What Are the Benefits and Risks of High Cholesterol Medication?

Have you recently been diagnosed with high cholesterol? If so, you may be wondering what types of cholesterol-lowering medications are available or how they may affect you.

While eating a healthy diet, exercising, and quitting smoking can all help lower cholesterol, your healthcare provider may also prescribe medications to adjust your cholesterol levels.

While lifestyle changes can be important for managing your cholesterol, sometimes medications need to be added in order to reduce cholesterol levels to target levels.

This article will review the benefits and risks of high cholesterol medication, which options are available, and the possible side effects of medications.

Nurse discussing a prescription with a patient


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What Is Cholesterol?

Cholesterol is a type of molecule used by your body to produce energy and store fats. Cholesterol plays an integral role in the formation of cell membranes and so it is essential for your body to function.

There are several different types of cholesterol. One type is known as high-density lipoprotein (HDL). It is considered the "good" cholesterol in the body. HDL cholesterol helps remove other types of cholesterol from the body.

Another type known as low-density lipoprotein (LDL) is considered the "bad" cholesterol in the body. This type of cholesterol can build up in the walls of the arteries. This causes damage inside the arteries known as atherosclerosis. Atherosclerosis causes the arteries to become damaged and narrowed.

Over time, atherosclerosis can limit the amount of blood that can flow through the blood vessels and into the organs of your body. In severe cases, high cholesterol levels can lead to the formation of complete blockages in the small arteries that supply blood to your heart and brain. These blockages can abruptly cutoff the supply of blood, causing a heart attack or stroke.

Causes and Risks Factors

Many factors influence your cholesterol levels. Lifestyle choices can have a big impact on your dietary cholesterol levels and your body’s ability to effectively remove cholesterol from the blood. A diet that is rich in high-fat foods and animal products such as red meats, eggs and butter, and lower in fruits, vegetables, and whole grains has been linked to higher cholesterol levels.

In addition, a sedentary lifestyle can increase your risk. Smoking cigarettes or using vaping products can also directly raise cholesterol levels.

Cholesterol levels can also be partially determined by your genetics. Some people have genetic disorders, such as a condition called familial hypercholesterolemia (FH), that can lead to high levels of LDL cholesterol in their blood.

How High Cholesterol Medication Is Used

The treatment of high cholesterol is a two-pronged approach focused on lowering bad LDL cholesterol and increasing good HDL cholesterol.

Your healthcare provider will typically recommend treatment with high cholesterol medications, aimed at lowering your total cholesterol and, more specifically, your LDL levels. An elevated total cholesterol level is usually defined as a level above 200 milligrams per deciliter (mg/dL), or an LDL level above 130 mg/dL, but these cutoffs may vary based on your risk for coronary artery disease. In general, lower is better when it comes to LDL cholesterol.

Statin medications are often the first medications used for high cholesterol. Therapy with statins is divided into low-, medium-, and high-intensity levels. The higher the intensity level, the greater the targeted reduction in LDL levels.

Depending on the severity of your high cholesterol levels, other cholesterol-lowering medication may also be prescribed.

Types of Cholesterol-Lowering Medications

There are many different types of cholesterol medications, but they all work to either lower LDL cholesterol or raise HDL cholesterol, including the following:

Types of Cholesterol-Lowering Medications
 Medication Mechanism Potential Side Effects
Statins: Lipitor (atorvastatin), Zocor (Simvastatin), Crestor (rosuvastatin)  Decrease LDL cholesterol levels, reduce total cholesterol, reduce triglycerides, and may slightly raise HDL levels Elevation in liver enzymes, muscle aches
Zetia (ezetimibe) Reduces total cholesterol and lowers LDL cholesterol No major side effects 
Fibrates: Antara (fenofibrate), Lopid (gemfibrozil)  Decrease triglyceride levels and increase HDL cholesterol levels Multiple drug interactions (gemfibrozil), nausea, stomach pain, muscle aches
PCSK9 inhibitors:  Praluent (alirocumab), Repatha (evolocumab) Decrease LDL cholesterol levels significantly  Itching or pain at the site of injection
Omega -3 fatty acids: Vascepa (icosapent ethyl)   Decrease triglyceride levels and modestly increase HDL cholesterol levels Gas, burping, fishy odor on breath
Bile acid sequestrants: Welchol (colesevelam), Colestid (colestipol) Decrease LDL cholesterol levels  Constipation, bloating, gas, nausea, diarrhea  
  • Statins: The most common and widely prescribed medications to treat high cholesterol are known as statins. The statin medications work by blocking the enzymes in your body that restrict cholesterol uptake. They also have multiple effects throughout the body, including lowering inflammation and stabilizing and even reducing plaques in the arteries. These medications are used first and the other medications are usually added if needed or if your cholesterol levels remain elevated.
  • Zetia (ezetimibe): This medication specifically reduces the absorption of cholesterol in the body, lowering LDL levels.
  • Fibrates: These drugs promote uptake of triglycerides and subsequently reduce cholesterol levels.
  • PCSK9 inhibitors: A newer medication that is administered by injection every two weeks or once a month, these are extremely effective in lowering high LDL levels, but are usually only used in patients whose cholesterol levels are not responding to other medications or those with genetic causes of high cholesterol.
  • Omega-3 fatty acids: Also found in fish oil supplements, the prescription-grade dose has been shown to help decrease LDL cholesterol and triglycerides and increase HDL cholesterol levels.
  • Bile acid sequestrants: This class of drugs helps reduce LDL levels in the blood by acting on your gallbladder and bile system.

