-5881, email or app.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and currently delivers across the greater SF Bay Area, Los Angeles, Orange County, Seattle, Denver, Las Vegas, New York City, Houston and Dallas.

Lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Here's what to know.

What to Know About Lung Cancer Screening

Lung cancer, the leading cause of cancer death among both men and women, is more likely to be cured when detected early. The five-year survival rate is about 60% when the disease is confined to one lung. 

However, the majority of cases are diagnosed after the cancer has already spread to both lungs or other organs, at which point  the five-year survival rate is 20% or less. Delayed diagnoses are due in part to the fact that lung cancer symptoms often do not appear until the disease has progressed to more advanced stages.

This is why lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Some studies have found that screening detects 80% of lung cancer cases at an early stage. Read on to learn more about what to expect during lung cancer screening and whether it may be right for you.

Smoking is the number one cause of lung cancer, contributing to 80-90% of lung cancer fatalities. However, there are additional risk factors to developing lung cancer:

Exposure to radon, a naturally occurring gas that can get trapped in houses and buildings, and the second leading cause of lung cancer

Exposure to asbestos or other carcinogens like uranium, diesel exhaust, and inhaled chemicals in the workplace

Radiation therapy to the chest during cancer treatment

While lung cancer symptoms typically appear once the disease has progressed to a more advanced stage, some people do experience some of the following early signs of lung cancer:

A cough that does not go away or gets worse

Chest pain that often worsens with deep breathing, coughing, or laughing

Infections such as bronchitis and pneumonia that don’t go away or keep coming back

Many of these symptoms overlap with those of other respiratory conditions like COPD, and you should schedule an appointment with your doctor as soon as possible. Even if you do not have lung cancer, it’s important to identify the cause of these symptoms and treat them, if needed.

What happens during lung cancer screening?

During your lung cancer screening, doctors will use a non-invasive test known as a low-dose computerized tomography (LDCT) scan to search for abnormal spots in the lungs that could be cancer. 

During the scan, you will lie still on a long table as it slides through a machine that uses a low level of radiation — about half of what you’re exposed to naturally from the environment every year, and much less than what you’d be exposed to in a standard CT scan — to create images of your lungs. It is painless and will take less than a minute.

If you are experiencing signs of a respiratory infection such as congestion, runny nose, sore throat, and body aches, or if you recently recovered from one, let your doctor know as it may affect the results of an LDCT scan. They will let you know if you should reschedule.

There are several possible outcomes of an LDCT scan. If the screening test detects abnormal spots, often called a nodule, you may need additional tests to determine if you have lung cancer. 

For small nodules, doctors often recommend another LDCT scan after a few months to see if the nodule has grown. If the nodule is bigger, your doctor may order additional testing like a positron emission tomography (PET) scan or a biopsy, a procedure that removes a piece of the nodule for lab testing, to find out if it is cancerous.

In cases where lung cancer screening does not detect any abnormal spots, your doctor may recommend continuing with annual screening depending on your risk.

Since lung cancer screening involves exposure to radiation, doctors primarily reserve screening for people at high risk of developing lung cancer, namely older adults who have smoked heavily for many years. 

The U.S. Preventive Services Task Force (USPSTF) — an independent group of prevention experts who help healthcare providers make informed recommendations for their patients — recommends annual LDCT lung cancer screening for people who meet each of the following criteria:

Have a 20 pack year or more smoking history

Smoke now or have quit within the past 15 years

A “pack year” is defined as smoking an average of one pack of cigarettes per day for a year.  The 20 pack year history threshold could be met by smoking one pack a day for 20 years or two packs a day for 10 years. It’s important to share all the details of your smoking history with your doctor so they can determine if you would benefit from lung cancer screening.

Your doctor may also recommend lung cancer screening if you were treated for lung cancer more than five years ago, have another serious lung disease such as chronic obstructive pulmonary disease (COPD), a family history of lung cancer, or have been exposed to asbestos at work.

They will also take your overall health into account, as lung cancer screening is typically recommended for individuals who would be physically able to tolerate treatment for early-stage lung cancer and lung surgery, if it is needed.

While lung cancer screening saves lives — without screening, 70% of lung cancer cases would be detected at a later stage — it carries some risks, like all screening procedures.

First, while the level of radiation you are exposed to during an LDCT scan is not significant, it can potentially become harmful with repeated scans. In addition, when screening for any disease, doctors will sometimes find abnormalities that look cancerous but are not, which is referred to as a false positive. They may also find cancers that grow so slowly they would never lead to symptoms.

The frequency of false positives continues to decline every year. Currently, about 12-14% of lung cancer screenings have a false positive, similar to the rates for mammograms. False positives are even less common with continued annual LDCT screening since it is easier to identify notable changes between the scans. 

Plus, as the technology behind lung cancer screening evolves, doctors have a clearer understanding of who actually needs follow-up testing after the initial LDCT scan. Ultimately, it is important to discuss the benefits and risks of lung cancer screening with your doctor and work together to determine if you would benefit from it.

At Alto, we go above and beyond to help you stay on track with your doctor’s recommendations, getting you the medication you need at the best price possible. And our team of patient care pharmacists is also here to chat whenever questions come up.

Switch to a better pharmacy for free same-day delivery and support with insurance and savings opportunities. Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable.

Prioritize Your Health with Preventative Care

If you’ve ever waited until you’re sick to see a doctor, you’re not alone. Many adults in the U.S. put off routine doctor’s appointments — sometimes even when they don’t feel well. 

