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If you have high cholesterol (or are simply interested in the topic), this article will walk you through some of the treatment options that exist for hypercholesterolemia. But first, it’s important to understand the 2 main types of cholesterol:

Low-density lipoprotein (LDL). This is “bad cholesterol” that carries cholesterol to your cells and arteries. High LDL levels can promote plaque build up in your arteries.

High-density lipoprotein (HDL). This is “good cholesterol” that absorbs extra cholesterol found in your blood and carries it back to the liver, where it gets removed from the body.

Read more about cholesterol levels, lipid panels and testing here.

What’s the difference between hypercholesterolemia, dyslipidemia, & hyperlipidemia?

You may have seen these terms tossed around, but there is a key difference between them.

  • Dyslipidemia refers to an imbalance in lipids, including cholesterol and triglycerides, in the bloodstream.

  • Hypercholesterolemia specifically focuses on elevated levels of cholesterol, particularly the low-density lipoprotein (LDL) cholesterol often associated with cardiovascular risk.

  • Hyperlipidemia is a broader term encompassing high levels of both cholesterol and triglycerides, indicating a general elevation of fats in the blood.

Each of these conditions can contribute to cardiovascular disease and other health complications, underscoring the importance of managing lipid levels for overall well-being.

Lifestyle Changes

Lifestyle changes can be very effective at lowering or improving your cholesterol levels. In fact, adopting heart-healthy habits alone can lower cholesterol enough for some people. Some of these changes include:

Adopting a more heart-healthy diet. Not only can a healthier diet reduce your “bad” cholesterol, but it can also improve your overall cardiovascular (heart) health. Looking to make some changes? Here’s how you can start:

  1. Decrease your consumption of foods that are high in saturated fats.

  2. Ditch the trans fats—your body doesn’t need or benefit from them.

  3. Consume more foods that are high in soluble fiber.

  4. Incorporate foods that are rich in omega-3 fatty acids into your diet.

  5. Eat more whole foods, like fruits, vegetables, whole grains.

Exercising regularly—and we mean almost every, if not every, day of the week. Incorporating at least 30 minutes of moderate physical activity into your daily routine can help raise your HDL cholesterol.

Maintaining a healthy weight. If you’re overweight, shedding some pounds can lower your LDL cholesterol.

Quitting smoking. Quitting smoking can increase your HDL cholesterol. And within a year of quitting, your heart disease risk is already half that of an active smoker.

Managing your stress. Research has found that chronic stress can raise your LDL cholesterol and lower your HDL cholesterol.

Treatment Options

If lifestyle changes weren't enough to lower fat levels in your blood, your healthcare provider may prescribe medicine to reach your goals.

Cholesterol-lowering drugs include:

1. Statins

How do they work? Statins work by blocking an enzyme in the liver that is necessary for cholesterol production. This leads to a reduction in LDL cholesterol levels.

How effective are they? Statins are highly effective in reducing LDL cholesterol levels, with an average reduction of 30-55%.

Common medications in this family: Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin (Crestor), Pravastatin (Pravachol) and Lovastatin (Altoprev)

Common side effects: muscle pain, liver enzyme abnormalities, and digestive issues

Pharmacist Tip: Statins may interact with other medications, so it's important to inform your doctor of all the medications you are taking.

2. Cholesterol Absorption Inhibitors

How do they work? Cholesterol absorption inhibitors work by blocking the absorption of dietary cholesterol in the intestines. This helps lower overall cholesterol levels in the bloodstream.

How effective are they? Cholesterol absorption inhibitors can effectively lower LDL cholesterol levels by about 18-25%.

Common medication in this family: Ezetimibe (Zetia)

Common side effects: diarrhea, stomach pain, and fatigue

Pharmacist Tip: It's important to inform your doctor about any existing liver conditions, as this medication may affect liver function.

3. Bile Acid Sequestrants (or Resins)

How do they work? Bile-acid binding resins work by binding to bile acids in the digestive system, preventing them from being reabsorbed. This leads the liver to use more cholesterol to make new bile acids, reducing cholesterol levels in the blood.

How effective are they? Bile-acid binding resins can lower LDL cholesterol levels by about 15-30%.

Common medications in this family: Cholestyramine (Questran), Colesevelam (Welchol)

Common side effects: constipation, gas, and bloating

Pharmacist Tip: These medications may interfere with the absorption of other medications, so it's important to take them at least one hour before or four hours after taking other drugs.

4. Bempedoic Acid

How does it work? Bempedoic acid works by inhibiting an enzyme involved in cholesterol synthesis in the liver, ultimately reducing LDL cholesterol levels.

How effective is it? Bempedoic acid can lower LDL cholesterol levels by about 18-30%.

Common medications in this family: Bempedoic acid is available under the brand name Nexletol

Common side effects: muscle pain, upper respiratory infections, and back pain

Pharmacist Tip: Individuals with a history of muscle disorders should use this medication with caution, as it may exacerbate muscle symptoms.

5. PCSK9 Inhibitors

How do they work? PCSK9 inhibitors work by blocking a protein in the liver that regulates LDL receptor recycling. By doing so, they increase the liver's ability to remove LDL cholesterol from the bloodstream.

How effective are they? PCSK9 inhibitors can lower LDL cholesterol levels by about 50-60%.

Common medications in this family: Evolocumab (Repatha) and Alirocumab (Praluent)

Common side effects: injection site reactions, cold-like symptoms, and flu-like symptoms

Pharmacist Tip: PCSK9 inhibitors may be associated with allergic reactions in some individuals.

If you have high triglycerides, your doctor may prescribe:

1. Fibrates

How do they work? Fibrates primarily target triglyceride levels by increasing the breakdown of fats in the liver and reducing the production of triglycerides.

How effective are they? Fibrates can lower triglyceride levels by approximately 20-50%, and increase HDL cholesterol by about 10-20%.

Common medications in this family: Gemfibrozil (Lopid) and Fenofibrate (Tricor)

Common side effects: digestive issues, muscle pain, and liver enzyme abnormalities

Pharmacist Tip: Individuals with pre-existing liver or kidney conditions should use fibrates with caution.

2. Fish Oil (Omega-3 Fatty Acids)

How does it work? Omega-3 fatty acids, found in fish oil supplements, help reduce triglyceride levels and have anti-inflammatory effects.

How effective are they? Omega-3 fatty acids (fish oil) can reduce triglyceride levels by about 20-30%.

Common medications in this family: Omega-3 fatty acid supplements (e.g., Lovaza, Vascepa)

Common side effects: fishy aftertaste, digestive issues, and allergies in some individuals

Pharmacist Tip: Individuals with seafood allergies or those taking blood thinners should consult their doctor before starting fish oil supplements.

3. Niacin (Nicotinic Acid)

How does it work? Niacin, a B-vitamin, helps raise HDL cholesterol levels and lower LDL cholesterol levels by inhibiting the liver's production of VLDL cholesterol.

How effective are they? Niacin can increase HDL cholesterol levels by approximately 15-35% and reduce LDL cholesterol by about 5-25%.

Common medications in this family: Niaspan and over-the-counter niacin supplements

Common side effects: flushing, itching, and liver enzyme abnormalities

Pharmacist Tip: High doses of niacin should only be taken under a doctor's supervision due to potential side effects.

Remember, it's crucial to consult a healthcare professional before starting or changing any medication regimen. They can provide personalized recommendations based on individual health conditions and needs.

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