These Meds Can Help You Manage High Cholesterolby Lara DeSanto Health Writer
High cholesterol is no joke: It can lead to life-threatening issues like heart attacks and strokes. Thankfully, there are many tools to help tackle this health issue. When a healthy diet and exercise aren’t enough, medications are an important and effective way to lower cholesterol, but navigating the drug options can be overwhelming. Stick with us as we break down the different approaches available.
Lifestyle Changes Are a Must—Even With Meds
Taking a cholesterol-lowering drug doesn’t give you license to throw healthy lifestyle recommendations out the window. To get the most out of your cholesterol medication, you also need to prioritize clocking enough physical activity and eating a heart-healthy diet, among other healthy choices, says Randy Zusman, M.D., cardiologist and director of the division of hypertension at the Massachusetts General Hospital Heart Center in Boston, MA.
Statins: How Do They Work?
Statins are the most common high cholesterol drug treatment. Statins work in the liver by preventing cholesterol from forming, which helps lower the level of LDL cholesterol—aka “bad” cholesterol—in your bloodstream, according to the American Heart Association. Statins also help boost HDL—aka “good”—cholesterol and decrease triglycerides, both of which also reduce your risk of heart disease. “Statins are the first-line medication because they work well and they’re inexpensive,” says James Underberg, M.D, lipid specialist at the Center for the Prevention of Cardiovascular Diseases at NYU Langone Health in New York City.
Statins: Potential Side Effects
Like all medications, statins come with potential side effects. Most are mild and go away over time, per the American Heart Association. In rare cases, you may experience muscle or liver problems, but typically the benefits outweigh the risks. “Whenever we start someone on a statin, we have a shared decision-making conversation to weigh the risks and benefits,” says Dr. Underberg. If you have more severe side effects, your doctor will reduce your dose or take you off the drug altogether, moving on to one of the other options.
Cholesterol Absorption Inhibitors
Cholesterol absorption inhibitor drugs lower cholesterol levels by limiting how much cholesterol from your diet can be absorbed into your body, according to the Mayo Clinic. Sometimes your doctor may prescribe this kind of drug along with a statin. “This drug isn’t as effective as statins at lowering cholesterol, but it’s very well tolerated, and when you add it to statins, it can further reduce the risk of heart attack and stroke,” says Dr. Underberg.
A class of drugs called PCSK9 inhibitors can also be used to help reduce cholesterol. These injectable drugs work by helping the liver absorb more LDL (“bad”) cholesterol to lower the amount throughout the blood, according to the Mayo Clinic. “If your cholesterol is not adequately controlled, or you fall into a high-risk group, such as having familial hypercholesterolemia, we may move on to the use of PCSK9 inhibitors,” Dr. Zusman says. Your doctor may also put you on one of these meds if you have severe side effects from statins or other options, per the Mayo Clinic.
Bile Acid Sequestrants
Three drugs called bile acid sequestrants can also help reduce cholesterol in an indirect manner. Basically, these drugs prevent your body from absorbing bile acids, which play a role in digesting and absorbing fats, according to the National Institutes of Health (NIH). That tricks your body into using excess cholesterol in your blood to make even more bile acids, thereby reducing your cholesterol levels overall. (Again, your doctor may prescribe these medications alongside other cholesterol drugs, or in place of other options if you can’t tolerate them due to side effects or allergies, the National Institutes of Health says.)
Other Medication Options
Triglycerides are another type of fat in the blood that, when combined with high “bad” cholesterol or low “good” cholesterol, raise the risk of heart attack or stroke, says Dr. Zusman. Your doctor may prescribe other medications to help reduce high triglycerides, like fibrates, niacin, and omega-3 fatty acid supplements, the Mayo Clinic says.
More Drugs for Cholesterol Are Coming
Researchers are always looking for better ways to help manage high cholesterol and reduce the risk of cardiovascular disease. That means there are exciting new medication options on the horizon. For example, a PCSK9 inhibitor that you would only need to take once or twice a year is likely to be approved in the United States soon, says Dr. Zusman. “There are a number of drugs currently under study,” he says.
The Bottom Line on Cholesterol Medications
If lifestyle changes aren’t enough to get your cholesterol to a healthy level, your doctor will likely want to get you started on a medication to lower your cholesterol and reduce the risk of heart attack, stroke, and other health problems. Talk with your doctor about these options—they can help you weigh the risks and benefits of each to find the best medication for you. “We’re very lucky that if a patient does need pharmacologic treatment of high cholesterol, we have a lot of choices now to manage it,” Dr. Underberg says.