These delays can be serious: according to the Centers for Disease Control and Prevention, up to 40% of all fatalities linked to the five leading causes of death in the U.S. — heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries — could have been prevented. Untreated blood pressure or cholesterol and unhealthy lifestyle habits factors heavily into many of these cases.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable. Preventative care involves a combination of annual check-ups, vaccinations, screenings, and healthy lifestyle habits. 

If you haven’t been to the doctor in a while, don’t get discouraged. The important thing is to get back in the habit. Below is an overview of preventative care for both men and women, with recommendations from our pharmacists for how to ensure you’re prioritizing your health.

There are several important numbers that help your doctor understand your risk for health conditions such as heart disease and diabetes: your body mass index (BMI), blood pressure, cholesterol, and glucose levels.

Being overweight or obese increases your risk for many different health conditions, including high blood pressure, unhealthy cholesterol levels, type 2 diabetes, heart disease, and stroke. 

Body mass index (BMI) is a screening tool that doctors use for obesity. A healthy BMI is typically between 18.5 to 24.9, while a BMI between 25 to 29.9 is considered overweight and a BMI of 30 or higher is obese.

Keep in mind that while a BMI does help doctors understand your general risk for the chronic conditions mentioned above, it is merely a snapshot of your health and doesn’t account for other important health factors including age and genetics. Your healthcare provider can help you understand your overall priorities with preventative care beyond any single number, which is another important reason to stay up to date with doctor’s appointments.

Your blood pressure numbers are one of several factors that can help your doctor predict your risk for heart disease and cardiac events like a heart attack or stroke. There are five different blood pressure ranges recognized by the American Heart Association:

If your blood pressure is in the normal range, you should get screened at least once per year. If your blood pressure is in a higher range, consult with your doctor about recommended screening frequency.

Read our previous blog to learn more about managing blood pressure.

A cholesterol blood test, also called a lipid profile or lipid panel, gives results for several different readings: HDL (good) cholesterol, LDL (bad) cholesterol, triglycerides, and total blood (or serum) cholesterol. Your total cholesterol and HDL cholesterol levels are particularly important in helping your doctor identify if you are at risk for a heart attack or stroke.

A healthy range for total cholesterol is considered to be less than 200 mg/dL

A healthy range for HDL cholesterol is 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 considered to be less than 100 mg/dL

These targets are intended to be general guidelines, and each individual’s health needs are different. Having type 2 diabetes, smoking, being overweight, and not getting enough physical activity can affect your cholesterol levels. Your healthcare provider can help you determine your personal targets.

If your total cholesterol is under 200 mg/dL, you can have your cholesterol checked every 4-6 years. If you are at higher risk for heart disease and stroke, consult your doctor about recommended screening frequency.

Your blood glucose numbers can help your doctor determine if you have diabetes or are at risk for developing it. A blood sugar level under 140 mg/dL (7.8 mmol/L) is typical considered healthy, while a reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) may indicate prediabetes and a reading over 200 mg/dL may indicate diabetes. A discussion of these numbers with your healthcare provider is required for an official diagnosis of diabetes.

Generally speaking, if your blood glucose numbers are under 140 mg/dL, you should get screened at least every three years. If you have prediabetes you will need more frequent screening.

If you have diabetes, your healthcare provider can help you develop individualized targets for healthy blood sugar levels, which may be different from the numbers above. Try not to worry about what “normal” looks like for other people, and focus instead on taking simple actions to control your diabetes and live your healthiest life, like staying active and quitting unhealthy habits.

You should have an annual check-up once per calendar year. This appointment is the foundation of preventative care: since each individual’s risk for specific preventable health conditions may vary, discussing your personal health history and vital signs with your doctor will help you determine which preventative measures to prioritize.

In addition to checking with your physician about which vaccines, screenings, and medical tests you need, ask if your family history indicates an increased risk for any health conditions.

Prevention and screening become more important as you age. Regular colorectal cancer screening is recommended for everyone 50 and over. If you have risk factors like an immediate family member with colorectal cancer, your doctor may suggest earlier screening.

The American Cancer Society recommends annual mammograms for all women between 45 and 54. Some women begin screening for breast cancer as early as age 40 depending on their risk and family history. Women 55 and older can continue with yearly mammograms or switch to every two years. Your doctor can help you determine the right screening frequency for your individual needs. 

Preventative health doesn’t just happen in your doctor’s office. Everyday choices like what you eat and how often you exercise can protect your health for years to come.

Staying active is one of the most important things you can do to prevent cardiovascular disease and maintain a healthy weight. If you’re just starting to figure out your ideal exercise routine, know that you don’t have to exert yourself too hard to reap the benefits of physical activity. Even just 30 minutes of moderate exercise most days of the week can help strengthen your heart.

Everyone should do their best to limit their intake of the following foods, but it’s especially important if you face a greater risk for heart disease or diabetes:

Saturated and trans fats, which can raise your cholesterol

Sodium, which may increase your blood pressure

Sweets and sugar-sweetened beverages, which have been linked to both type 2 diabetes and an increased risk for heart disease

Other things you can do to stay healthy? Chronic stress can elevate your blood pressure, putting you at a greater risk for heart attack and stroke, so try to manage stress in heart-healthy ways like getting enough sleep, maintaining a fulfilling social life, and practicing mindfulness and gratitude. And it’s never a bad time to cut back on your alcohol consumption and quit smoking, if you currently smoke.

Prioritizing your physical and mental well-being today can help you prevent health issues in the future. We’re here to help make that as simple as possible.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of patient care pharmacists is available to chat whenever questions come up. Reach out via text or phone at 1-800-874-5881 or in our app.

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