High cholesterol is often treated by cholesterol-lowering medications and lifestyle changes.
The following lifestyle changes can help reduce high cholesterol:
- Lowering the intake of red meat, fatty foods, eggs, dairy, and fried foods
- Increasing your intake of fiber with fruits and vegetables.
- Use olive oil and canola oil instead of butter.
- Exercise 30 minutes daily if possible. Or exercise until you feel out of breath at least twice a week.
- Eat only whole grains, not refined flour.
- Broil or bake meats.
- Eat more fish and poultry.
- Maintain a normal weight/BMI.
There are a variety of medications that can be used to lower cholesterol, with statins being the most popular. Other medications may be prescribed for people who do not wish to take statins, or for people who are unsuitable due to other pre-existing conditions.
Statins work by blocking an enzyme in the liver that is involved in making LDL cholesterol. Statins can reduce LDL levels by 25-60%. Most people find that low-intensity statins such as Simvastatin, Fluvastatin and Pravastatin are enough to help reduce their cholesterol. But some patients with very high cholesterol levels may need high-intensity statins such as Atorvastatin or Rosuvastatin.
Bile acid binders
Bile acid binders such as Cholestyramine, Colesevelam and Colestipol help to lower LDL by binding to the bile duct and helping to prevent the LDL from reaching the bloodstream where it can clog up the arteries.
Fibrates help to encourage the breakdown of VLDL (very-low-density lipoprotein), one of the types of LDL cholesterol. Fibrates also help to eliminate triglycerides from the blood. A high level of triglycerides and LDL is linked to a build-up of cholesterol inside the arteries. Gemfibrozil, Fenofibrate, Fenofibrate (micronized) and Fenofibric Acid are types of fibrate medication.
Nicotinic agents, such as Niacin (Vitamin B3) lower the levels of triglycerides and LDL cholesterol whilst raising the levels of HDL cholesterol. Of all the cholesterol-lowering drugs, nicotinic agents have the strongest effect on HDL levels.
Cholesterol absorption inhibitors
Cholesterol absorption inhibitors help to prevent cholesterol being absorbed from food by the intestines. Ezetimbe is an example of a cholesterol absorption inhibitor.
Apolipoprotein B antisense oligonucleotide
This type of medication blocks the production of a substance that reduces the liver’s production of some harmful lipids (fats), including LDL. Mipomerson, is an example of an Apolipoprotein B antisense oligonucleotide.
MTP inhibitors, such as Lomitapide, impair the absorption of lipids and also blocks the conversion of triglycerides into a substance called apo-B, which is involved in the production of VLDL (very low-density lipoprotein) - a type of LDL cholesterol.
Omega 3 acids
Omega 3 is found in many foods and over-the-counter dietary supplements, however ASCEPA ® (icosapent ethyl) is the first prescription Omega-3, that has been clinically proven to lower high triglyceride levels without raising the levels of bad cholesterol.
Combinations of statins with high blood pressure medications or other lipid-lowering medications can also be used to treat high cholesterol. Combination drugs are used when one anti-cholesterol drug isn’t working well enough, or if you have both high blood pressure and high cholesterol. These combination drugs include:
- Atorvastatin and Amlodipine
- Lovastatin and Niacin (nicotinic acid)
- Simvastatin and Niacin
- Atorvastatin and Ezetimibe
- Simvastatin and Ezetimibe