Cholesterol Management (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- What is cholesterol?
- What are the different types of cholesterol?
- Why is high cholesterol dangerous?
- Where does cholesterol come from?
- What are normal cholesterol levels?
- Which foods can help lower cholesterol?
- What other lifestyle interventions help lower cholesterol?
- What medications are available to treat high cholesterol?
- Pictures of Cholesterol Levels - Slideshow
- Take the Cholesterol Quiz
- Lowering Cholesterol 15 Tips Slideshow Pictures
- High Cholesterol (Hyperlipidemia) FAQs
- Find a local Internist in your town
What other lifestyle interventions help lower cholesterol?
Weight loss and exercise are shown to decrease total cholesterol while increasing levels of HDL, the good cholesterol. Smoking cessation decreases LDL levels plus smoking is a primary risk factor for heart disease and stroke. One drink of alcohol a day may help increase HDL levels, but too much alcohol can damage the liver and increase the risk of elevated LDL.
What medications are available to treat high cholesterol?
There are four classes of medication that can lower cholesterol levels including statins, niacin, bile acid resins, and fibric acid derivatives.
- A variety of statin drugs are on the market including simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), fluvastatin (Lescol), lovastatin (Mevacor), and rosuvastatin (Crestor). These drugs primarily decrease LDL.
- Cholestyramine (Questran) is a bile acid resin and decreases LDL.
- Fibric acid resins lower LDL and include gemfibrozil (Lopid) and fenofibrate (Tricor).
- Niaspan is the prescription form of niacin and decreases LDL and triglycerides as well as increases HDL.
- Alirocumab (Praluent) and evolocumab (Repatha) are two new medications that are antibodies to a protein, PCSK9. These drugs are indicated in patients who have had heart attack or stroke or have familial hypercholesterolemia and are taking maximum therapy and continue to have high LDL cholesterol levels in their blood.
The choice as to what medication is most appropriate is usually individualized by the health care professional in discussion with the patient. These medications often need to be adjusted and monitored for side effects.
While all four medication groups may have a role in controlling cholesterol levels in association with diet, exercise, and smoking cessation, only statins are shown to decrease the risk of heart attack.
The American Heart Association and the American College of Cardiology recommend that statin therapy may benefit patients with a history of heart attack, those with elevated blood LDL cholesterol levels or type two diabetes, and a those with a 10-year risk of heart disease greater than 7.5%. Calculate your risk online with the American Heart Association's CV Risk Calculator.
When monitoring how well statin therapy works, the goal is no longer to reach a specific blood cholesterol level. Instead patients with a high risk of heart disease will aim to decrease their cholesterol levels by 50% and those with a lesser risk will aim to lower their cholesterol levels by 30% to 50%.
Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease
Greenland, P., et al. "2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 56.25 (2010): e50-e103.
Grundy, S. M., et al. "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines." Circulation 110.2 (2004): 227-239.
Stone, N. J., et al. "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 7 Nov. 2013.
Tips to keep it under control.