Cholesterol
Cholesterol is a waxy substance found in your blood. Your body needs cholesterol to build healthy cells, but high levels of cholesterol can increase your risk of heart disease.
With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke.
High cholesterol can be inherited, but it's often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol.
About Cholesterol
High cholesterol has no symptoms. A blood test is the only way to detect if you have it.
According to the National Heart, Lung, and Blood Institute (NHLBI), a person's first cholesterol screening should occur between the ages of 9 and 11, and then be repeated every five years after that.
The NHLBI recommends that cholesterol screenings occur every one to two years for men ages 45 to 65 and for women ages 55 to 65. People over 65 should receive cholesterol tests annually.
If your test results aren't within desirable ranges, your doctor might recommend more-frequent measurements. Your doctor might also suggest more-frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as diabetes or high blood pressure.
Cholesterol in your blood is carried on lipoproteins:
-
Low-density lipoprotein (LDL), sometimes called “bad” cholesterol
-
High-density lipoprotein (HDL), sometimes called “good” cholesterol.
High levels of “bad” LDL cholesterol cause plaque (fatty deposits) to build up in your blood vessels. This may lead to heart attack, stroke, or other health problems. High levels of “good” HDL cholesterol may actually lower your risk for health problems. HDL cholesterol carries cholesterol and plaque buildup from your arteries to the liver, so it can be flushed out of the body.
​
How do I lower my risk for high cholesterol and triglycerides?
You can work to prevent high cholesterol and triglycerides by reducing risk factors that are in your control. You can make healthy lifestyle decisions, such as choosing healthier foods with less saturated fat and quitting smoking.
If you already have high LDL cholesterol and triglyceride levels, your health care team may recommend medicines that treat high cholesterol and triglyceride levels and lifestyle changes to lower your risk for heart disease and stroke.
If you already have low HDL cholesterol levels, talk with your doctor about lifestyle changes that may help raise your levels.
Getting your cholesterol checked regularly is an important way of to stay in control of your cholesterol health. Work with your health care team on how often you should get screened.
​
Treatment
Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.
The choice of medication or combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effects.
​
Different Classes of Cholesterol Medication:
-
Statins. Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
-
Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.
-
Bempedoic acid. This newer drug works in much the same way as statins but is less likely to cause muscle pain. Adding bempedoic acid (Nexletol) to a maximum statin dosage can help lower LDL significantly. A combination pill containing both bempedoic acid and ezetimibe (Nexlizet) also is available.
-
Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
-
PCSK9 inhibitors. These drugs can help the liver absorb more LDL cholesterol, which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications. They are injected under the skin every few weeks and are expensive.
