Blood Cholesterol Treatment
To treat unhealthy blood cholesterol levels, your doctor may recommend heart-healthy lifestyle changes and prescribe medicines. If a medical condition or medicine is causing your blood cholesterol problem, your doctor may treat that condition or change your medicine or its dose.
Talk with your doctor about your cholesterol levels, your risk of developing heart disease, other medical conditions you have, and your lifestyle. You can learn about the benefits and side effects of medicines for lowering your blood cholesterol. Together, you can set up a treatment plan that will work for you.
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Healthy lifestyle changes
To help you lower your LDL cholesterol level, your doctor may talk to you about adopting a healthy lifestyle.
- Choose heart-healthy foods. The Therapeutic Lifestyle Changes and DASH eating plans can help you lower your “bad” LDL cholesterol. These plans also encourage limiting saturated fats found in fatty cuts of meats, dairy products, and desserts; and eating whole grains, fruits, and vegetables rather than refined carbohydrates such as sugar.
- Get regular physical activity. Studies have shown that physical activity can lower LDL cholesterol and triglycerides and raise your “good” HDL cholesterol. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
- Aim for a healthy weight. Research has shown that adults with overweight and obesity can lower “bad” LDL cholesterol and raise “good” HDL cholesterol by losing only 3% to 5% of their weight.
- Manage stress. Research has shown that chronic stress can sometimes increase LDL cholesterol levels and decrease HDL cholesterol levels.
- Quit smoking. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
- Get enough good quality sleep. Sleep helps heal and repair your heart and blood vessels. The recommended amount for adults is 7 to 9 hours of sleep a day.
- Limit alcohol. Visit the National Institute on Alcohol Abuse and Alcoholism for resources on support and treatment to stop drinking.
Your doctor may prescribe one of these medicines to help lower high blood cholesterol.
- Statins are the most common medicine used to treat high blood cholesterol. Studies have shown that statins lower the risk of heart attack and stroke in people with high LDL cholesterol. Statins usually don’t cause side effects, but they may raise the risk of diabetes. However, this mainly happens in people already at high risk of diabetes, such as those who have prediabetes, overweight or obesity, or metabolic syndrome. Statins may also cause abnormal results on liver tests, but actual liver damage is extremely rare. Other rare side effects include muscle damage. Learn more about how you can stay safe while taking statins.
- Medicine to treat familial hypercholesterolemia. These include mipomersen, ezetimibe, and lomitapide. Ezetimibe may also be used if statins cause side effects, or if statin treatment and lifestyle changes do not lower your “bad” LDL level enough. In rare cases, these medicines can cause liver injury. Your doctor will check your liver enzymes regularly and may recommend that you take vitamin E.
- Bile acid sequestrants may be prescribed if you cannot take statins or if you need to lower your cholesterol even more than a statin taken alone. Bile acid sequestrants help bile acids, which help you digest fats and oils, stay in the intestines instead of being reabsorbed. This medicine may cause diarrhea, make some other medicines less effective, or raise your blood triglyceride level.
- PCSK9 inhibitors are a type of medicine that you inject under your skin every 2 to 4 weeks. Your doctor may prescribe a PCSK9 inhibitor and a statin if you are at high risk of complications like heart attack or stroke, or if you have familial hypercholesterolemia. The most common side effects are itching, pain, or swelling at the place where you injected it.
If your doctor prescribes medicines as part of your treatment plan, be sure to continue your healthy lifestyle changes. The combination of the medicines and heart-healthy lifestyle changes can help lower and control your blood cholesterol levels.
Some people with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower their blood cholesterol levels. Lipoprotein apheresis uses a filtering machine to remove unwanted substances from the body. The machine removes “bad” LDL cholesterol from the blood, then returns the remainder of the blood to your body.