Treatment for Hyperlipidemia (High Cholesterol)

High cholesterol, or hyperlipidemia, is a common health concern that can increase the risk of heart disease and stroke. Cholesterol is a fatty substance produced by the liver that is essential for many bodily functions, but too much of it in the blood can be dangerous.^1,2

Understanding cholesterol numbers

Cholesterol is measured in milligrams per deciliter (mg/dL) and is categorized into 3 main types:^2,3

• Low-density lipoprotein (LDL) cholesterol – Often referred to as “bad” cholesterol because it can build up in the arteries, forming plaques. LDL levels should ideally be between 70 to 130 mg/dL. For people with coronary artery disease or diabetes, the lower your levels, the better.
• High-density lipoprotein (HDL) cholesterol – Referred to as “good” cholesterol because it helps remove LDL cholesterol from the bloodstream. Higher levels of HDL cholesterol are good, meaning 60 mg/dL or more.
• Triglycerides – These are another type of fat in the blood. Normal levels are below 150 mg/dL.

How to treat high cholesterol

Managing high cholesterol involves lifestyle changes and, in some cases, medicines. Successful treatment depends on an early diagnosis.^1-4

It is important to know whether you have any risk factors that increase your chance of developing high cholesterol. Risk factors may include a family history of high cholesterol or other medical conditions like diabetes.^1-4

Lifestyle changes to treat high cholesterol

Evidence shows that making certain lifestyle changes can greatly improve cholesterol numbers.^1-4

Healthy diet

Adopting a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can improve cholesterol levels. When in doubt, eat food your grandmother would recognize. This means more whole foods and less processed foods. Also aim to:^1-4

• Choose healthy fats – Opt for unsaturated fats found in olive oil, avocados, and nuts. Limit saturated and trans fats found in fried foods, fast food, and processed foods.
• Increase fiber intake – Fiber-rich foods like fruits, vegetables, and whole grains help lower cholesterol levels.

Regular exercise

Regular physical activity can raise HDL cholesterol and lower LDL cholesterol and triglycerides. Aim for at least 150 minutes of moderate-intensity exercise per week. That breaks down to about 30 minutes a day.^1-4

There are lots of ways to incorporate more movement into your life. Your doctor can help you decide what is safe for you. Two basic types of exercise are:^1-4

• Aerobic exercise – Activities like walking, jogging, or cycling can improve overall heart health and keep cholesterol in check.
• Strength training – Building muscle by lifting weights and doing resistance exercises helps keep your weight down and improves total cholesterol levels. Examples of resistance exercises are push-ups and squats.

Weight management

Maintaining a healthy weight contributes to overall heart health and can help lower cholesterol levels. The weight loss drug semaglutide (Wegovy®), a GLP-1 agonist, has been approved by the U.S. Food and Drug Administration (FDA) to treat people with obesity and overweight who also have heart issues like high cholesterol. If you are overweight or are living with obesity, talk with your doctor about healthy and sustainable ways to lose weight.^1-5

Medicines to treat high cholesterol

There are several medicines that can help treat and manage high cholesterol.^1,3,4,6

Statins

Statins are commonly prescribed medicines to treat high cholesterol. Statins work by stopping the liver from making LDL cholesterol. Examples of statins include:^4,6

• Atorvastatin (Lipitor®)
• Fluvastatin (Lescol® XL)
• Lovastatin (Altoprev®)
• Pitavastatin (Livalo®)
• Pravastatin (Pravachol®)
• Rosuvastatin (Crestor®)
• Simvastatin (Zocor®)

For people who are not able to take statins, ezetimibe (Zetia®) with bempedoic acid (Nexletol®) may be prescribed.⁷

Bile-acid-binding resins

​​Bile-acid-binding resins lower cholesterol by attaching to bile acids in the intestine. The liver then has to use more cholesterol to produce new bile acids. This process reduces LDL cholesterol levels in the bloodstream. Examples of these drugs include:^4,6

• Cholestyramine (Prevalite®, Questran®, Questran Light®, Locholest®, Locholest Light®)
• Colesevelam (Welchol®)
• Colestipol (Colestid®)

PCSK9 inhibitors

These newer drugs are injectable medications that lower LDL levels by increasing the liver’s ability to remove cholesterol from the bloodstream. Examples of PCSK9 inhibitors include:^4,6

• Alirocumab (Praluent®)
• Evolocumab (Repatha®)

Ezetimibe (Zetia®) with bempedoic acid (Nexletol®) may be used for people unable to take PCSK9 inhibitors.⁷

Fibrates

These drugs primarily target triglycerides but also may have a modest impact on other cholesterol levels. Fibrates also reduce the liver’s production of very low-density lipoprotein (VLDL) cholesterol. Examples of fibrates include:^4,6

• Fenofibrate (Tricor®, Fenoglide®, Triglide®, Antara®)
• Gemfibrozil (Lopid®)
• Clofibrate (Atromid-S)

Omega-3 fatty acid supplements

These over-the-counter medicines can help to lower triglycerides. But supplements are not regulated like other drugs are, so take caution when choosing one. Before you begin taking an omega-3 fatty acid supplement, ask your doctor about safe options.^4,6

Ways to prevent high cholesterol

In many cases, it is possible to prevent high cholesterol. Preventing high cholesterol involves eating a healthy diet, getting regular exercise, and maintaining a healthy weight. The following behaviors can also help:^1-4,8

• Quitting smoking – Smoking damages blood vessels and lowers HDL cholesterol, the good kind of cholesterol.
• Drinking less alcohol – Alcohol is linked to many health issues, including high blood pressure, heart failure, and stroke.
• Getting adequate sleep – Aim for at least 7 hours of sleep each night.
• Managing stress – Stress can cause short spikes of raised blood pressure. Do things that relieve stress.

Regular checkups with your doctor to get your cholesterol levels checked are essential. You can then adjust your treatment plan depending on your cholesterol numbers. If you have high cholesterol, there are many ways to treat it. Talk to your doctor about what they recommend.