Tips If Youre Starting Treatment for High Cholesterol

Curated by Claudia Shannon / Research Scientist / ishonest

Cholesterol is a fatty substance that circulates in your blood. Your body makes some cholesterol. You get the rest from foods you eat.

Your body needs some cholesterol to build healthy cells and make hormones. But when you have too much cholesterol, it collects inside your arteries and blocks the flow of blood.

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Having untreated high cholesterol can increase your risk of heart disease, heart attack, and stroke.

There are two types of cholesterol:

  • Low-density lipoprotein (LDL) cholesterol is the unhealthy kind that builds up inside your arteries.
  • High-density lipoprotein (HDL) cholesterol is the healthy kind that helps clear LDL cholesterol from your blood.

If your LDL or total cholesterol levels are too high, your doctor can recommend lifestyle changes and medications to improve them.

Here are some tips to help bring your cholesterol numbers into a healthy range.

Know your goals

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Ask your doctor how much you need to lower your LDL cholesterol and raise your HDL cholesterol. The following levels are ideal:

  • total cholesterol: less than 200 mg/dL
  • LDL cholesterol: less than 100 mg/dL
  • HDL cholesterol: 60 mg/dL or higher

Your target cholesterol levels may be slightly lower or higher depending on your age, sex, and heart disease risks.

Change your diet

Making a few changes to your diet can help bring your numbers to healthy levels. Avoid or limit foods that contain these types of fats:

  • Saturated fats. Animal-based products increase LDL cholesterol. Red meat, whole fat dairy, eggs, and vegetable oils like palm and coconut oil are all high in saturated fat.
  • Trans fats. Manufacturers produce these artificial fats through a chemical process that turns liquid vegetable oil into a solid. Foods high in trans fats include fried foods, fast foods, and baked goods. These foods are low in nutrition and can raise your LDL cholesterol.

Many of the foods listed above are also high in cholesterol, including red meat and whole fat dairy products.

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On the other hand, certain foods can help either lower LDL cholesterol directly or block your body from absorbing cholesterol. These foods include:

  • whole grains, like oats and barley
  • nuts and seeds
  • avocados
  • beans
  • healthy oils, like sunflower, safflower, avocado, and olive oil
  • fatty fish, like salmon, mackerel, and herring
  • soy
  • fruits, like apples, pears, and berries
  • products fortified with sterols and stanols, like orange juice and margarine

Get more active

A fast walk or bike ride each day can boost your HDL cholesterol, which helps sweep excess LDL cholesterol out of your bloodstream. Try to get in at least 30 minutes of moderate-intensity aerobic exercise 5 days a week.

Extra fat around your middle section can increase your LDL cholesterol and lower your HDL cholesterol. Losing just 10 percent of your body weight will help manage your cholesterol. Better nutrition and regular exercise can help you lose extra weight.

Quit smoking

In addition to raising your risk of cancer and COPD, smoking can negatively affect your cholesterol levels. People who smoke cigarettes tend to have high total cholesterol, high LDL, and low HDL levels.

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Quitting is easier said than done, but there are many options. If you’ve tried a few methods and failed, ask your doctor to recommend a new strategy to help you stop smoking for good.

Medications

Prescription medication is an option if lifestyle changes alone haven’t improved your cholesterol levels.

Speak with your doctor about the best options for you. They will consider your heart disease risks and other factors when deciding whether to prescribe one of these cholesterol-lowering medications.

Statins

Statin drugs block a substance your body needs to make cholesterol. These medications decrease LDL cholesterol and increase HDL cholesterol:

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol XL)
  • lovastatin (Altoprev)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)
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Side effects of statins can include:

  • muscle pain and soreness
  • increased blood sugar levels
  • nausea
  • headaches
  • diarrhea
  • constipation
  • stomach cramps
Bile acid sequestrants

Bile acid sequestrants block bile acids in your stomach from being absorbed into your blood. To make more of these digestive substances, your liver has to pull cholesterol from your blood, which lowers your cholesterol levels.

These drugs include:

  • cholestyramine (Prevalite)
  • colesevelam (Welchol)
  • colestipol (Colestid)

Side effects of bile acid sequestrants can include:

  • heartburn
  • bloating
  • gas
  • constipation
  • nausea
  • diarrhea
Cholesterol absorption inhibitors
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Cholesterol absorption inhibitors lower cholesterol by blocking the absorption of cholesterol in your intestines.

There are two drugs in this class. One is ezetimibe (Zetia). The other is ezetimibe-simvastatin, which combines a cholesterol absorption inhibitor and a statin.

Side effects of cholesterol absorption inhibitors can include:

  • stomach pain
  • gas
  • constipation
  • muscle soreness
  • tiredness
  • weakness
Niacin

Niacin is a B vitamin that can help raise HDL cholesterol. Prescription niacin brands are Niacor and Niaspan. Side effects of niacin can include:

  • flushing of the face and neck
  • itching
  • dizziness
  • belly pain
  • nausea and vomiting
  • diarrhea
  • increase in blood sugar levels
Protein blockers: PCSK9 inhibitors
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These newer medications block a protein called PCSK9 to aid in removing LDL cholesterol from the blood. PCSK9 inhibitors are often used when lifestyle changes and statins alone aren’t enough.

Some people have a genetic condition called familial hypercholesterolemia, which causes higher LDL cholesterol levels. This can make it harder to address high cholesterol.

PCSK9 inhibitors include:

  • alirocumab (Praluent)
  • evolocumab (Repatha)

These are newer drugs, so potential side effects are still being determined. Here are some seen in clinical trials:

  • itching, pain, swelling, or bruising at the injection site
  • colds and flu
  • back pain
Fibrates
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Fibrates target triglycerides in your body and may also increase HDL cholesterol in the blood.

Examples of fibrates include:

  • fenofibrate (Tricor)
  • gemfibrozil (Lopid)

Side effects can include:

  • stomach issues, such as nausea, discomfort, and diarrhea
  • liver inflammation
ATP citrate lyase (ACL) inhibitors

ACL inhibitors prevent your liver from processing cholesterol to aid in lowering LDL cholesterol. People with familial hypercholesterolemia and atherosclerotic cardiovascular disease (ASCVD) can benefit.

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An example of an ACL inhibitor includes:

Side effects of ACL inhibitors can include:

  • upper respiratory tract infections
  • muscle spasms
  • back pain
  • abdominal pain
  • anemia
  • increased liver enzymes
  • an increase in uric acid in the blood

Takeaway

A variety of lifestyle changes can help you manage high cholesterol levels. This includes eating a heart-healthy diet, exercising regularly, and maintaining a moderate weight.

If those changes aren’t enough, speak with your doctor about prescription medications that can help treat high cholesterol.

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