High Cholesterol
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High Cholesterol
Treatment Overview
The goal in treating high cholesterol is to reduce your chances of having a heart attack or stroke.
Most people need to adjust their lifestyles to eat less saturated fat and trans fat, be more active, and lose weight if needed. Others also need to take one or more medicines.
No matter what approach you need, your treatment will focus on lowering your "bad" LDL cholesterol.
You may also need to raise your "good" HDL cholesterol at the same time. Although it may seem odd to raise a type of cholesterol, HDL can help remove the LDL from your arteries.
Initial treatment
After your doctor has looked at your cholesterol test, he or she will base your treatment on your cholesterol levels and overall health.
First, you will need some guidance on how to eat. Your doctor may suggest that you follow a cholesterol-lowering diet that cuts back on saturated fat while still allowing good fat such as olive and canola oils.
Increasing your activity is very important. Exercise can raise your HDL and may help you lose weight, if you need to. If you smoke, quitting will also help you raise your HDL. For more information on quitting smoking, see the topic Quitting Tobacco Use.
If you have diabetes, high blood pressure, or coronary artery disease (CAD) or if your cholesterol is very high, you may need to start on medicine right away. This is because your chances of having a heart attack are high, and medicines can reduce this risk.
Use the
Interactive Tool: Are You at Risk for a Heart
Attack?
This interactive tool will tell you your percentage of risk. After you know this, you can find your risk category for treatment. Your doctor will base your need for medicine on your risk category. After you have checked your risk, you can learn more about your treatment.
If you need medicine, it likely will be a statin. These drugs reduce the body's natural production of cholesterol. They are proved to lower the risk of heart attack, stroke, and death in people with a high risk of heart attack or stroke.3, 4
| Generic names | Brand names | How they work |
|---|---|---|
| atorvastatin, lovastatin, pravastatin, simvastatin, fluvastatin, rosuvastatin | Lipitor, Mevacor, Pravachol, Zocor, Lescol, Crestor | Reduce how much cholesterol your liver makes |
Some statins are combined with another medicine.
| Generic names | Brand names | How they work |
|---|---|---|
| ezetimibe with simvastatin | Lower how much cholesterol your liver makes and affect how your body absorbs cholesterol | |
| atorvastatin with amlodipine | Lower how much cholesterol your liver makes and lower blood pressure | |
| niacin with lovastatin | Raise good HDL cholesterol and lower bad LDL cholesterol |
Your doctor may prescribe other medicines. Some are used with a statin.
Type of drug | Generic names | Brand names | How they work |
|---|---|---|---|
| cholestyramine, colestipol, colesevelam | Questran, Colestid, Welchol | Affect how your body removes cholesterol | |
| gemfibrozil, fenofibrate | Lopid, Tricor | Lower triglycerides and can raise good HDL cholesterol. LDL may go up slightly. | |
| niacin | Niacor, Niaspan, Nicolar | Raise good HDL cholesterol and lower triglycerides and LDL | |
| ezetimibe | Zetia | Lower how much cholesterol your body can absorb |
Guidelines from the U.S. National Cholesterol Education Panel (NCEP) recommend higher doses of statins for people who have a moderate to high risk of heart attack.5 The goal is to lower your chances of having a heart attack or stroke. Side effects are more likely and may be more severe when higher doses of statins are used.
You are considered at very high risk if you have coronary artery disease and you also have diabetes, acute coronary syndrome, or metabolic syndrome or you smoke.
Work with your doctor to treat other diseases that you may have, such as high blood pressure and diabetes, and to stop smoking, if you smoke.
Ongoing treatment
As you continue your treatment for high cholesterol, your doctor will check your cholesterol at times, to see how you are doing. If you have been trying lifestyle changes alone, another cholesterol test can show if those changes have helped or if you need to add medicine to your treatment.
If you are taking medicine already, a cholesterol test can show whether you need your dose lowered or increased or whether you need a different drug.
At this time you may also want to ask for help if you are having trouble changing how you eat. Your doctor can recommend a dietitian to help you plan meals.
Staying physically active is important. Managing your weight and exercising are important because they can help you raise your HDL and lower your LDL levels. Research shows that people who exercise longer have more improvement in their LDL and HDL levels.6
Losing weight can also help lower high blood pressure. For more information, see the topics Fitness and Healthy Weight.
Treatment if the condition gets worse
It is important to follow your doctor's advice for making lifestyle changes and taking medicines, if prescribed. If high cholesterol is not treated, it can lead to coronary artery disease, heart attack, and stroke.
What to think about
High cholesterol that is caused by inherited (genetic) lipid disorders usually is treated with medicines.
Last Updated:
July 11, 2008- Author:
- Robin Parks, MS
- Medical Review:
- E. Gregory Thompson, MD - Internal Medicine
Robert A. Kloner, MD, PhD - Cardiology
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