Cholesterol Medicines

Your healthcare provider has prescribed medicine to help control your cholesterol. This sheet tells you how cholesterol affects your health. It also explains how medicines can help improve your cholesterol levels.

Understanding cholesterol

Cholesterol is a type of fat (lipid) that’s carried in the blood. Your body makes cholesterol in the liver. You also get it from certain foods. Your body needs some cholesterol to stay healthy but high cholesterol makes more plaque buildup in blood vessels. Plaque is a fatty substance. Over time, this plaque narrows and hardens the blood vessels. This reduces or blocks blood flow in these vessels and raises your risk for heart attack (acute myocardial infarction, or AMI), stroke, and other health problems. This is known as atherosclerotic cardiovascular disease (ASCVD).

Types of lipids

Your blood has 3 key fats:

• LDL (low-density lipoprotein) cholesterol. This is called “bad” because it can cause plaque to build up in the blood vessels.
• HDL (high-density lipoprotein) cholesterol. This is called “good” because it helps get rid of harmful cholesterol in the bloodstream.
• Triglycerides. Your body uses this form of fat to store energy. Like LDL cholesterol, this fat can cause plaque to build up in the blood vessels.

Healthy cholesterol levels

You can find out your levels by having a blood test. High blood cholesterol is a risk factor for getting ASCVD. Talk to your healthcare provider about what levels are best for you. To find out more about cholesterol levels, visit www.heart.org/cholesterol.

You may need your cholesterol levels checked at regular intervals. This is to see if you are meeting the cholesterol goals you and your provider have agreed on. Make sure you know what this schedule will be and how to get ready for this test.

Types of cholesterol medicines

Medicines can help control the amount of cholesterol in the blood. There are several types. Each controls cholesterol in a different way. They also have different effects in terms of how well they work to lower cholesterol and reduce death rates. Discuss these effects with your healthcare provider. Your healthcare provider will prescribe the type of medicine that is best for you. Medicines may be used alone or combined. The main types are:

• Statins (HMG-CoA reductase inhibitors). Statins are thought to be the best at lowering cholesterol. They do this by keeping your body from making cholesterol. Benefits: Statins lower LDL cholesterol. They also slightly raise HDL cholesterol and lower triglycerides.
• Selective cholesterol absorption inhibitors. These prevent your body from taking cholesterol from food. They may be prescribed to use alone or with a statin. Benefits: These medicines lower LDL cholesterol. They also slightly raise HDL cholesterol and lower triglycerides.
• Resins (bile acid sequestrant or bile acid-binding medicines). Resins help you get rid of cholesterol through the intestines. They work by binding to bile. Bile is a substance that helps the body digest food. Your body uses cholesterol to make bile. Normally, most bile is absorbed by the body during digestion but when bile is bound to resin, it is eliminated from the body. So the body must make more bile. To do this, the body takes up more cholesterol from the blood. Benefits: Resins lower LDL cholesterol.
• Fibrates (Fibric acid derivatives). These are best at cutting back on how much triglycerides your body makes. They do not work well to lower LDL. Benefits: Fibrates lower triglycerides. They also raise HDL cholesterol.
• Niacin (nicotinic acid). Niacin (vitamin B-3) affects how the liver makes blood fats, but do not use over-the-counter niacin for cholesterol problems. It is not regulated by the FDA. Benefits: Niacin raises HDL cholesterol. It also lowers triglycerides and LDL cholesterol.
• Omega-3 fatty acids. These reduce the amount of triglycerides your body makes. They also help to clear these lipids from the blood. Omega-3 fatty acids are found in many foods. These include salmon and other oily fish, and walnuts. Your healthcare provider may prescribe these fatty acids in capsule form. Benefits: Omega-3s lower triglycerides. (Note: They may increase LDL cholesterol in some patients.) 
• PCSK9 inhibitors. These medicines lower LDL cholesterol levels by breaking down the chemicals in the liver that control making LDL cholesterol. These medicines are given by an injection. They are used for people who have an inherited form of high cholesterol (familial hypercholesterolemia). They are also for people who have a hard time controlling their cholesterol with other medicines.

High-risk groups

Some people may need to take medicines called statins to control their cholesterol. This is in addition to eating a healthy diet and getting regular exercise.  Statins can help you stay healthy. They can also help prevent a heart attack or stroke. You may need to take a statin if you are in one of these groups:

• Adults who have had a heart attack or stroke, or who have had peripheral vascular disease, a mini-stroke (transient ischemic attack), or stable or unstable angina. This group also includes people who have had a procedure to restore blood flow through a blocked artery. These procedures include percutaneous coronary intervention, angioplasty, stent, and open-heart bypass surgery.
• Adults who have diabetes or who are at higher risk of having a heart attack or stroke and have an LDL cholesterol level of 70 to 189 mg/dL
• Adults who are 21 years old or older and have LDL cholesterol level of 190 mg/dL or higher.

