High Blood Cholesterol - Treatment - Treatment
Unhealthy blood cholesterol levels are treated with heart-healthy lifestyle changes and medicines. People who have familial hypercholesterolemia may need special procedures.
If a medical condition or medicine is causing your blood cholesterol problem, your doctor may treat the condition or change your medicine or its dose.
Talk with your doctor about your cholesterol levels, your risk of developing heart or blood vessel disease, other medical conditions you have, and your lifestyle. Your doctor can tell you 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.
Healthy lifestyle changes
To help you lower your LDL cholesterol level, your doctor may talk to you about adopting a healthy lifestyle.
- Heart-healthy eating. As recommended in the 2015–2020 Dietary Guidelines for Americans, heart-healthy eating includes limiting saturated and trans fats that are found in fatty cuts of meat, dairy products, and many packaged snacks or desserts. The guidelines also recommend eating fish high in omega-3 fatty acids, nuts, and certain vegetable oils such as olive oil. The Therapeutic Lifestyle Changes and DASH eating plans can help you lower your “bad” LDL cholesterol. These plans also encourage eating whole grains, fruits, and vegetables rather than refined carbohydrates such as sugar. Talk to your doctor about other nutritional changes that you can make.
- Get regular physical activity. There are many health benefits to being physically active and getting the recommended amount of physical activity each week. 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. If you have high blood cholesterol and overweight or obesity, you can improve your health by aiming 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.
Medicines
Depending on your risk for complications such as heart attack and stroke and whether you are able to lower your high blood cholesterol levels with lifestyle changes alone, your doctor may prescribe a medicine.
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.
Doctors now have a range of medicines they can prescribe to treat 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 enzymes 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.
- Ezetimibe may be used if you have familial hypercholesterolemia, if statins cause side effects, or if statin treatment and lifestyle changes do not lower your “bad” LDL level enough. In rare cases, ezetimibe can cause liver injury.
- 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. 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 or 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.
- Lomitapide may be prescribed if you have familial hypercholesterolemia. If you take lomitapide, your doctor will check your liver enzymes regularly, because this medicine can cause liver injury. Your doctor will also recommend that you take vitamin E and other supplements.
- Mipomersen may also be used to treat familial hypercholesterolemia. If you take this medicine, your doctor will regularly check your liver because of the risk of liver injury.
Want to know how these medicines work to manage cholesterol?
- Statins work by lowering the amount of cholesterol made by the liver and by helping the liver remove cholesterol from the blood. Statins also work against atherosclerosis by reducing inflammation .
- Ezetimibe keeps cholesterol in your food from being absorbed in the intestine.
- Bile acid sequestrants help bile acids, which are made of cholesterol, stay in the intestines so they can be removed from the body instead of being reabsorbed. Bile acids help you digest fats and oils. Once they are removed, the liver uses up more cholesterol to make more bile acids. This lowers cholesterol in the blood.
- PCSK9 inhibitors are monoclonal antibodies that prevent LDL receptors on your liver from being destroyed. With more receptors, the liver can remove more “bad” LDL cholesterol from the blood.
- Lomitapide prevents the liver from releasing a lipoprotein needed to make “bad” LDL cholesterol. This in turn lowers the levels of “bad” LDL cholesterol in the blood.
- Mipomersen lowers levels of non-HDL cholesterol in the blood.
Lipoprotein apheresis
Some people with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower their blood cholesterol levels. Lipoprotein apheresis is similar to dialysis, in that it uses a filtering machine to remove unwanted substances from the body. In lipoprotein apheresis, the machine removes “bad” LDL cholesterol from the blood, then returns the remainder of the blood to your body.