Benefits

High cholesterol medications are very effective at lowering LDL cholesterol, which in turn significantly reduces the risk of coronary artery disease, heart attack, and stroke.

Many cholesterol medications, particularly statins, have been studied for decades and have been shown to have real benefits for patients that may go beyond their cholesterol-lowering abilities. Statins, for instance, may help improve blood vessel function and reduce inflammation.

Side Effects and Risks

As with many prescription medications, the most common risk associated with high cholesterol medication is the potential for liver damage. To prevent this complication, your healthcare provider will monitor your blood work for changes in your liver enzyme levels after you start these medications and may change your medications, if necessary.

Physical side effects of high cholesterol medications vary by the type of drug and include:

  • Statins: This class of drug may cause muscle aches, and fatigue. Research shows an estimated 10%–15% of statin users complain of muscle pain that ranges from mild to severe. Statins may also increase the risk of developing type 2 diabetes, but this has only been found to be the case in people whose blood sugar was already elevated (borderline diabetes).
  • Zetia (ezetimibe): This is a cholesterol-lowering medication that has very few known side effects and may be a good option for some people who have problems with other medications.
  • Fibrates: This med may cause some stomach issues, such as bloating, cramping, or nausea.
  • PCSK9 Inhibitors: This drug has very few side effects.
  • Omega-3 fatty acids: The most common adverse reaction is gastrointestinal trouble.
  • Bile acid sequestrants: This type of drug can have notable side effects on the stomach and gastrointestinal tract. These medications are known to cause symptoms like bloating, nausea, and stomach pain.

Prevention

Adopting heart-healthy lifestyle strategies can help prevent the development of high cholesterol, particularly in those who don't have a genetic disorder that causes high cholesterol.

The American Heart Association recommends sticking to a low-fat, low-sodium diet that is rich in fruits and vegetables, whole grains, and lean protein sources such as fish, poultry, and beans. You'll also want to limit your consumption of high-fat foods, including red meat, full-fat dairy products, fried foods, and heavily processed foods.

Exercising regularly and avoiding smoking or vaping can also go a long way toward lowering your cholesterol levels.

A Word From Verywell

High cholesterol levels are extremely common and many people need to take medications to lower their cholesterol to a normal range. Importantly, these medications are just one tool that you can use to lower cholesterol levels. When combined with diet, exercise, and lifestyle changes, these medications can be a powerful tool to help you live a healthy and full life.

Frequently Asked Questions

  • Can you lower your cholesterol without cholesterol medication?

    In some cases, you can lower your cholesterol with healthy habits, including adopting a low-fat, low-sodium diet, and exercising regularly. However, it is important to work with your healthcare provider to determine whether medication is necessary because high cholesterol can be dangerous if left untreated.

    If you smoke, the most important thing you can do to reduce your cholesterol levels is to quit smoking. Cigarettes and vaping can directly increase your cholesterol levels.

  • How high does your cholesterol need to be to require high cholesterol medication?

    This depends upon your underlying risk for cardiovascular disease, which your healthcare professional can help you calculate. If you have no other risk factors, a total cholesterol level above 200 mg/dL is considered the threshold for treatment with medications. Depending on your overall health and other considerations, your healthcare provider may prescribe statins or other medications at this level in addition to heart-healthy lifestyle changes. 

  • Should I start cholesterol-lowering medication if I have a history of high cholesterol in my family?

    If you have a family history of high cholesterol, it's important to consult with your healthcare provider for screening. They will order blood tests and can monitor your cholesterol levels. There is a genetic disorder called familial hypercholesterolemia that can cause sky-high cholesterol levels. It needs to be diagnosed as early as possible and carefully managed to reduce the risk of developing serious heart problems.

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