If you are in a high-risk group, talk with your healthcare provider about your treatment goals. Make sure you understand why these goals are important, based on your own health history and your family history of heart disease or high cholesterol.

Make a plan to have regular cholesterol checks. You may need to fast before getting this test. Also ask your provider about any side effects your medicines may cause. Let your provider know about any side affects you have. You may need to take more than one medicine to reach the cholesterol goals that you and your provider decide on.

Taking cholesterol medicines

Take your medication exactly as your healthcare provider tells you to. This will help it work best. Here are tips for taking cholesterol medicines:

• Know when and how to take your medicines. Some may need to be taken with food. Others may need to be taken on an empty stomach or at a certain time of day.
• Stick to a schedule. Try the following:
  • Do not skip doses or stop taking your medicine. This is important even if you feel better or if your cholesterol numbers improve.
  • Set things up to help you remember. For instance, work taking your medicines into your routine. You could plan to take them when you get up in the morning or when you go to bed at night.
  • Keep track of what you take. You may take a few different medicines. If so, a list or chart can help you take the right pills at the right time. A pillbox with days of the week or times of day is also a good tool for keeping track.
• Prevent medicine interactions. Some medicines and supplements can interact with one another. This means they affect how other medicines work when taken together. Be sure to tell your healthcare provider about all other medicines you take. This includes vitamins, herbs, and over-the-counter medicines.
• Know how to deal with side effects. Many people have side effects when they first start taking a medicine. These are things like headache and stomach upset. Side effects should go away in a few weeks. Tell your healthcare provider about any side affects you have.  Do not stop taking your medications without speaking to your doctor. Certain side effects should be reported to your healthcare provider right away, so they can either change your medicine or adjust the dosage. These include yellowing of the eyes and blurred vision. Also report muscle aches and breathing problems.

If you are pregnant or breastfeeding, tell your health care provider before taking any cholesterol medicines.

A healthy lifestyle

Your healthcare provider will help you make changes your lifestyle if needed. These changes are needed to help you lower your cholesterol and keep the ASCVD from getting worse. Things you may need to work on are:

Diet

Your healthcare provider will give you information on changes that you may need to make to your diet. You may need to see a registered dietitian or nutritionist for help with these changes. You might be asked to:

• Eat less meat containing saturated fat and high levels of cholesterol
• Eat less sodium (salt), especially if you have high blood pressure
• Eat more fresh vegetables and fruits
• Eat lean protein, like fish, chicken and turkey, and beans and peas
• Eat less processed meats, like deli meats, sausage, and pepperoni
• Choose non-fat and low-fat milk, yogurt and cheese
• Use vegetable and nut oils instead of butter, shortening, and margarine
• Limit sweets and packaged foods, like chips, cookies, and baked goods
• Limit eating out at restaurants and eating fast foods

Physical activity

Your healthcare provider may ask you to be more active. Depending on your health, your provider may recommend that you get moderate to vigorous intensity exercise for at least 40 minutes each day, 3 to 4 days each week. Some examples of moderate to vigorous exercise are:

• Walking at a brisk pace, about 3-4 miles per hour
• Jogging or running
• Riding a bicycle or stationary bike
• Swimming or water aerobics
• Dancing
• Hiking
• Martial arts
• Tennis

You may not be able to do 40 minutes right away. You may have to start with 5 to 10 minutes a day, 2 times a day, and then keep adding to it until you can do 40 minutes.

Weight management

If you are overweight or obese, your healthcare provider may tell you to lose weight and lower your BMI (body mass index). Changing your diet and getting more exercise can help. Controlling the number of calories you eat is the best way to lose weight.

Smoking

If you smoke, quit now. Ask your health care provider for information on medications that can help you fight cravings. Enroll in a stop-smoking program to improve your chances of success. Ask your provider for smoking-cessation referrals and products.

Stress

Learn ways to help you deal with stress in your home and work life. Here are a few ideas:

• Take a yoga class. You can find classes at local community centers or on the Internet.
• Get regular exercise. Exercise helps your mind let go of problems and release stress in your muscles.
• Deep breathing. Take a few minutes several times a day to just sit quietly and breathe. Concentrate on the air going into and out of your body.
• Talk with loved ones. Take a few minutes each day to connect with people that make you feel supported.