What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol is made by your liver. It travels through the blood on proteins called lipoproteins. One type of lipoprotein, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are the treatments for high cholesterol?

If you have high cholesterol, lifestyle changes can help you lower your cholesterol levels. But sometimes the lifestyle changes are not enough, and you need to take cholesterol medicines. But you should still continue with the lifestyle changes even though you are taking medicines.

Who needs cholesterol medicines?

Your health care provider may prescribe cholesterol medicines for you if:

• You have already had a heart attack or stroke, or you have peripheral arterial disease
• Your LDL (bad) cholesterol level is 190 mg/dL or higher
• You are 40-75 years old, you have diabetes, and your LDL cholesterol level is 70 mg/dL or higher
• You are 40-75 years old, you have a high risk of developing heart disease or stroke, and your LDL cholesterol level is 70 mg/dL or higher

What are the different types of cholesterol medicines?

There are several types of cholesterol-lowering drugs available, including:

• Statins. They reduce the amount of cholesterol made in the liver. They also increase your liver's ability to remove LDL cholesterol that is already in the blood. Statins are the most common medicines used to treat high cholesterol.
• Bile acid sequestrants. They keep bile acids, which digest fats and oils, from being absorbed into the body. But your body needs bile acids, so your liver will make more of them. It makes them by breaking down LDL cholesterol, so this helps lower your LDL cholesterol. Your provider may prescribe these medicines if you cannot take statins or if statins alone are not lowering your cholesterol enough.
• Cholesterol absorption inhibitors. They block how cholesterol is absorbed into the body. They are also used if you cannot take statins or if statins alone are not lowering your cholesterol enough.
• Nicotinic acid (niacin). It is a type of B vitamin. It reduces the amount of fats made by your liver, so it lowers your LDL cholesterol and triglycerides. Niacin also raises HDL cholesterol. Even though you can buy niacin without a prescription, you should talk to your provider before taking it to lower your cholesterol. High doses of niacin can cause serious side effects.
• PCSK9 inhibitors. These are medicines that you inject under your skin. They block a protein called PCSK9. This helps your liver remove and clear LDL cholesterol from your blood. Your provider may prescribe a PCSK9 inhibitor and a statin if you are at high risk of complications like heart attack or stroke, or if you have familial hypercholesterolemia (FH). FH is an inherited disorder that causes very high levels of cholesterol in the blood.
• Fibrates. They lower triglycerides in several complex ways, including reducing the amount of triglycerides made by the liver. They may also help increase HDL cholesterol and may lower LDL levels a bit. If you take them with statins, it might increase the risk of side effects.
• Combination medicines. They include more than one type of cholesterol-lowering medicine. There are also combination medicines that can treat both high blood pressure and cholesterol.

There are also a few other cholesterol medicines (lomitapide and mipomersen) that are only for people who have FH.

How does my health care provider decide which cholesterol medicine I should take?

When deciding which medicine you should take and which dose you need, your provider will consider:

• Your cholesterol levels.
• Your risk for heart disease and stroke.
• Your age.
• Any other health problems you have.
• Possible side effects of the medicines. Higher doses are more likely to cause side effects, especially over time.

Medicines can help control your cholesterol, but they don't cure it. You need to keep taking your medicines and get regular cholesterol checks to make sure that your cholesterol levels are in a healthy range.