Cholesterol Medicines
When lifestyle changes are not enough to manage high cholesterol, medications may be necessary to reduce your risk of heart disease and stroke.
What is cholesterol?
Cholesterol is a waxy, fat-like substance found in all body cells. While the body needs some cholesterol, excess amounts in the blood can stick to artery walls, narrowing or blocking them. Cholesterol is produced by the liver and travels via lipoproteins. LDL ("bad" cholesterol) leads to arterial buildup, while HDL ("good" cholesterol) carries cholesterol back to the liver for removal.
Who needs cholesterol medicines?
Your healthcare provider may prescribe medication if:
- You have already had a heart attack or stroke, or have peripheral arterial disease.
- Your LDL level is 190 mg/dL or higher.
- You are 40-75 years old, have diabetes, and your LDL level is 70 mg/dL or higher.
- You are 40-75 years old, have a high risk of heart disease or stroke, and your LDL level is 70 mg/dL or higher.
What are the different types of cholesterol medicines?
- Statins: The most common medicine; they reduce cholesterol production in the liver and increase the liver's ability to remove LDL from the blood.
- Bile acid sequestrants: Prevent bile acids from being absorbed, forcing the liver to use LDL cholesterol to make more.
- Cholesterol absorption inhibitors: Block the absorption of cholesterol into the body.
- Nicotinic acid (niacin): A B vitamin that lowers LDL and triglycerides while raising HDL. Consult a provider before use, as high doses can cause serious side effects.
- PCSK9 inhibitors: Injectable medicines that block the PCSK9 protein, helping the liver clear LDL from the blood.
- Fibrates: Primarily lower triglycerides and may increase HDL or slightly lower LDL.
- Combination medicines: Include more than one type of cholesterol-lowering drug or treat both high blood pressure and cholesterol.
Other specific medicines, such as lomitapide and mipomersen, are reserved for people with familial hypercholesterolemia (FH).
How does my health care provider decide which medicine I should take?
Providers consider your specific cholesterol levels, risk for heart disease and stroke, age, other health conditions, and potential side effects. While medicines help control cholesterol, they do not cure it; consistent use and regular check-ups are required to maintain healthy levels.