Blood Cholesterol Treatment
To treat unhealthy blood cholesterol levels, your healthcare provider may recommend heart- healthy lifestyle changes and prescribe medicines. If a medical condition or medicine is causing your blood cholesterol problem, your provider may treat that condition or change your medicine or its dose.
Talk with your provider about your cholesterol levels, your risk of developing heart disease, other medical conditions you have, and your lifestyle. You can learn about the benefits and side effects of medicines for lowering your blood cholesterol. Together, you can set up a treatment plan that will work for you.
The NHLBI leads and sponsors many studies on blood cholesterol and related conditions. Find clinical trials and observational studies for you or your loved one.
Healthy lifestyle changes
To help you lower your LDL cholesterol level, your healthcare provider may talk to you about adopting a healthy lifestyle:
- Choose heart-healthy foods. The Therapeutic Lifestyle Changes and DASH eating plans can help you lower your “bad” LDL cholesterol. These plans encourage:
- Limiting saturated fats found in fatty cuts of meats, dairy products, and desserts
- Eating whole grains, fruits, and vegetables rather than refined carbohydrates such as sweets and other high-sugar foods
- Eating a variety of nuts
- Preparing foods with little or no salt
- Get regular physical activity. Studies have shown that physical activity can lower LDL cholesterol and triglycerides and raise your “good” HDL cholesterol. For example, resistance training among postmenopausal women may decrease total cholesterol, LDL cholesterol, and triglycerides. Before starting any exercise program, ask your provider what level of physical activity is right for you.
- Aim for a healthy weight. Research has shown that adults with overweight and obesity can lower “bad” LDL cholesterol and raise “good” HDL cholesterol by losing only 3% to 5% of their weight.
- Manage stress. Research has shown that chronic stress can sometimes increase LDL cholesterol levels and decrease HDL cholesterol levels.
- Quit smoking. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
- Get enough good quality sleep. Getting 7 to 9 hours of sleep a day lowers your risk for high “bad” cholesterol (LDL) and total cholesterol.
- Limit alcohol. Visit the National Institute on Alcohol Abuse and Alcoholism for resources on support and treatment to stop drinking.
The TLC guide is a set of tools, including lifestyle changes and sample menus, you can use to help lower your cholesterol.
Your Guide to Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC)
Medicines
Your healthcare provider may prescribe one of these medicines to help lower high blood cholesterol:
- Statins are the most common medicine used to treat high blood cholesterol. They reduce the amount of cholesterol made in the liver. Studies have shown that statins lower the risk of heart attack and stroke in people with high LDL cholesterol. Statins usually don't cause side effects, but they may raise the risk of diabetes. However, this mainly happens in people already at high risk of diabetes, such as those who have prediabetes, overweight or obesity, or metabolic syndrome. Statins may also cause abnormal results on liver enzymes tests, but actual liver damage is extremely rare. Other rare side effects include muscle damage and cognitive impairment. Learn more about how you can stay safe while taking statins.
- Medicine to treat familial hypercholesterolemia, which includes mipomersen, ezetimibe, bempedoic acid, and lomitapide. Ezetimibe or bempedoic acid may be used if statins cause side effects, or if statin treatment and lifestyle changes do not lower your “bad” LDL level enough. Ezetimibe works by blocking how cholesterol is absorbed into the body. In rare cases, these medicines can cause liver injury. Your provider will check your liver enzymes regularly and may recommend that you take vitamin E.
- Bile acid sequestrants may be prescribed if you cannot take statins or if statins alone are not lowering your cholesterol enough. Bile acid sequestrants help lower LDL cholesterol. They keep bile acids, which digest fats and oils, from being absorbed into the body. These medicines may cause diarrhea, make some other medicines less effective, or raise your blood triglyceride level.
- PCSK9 inhibitors are a type of medicine that you inject under your skin. The liver makes the protein, PCSK9. PCSK9 destroys parts of cells in the liver that allow LDL cholesterol to be absorbed. By stopping the PCSK9 protein, these inhibitors can reduce LDL cholesterol levels. 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. In 2021, the United States Food and Drug Administration approved the PCSK9 inhibitor, inclisiran, joining the already approved alirocumab, for patients with familial hypercholesterolemia. The most common side effects are itching, pain, or swelling at the place where you injected it.
If your provider prescribes medicines as part of your treatment plan, be sure to continue your healthy lifestyle changes. The combination of the medicines and heart-healthy lifestyle changes can help lower and control your blood cholesterol levels.
Lipoprotein apheresis
Some people with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower their blood cholesterol levels. Lipoprotein apheresis uses a filtering machine to remove unwanted substances from the body. The machine removes “bad” LDL cholesterol from the blood, then returns the remainder of the blood to your body.