High Cholesterol: Treatment Overview

High cholesterol is a common health problem affecting millions of people around the world. It occurs when there's too much cholesterol, a type of fat, in your bloodstream. Even though our bodies need cholesterol to build healthy cells, having too much of it can be harmful. It can create fatty deposits in blood vessels which can limit the flow of blood and increase the chance of heart disease, stroke and other serious health problems.

You can find out if you have high cholesterol through a simple blood test known as a lipid panel. This test measures the levels of total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides in your blood. High cholesterol treatment options aim to lower LDL cholesterol levels and reduce the risk of heart problems. Read on to learn about the treatment options available for managing high cholesterol, including lifestyle changes and medications.

Lifestyle Changes

Healthy lifestyle changes may help manage high cholesterol levels and can be considered high cholesterol treatment for mild cases. Not only do these changes help lower "bad" cholesterol (LDL), but they also boost overall heart health. Here are some lifestyle changes you might want to think about:

• Diet: Opt for a balanced meal plan that includes foods low in saturated and trans fats to lower your LDL cholesterol. Try to eat more foods that are high in fiber and healthy for your heart like whole grains, fruits, vegetables and legumes.
• Exercise: Regular physical activity may help increase good cholesterol (HDL) levels and decrease LDL cholesterol. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week.
• Weight loss: Losing extra weight may help improve cholesterol levels. Even losing just 5% to 10% of your body weight can make a difference in managing your cholesterol.
• Quit smoking: Giving up smoking not only lowers LDL cholesterol levels, it also raises HDL cholesterol and lowers your chances of having a heart attack or stroke.
• Limit alcohol consumption: While it may be possible that drinking alcohol in moderation could raise HDL cholesterol, drinking too much can raise your triglyceride levels and can lead to other serious health problems.

These lifestyle changes may be used along with medications to help manage cholesterol levels more effectively. Talk to a healthcare professional before you make any changes to make sure they're the right fit for you.

Medications

There are various medications that can help lower cholesterol levels, and they work in different ways. The most suitable medication depends on different factors, such as a person’s medical history, cholesterol levels and other medications they’re taking. In some cases, a combination of high cholesterol treatments may be used. Let’s take a look at some of the main drugs used for high cholesterol.

Statins

Statins, also known as HMG-CoA reductase inhibitors, are the most commonly prescribed cholesterol medication. They work in the liver to stop the formation of cholesterol and help lower LDL cholesterol, raise HDL cholesterol and reduce triglyceride levels. Some potential side effects of statins include muscle pain, increased liver enzymes, and an increased risk of type 2 diabetes. Examples of statins include atorvastatin (Lipitor®), simvastatin (Zocor®) and rosuvastatin (Crestor®).

Bile Acid Sequestrants

Bile acid sequestrants work by binding to bile acids in your intestines, stopping them from being reabsorbed and helping to get rid of them. The body uses cholesterol to make bile acids. Since the liver senses it will need more bile acids, it uses cholesterol to make more bile acid, therefore helping to lower LDL cholesterol. Some possible side effects may include constipation, bloating and gas. Examples of bile acid sequestrants are cholestyramine (Questran®) and colesevelam (Welchol®).

Cholesterol Absorption Inhibitors

Cholesterol absorption inhibitors, like ezetimibe (Zetia®), work by blocking the absorption of cholesterol from food in the small intestine, which helps lower LDL cholesterol levels. Potential side effects may include stomach pain, diarrhea, muscle pain and increased liver enzymes.

Fibrates

Fibrates mainly lower triglyceride levels and raise HDL cholesterol. They work by activating a protein to break down triglycerides. Some potential side effects include stomach pain, nausea, an increased risk of gallstones and increased liver enzymes. Some examples of fibrates are fenofibrate (TriCor®) and gemfibrozil (Lopid®).

Niacin

Niacin (vitamin B3) has been used to help raise HDL cholesterol and lower LDL cholesterol and triglyceride levels. It works by reducing the liver's production of certain types of cholesterol. It may cause side effects like flushing, itching and liver damage. Niacin is available under the brand name Niaspan® and in generic forms.

PCSK9 Inhibitors

PCSK9 inhibitors are a newer type of cholesterol-lowering medicine. They work by blocking a protein (PCSK9) that reduces the number of LDL receptors on the liver's surface. By blocking this protein, more LDL receptors become available, which helps lower LDL cholesterol levels. Some examples of PCSK9 inhibitors are evolocumab (Repatha®) and alirocumab (Praluent®). Possible side effects may include reactions at the injection site and flu-like symptoms.

Bempedoic Acid

Bempedoic acid is a medication that works by blocking an enzyme involved in cholesterol production. It helps lower LDL cholesterol levels and can be used with other cholesterol-lowering medicines. The brand name for bempedoic acid is Nexletol®. Possible side effects include muscle pain, fatigue and increased liver enzymes.

Working With a Healthcare Provider

Consult a healthcare provider before starting any new high cholesterol treatments. A healthcare provider can look at your individual risk factors, come up with a treatment plan that's tailored to your needs and keep an eye on your progress. Usually, they'll do regular blood tests to keep tabs on your cholesterol levels to see how you are responding. You should work with a healthcare provider to set treatment goals based on your specific health conditions and risk factors. Treatment plans might involve making changes to your lifestyle, like eating healthier and exercising more, as well as taking medication.

Sources: https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/02/20/15/56/a-stepwise-approach https://www.ccjm.org/content/87/4/231 https://www.cdc.gov/cholesterol/treating_cholesterol.htm