Treatment for High Cholesterol Everyday Health MenuNewslettersSearch High Cholesterol Treatment for High Cholesterol By Patricia Kelly YeoMedically Reviewed by Michael Cutler, DO, PhDReviewed: August 12, 2022Medically ReviewedPrescription medications, dietary changes, and exercise can all help to treat high cholesterol.Canva; Everyday HealthHigh or abnormal cholesterol numbers can be treated by both lifestyle changes and medication. Without treatment, high cholesterol increases your risk of severe cardiovascular disease, including heart attack and stroke. Since high cholesterol has no symptoms, people typically find out they have high cholesterol after receiving a blood test at the doctor’s office known as a lipid panel. If your lipid panel results show you have high total cholesterol, high LDL cholesterol, or low HDL cholesterol, your doctor may initially recommend that you make some lifestyle changes to get your cholesterol numbers back on track.The CDC’s recommended levels for each component of a lipid panel in adults are as follows: LDL cholesterol: less than 100 mg/dLHDL cholesterol: greater than or equal to 60 mg/dLTriglycerides: less than 150 mg/dLTotal cholesterol: less than 200 mg/dL If these changes don’t result in more desirable cholesterol numbers within a few months, you may need to take medication to lower your cholesterol. For people who have already developed heart disease or who have diabetes or familial hypercholesterolemia (FH), your doctor may initially prescribe cholesterol management drugs. Editor' s Picks 10 FAQs About High Cholesterol Treatment AnsweredHere’s what you need to know if you’ve been prescribed medication to help lower your cholesterol.…Learn More How Can I Lower My Cholesterol Without Medication Fortunately, there are plenty of lifestyle changes that can help prevent high cholesterol and lower it when it's elevated, without the need for regular medication.According to the American Heart Association (AHA), these lifestyle habits include a heart-healthy diet, increased physical activity, and smoking cessation. A healthier lifestyle can also prevent your cholesterol levels from changing in the first place. DietIn terms of diet, the best way to lower your cholesterol is to reduce your intake of saturated fat and trans fat. Per Johns Hopkins, foods that are thought to promote lower cholesterol are rich in monounsaturated fats (found in nuts and olive oil), polyunsaturated fats (found in fish and canola oil), and water-soluble fiber (found in oats, beans, lentils, and other plants). Although experts once cautioned against eating dietary cholesterol, the AHA has stopped explicitly warning against dietary cholesterol after finding consumption of it did not significantly correlate with increased risk of heart disease. Dietary cholesterol is found in foods like eggs, cheese, and shellfish. Many diets, such as the DASH diet for lowering blood pressure and the Mediterranean diet, fit the general description of a cholesterol-lowering diet. All of them focus on vegetables, fruit, whole grains, poultry, fish, nuts, and vegetable oils, while advising against excessive consumption of red and processed meats as well as foods and beverages with added sugar. RELATED: 5 Diets That Can Help Lower Cholesterol To find a heart-healthy diet that works for you, a consultation with a registered dietitian or nurse specializing in nutrition might be helpful. Ask your doctor about a referral if you think you could benefit from professional guidance. Exercise and Physical ActivityGetting and staying active can help lower your cholesterol. Experts recommend at least 150 minutes of moderate-intensity aerobic exercise a week, preferably split up over most days. This can include swimming, brisk walking, jogging, and bicycling. If you’re new to a regular exercise routine, low-impact aerobic exercise is a good way to get started. Always talk to your doctor about any long-term lifestyle changes, including increased physical activity. Tobacco Use Quit smoking tobacco to improve your high cholesterol. Tobacco use tends to lower HDL levels, and can damage your blood vessels, making it easier for excess cholesterol to form plaques and contribute to heart disease. It also compounds other heart disease risk factors, like high blood pressure. Weight Management Although body mass index (BMI) is not a perfect indicator of health, having a BMI in the overweight or obese range tends to be associated with elevated LDL cholesterol and lower HDL cholesterol. According to the AHA, losing as little as 5 to 10 percent of your body weight, if you’re considered overweight, can help lower your cholesterol numbers.But weight isn’t the only factor. According to Canada’s Heart and Stroke Foundation, a large waist circumference is also a risk factor for heart disease. Even if you have a BMI in the normal range, excess abdominal fat can increase your risk of high cholesterol, high blood pressure, and type 2 diabetes. A waist measurement of 40 inches or more for men and 35 inches or more for women generally puts you at greater risk of high cholesterol. Medications for High Cholesterol If lifestyle changes alone don’t bring your cholesterol levels into the desired range, your doctor may prescribe one or more medications to lower your cholesterol. These drugs fall into a few different categories. Statins Most patients with high cholesterol will be prescribed statins. Statins are a class of drugs that prevent cholesterol from forming in the liver, where it is made. This then lowers the amount of cholesterol circulating in the blood. They are most effective at lowering LDL cholesterol, but can also lower triglycerides and increase HDL cholesterol.According to the U.S. Food and Drug Administration (FDA), statins typically don’t cause serious side effects. Most side effects are mild and disappear if you continue to use the drugs. The most common side effects of statins include:Muscle pain and weaknessStomach painConstipationNauseaDiarrhea But statin use may increase hemoglobin A1C in people who are pregnant or have diabetes, and those with certain types of liver disease should not take statins. Commonly prescribed statins in the United States include:lovastatin (Altoprev, Mevacor)rosuvastatin (Crestor)fluvastatin (Lescol)atorvastatin (Lipitor)pitavastatin (Livalo)pravastatin (Pravachol)simvastatin (Zocor) If you are intolerant of statins or they aren’t working to decrease your high cholesterol, your doctor may prescribe other cholesterol-lowering medications. Bile Acid Sequestrants Also known as bile acid binding agents, these drugs work by removing bile acids from the liver. Since LDL cholesterol is needed to make bile acids, the body breaks down more LDL cholesterol particles. Bile acid sequestrants typically are prescribed with a statin. They include: colestipol (Colestid)cholestyramine (Prevalite, Questran)colesevelam (Welchol) Cholesterol Absorption InhibitorsCurrently, ezetimibe (Zetia) is the only cholesterol absorption inhibitor drug on the market, and it's the most commonly used nonstatin cholesterol drug, according to the AHA. Ezetimibe works by preventing cholesterol from being absorbed in the intestine. This means less cholesterol is delivered to the liver, and ultimately the blood. PCSK9 InhibitorsA newer type of medicine, PCSK9 inhibitors bind to and deactivate a protein on certain liver cells, which then lowers LDL cholesterol. Administered by injection, they are often given to patients with high cholesterol that doesn’t respond to statins or to people with familial hypercholesterolemia. FDA-approved PCSK9 inhibitors include:alirocumab (Praluent) a monoclonal antibody approved for use in people with heterozygous familial hypercholesterolemia, taken every two or four weeksevolocumab (Repatha) a biweekly or monthly monoclonal antibody approved for use in people with homozygous and heterozygous familial hypercholesterolemiainclisiran (Leqvio) a small interfering RNA (siRNA) therapy approved for use in people with heterozygous familial hypercholesterolemia and clinical atherosclerotic cardiovascular disease, taken twice per year Adenosine Triphosphate-Citrate Lyase ACL Inhibitors ACL inhibitors work by blocking the production of cholesterol in the liver. They are used as a primary prevention of high cholesterol in individuals with heterozygous familial hypercholesterolemia (FH), according to research in the journal Expert Opinion on Investigational Drugs. ACL inhibitors are also used for the secondary prevention of high cholesterol in combination with statins and dietary changes for adults who have established atherosclerotic cardiovascular disease and need additional lowering of LDL cholesterol. To date, the only FDA-approved ACL inhibitor used to reduce LDL cholesterol is bempedoic acid (Nexletol). Add-On Treatments for High Cholesterol Although the data doesn’t support the ability of the following drugs to directly lower LDL and total cholesterol, your doctor may also prescribe these drugs to manage your triglyceride levels. Fibrates These medications reduce overall triglyceride levels by reducing the liver’s production of very low density lipoproteins, which are made up mostly of triglycerides. They also increase the removal of triglycerides from the blood. Some commonly prescribed fibrates are:gemfibrozil (Lopid)fenofibric acid (Trilipix)fenofibrate (TriCor)fenofibrate (Lipofen) Niacin Also known as nicotinic acid or vitamin B3, niacin is a B vitamin that can raise HDL cholesterol while lowering levels of total cholesterol, LDL cholesterol, and triglycerides by limiting your liver’s ability to produce cholesterol. Niacin hasn’t been shown to provide any additional benefit over statins alone, and has been linked to liver damage and increased stroke risk. As a result, most doctors recommend niacin only for people who can’t take statins. Combination Drugs Drug manufacturers have started combining cholesterol absorption inhibitors or niacin with statins in a single formulation. Together, these combination drugs limit production of cholesterol in your liver alongside the effects of either niacin (which raises HDL cholesterol) or ezetimibe (which limits cholesterol absorption in the small intestine). These combination drugs include:ezetimibe and rosuvastatin (Roszet)ezetimibe and simvastatin (Vytorin)niacin and lovastatin (Advicor)niacin and simvastatin (Simcor) Omega-3 Fatty Acid Supplements In large doses, omega-3 fatty acids can help lower triglyceride levels. The most common supplement is OTC fish oil, but they are also available by prescription. Omega-3 supplement prescriptions are sold under several brand names, including:EpanovaLovazaOmtrygVascepa Let your doctor know if you plan to take OTC omega-3 or fish oil supplements, since they can affect how your body responds to other medications you’re already taking. Side Effects of Cholesterol Medications To minimize side effects of cholesterol-lowering drugs, it’s important to take them in the manner prescribed. Because some cholesterol-lowering drugs affect your liver, you may need to have your liver function tested occasionally. Let your doctor know if you have any problems after starting a new medication. They may be able to adjust your dosage or switch you to an alternative medication. Contact your doctor immediately if your symptoms are severe or seem life-threatening. Editorial Sources and Fact-Checking Prevention and Treatment of High Cholesterol. American Heart Association.Cholesterol Abnormalities & Diabetes. American Heart Association.High Blood Cholesterol: What You Need to Know. National Heart, Lung, and Blood Institute.High Cholesterol. Mayo Clinic.Cholesterol Medications: Consider the Options. Mayo Clinic.Treatment for FH. FH Foundation.New Drug Application Approval Letter for Leqvio. U.S. Food and Drug Administration.Show LessNEWSLETTERS Sign up for our Heart Health Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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