There are several types of drugs to help lower blood cholesterol levels, and
they work in different ways. Some are better at lowering LDL (bad) cholesterol,
some are good at lowering triglycerides, while others help raise HDL (good)
Whether or not you need a medication depends on how high your LDL levels are,
your risk factors for heart disease (or whether you have it already), age,
smoking habits, and other considerations. Unless you are at high risk, your
doctor may try to control your cholesterol through diet, exercise, and weight
loss first, and see if that brings your cholesterol down sufficiently so that
medication is not needed. But, depending on your risks, your doctor may want
you to start medication sooner. Risk factors include:
- Cigarette smoking
- High blood pressure (hypertension)
- Low HDL cholesterol
- Family history of premature heart disease
- Age (male 45 and older, female 55 and older)
Other risk factors may include:
- Physical activity
- Unhealthy diet
- Lipoprotein a
- Small dense LDL particles
- Proinflammatory factors
- Impaired fasting glucose
- Evidence of atherosclerosis (not yet causing symptoms)
Following the latest guidelines, your doctor will start or consider medication
- Your LDL cholesterol is 160 - 189 mg/dL (optional), or 190 mg/dL or higher
- Your LDL cholesterol is 160 mg/dL or higher AND you have one risk factor
for heart disease.
- Your LDL cholesterol is 130 mg/dL or higher AND you have either diabetes
or two other risk factors for heart disease.
- Your LDL cholesterol is 100 mg/dL or higher AND you have heart disease.
(If you have diabetes, even if you don't have known heart disease, medication
may be considered for an LDL cholesterol of 100 mg/dL)
- Your LDL cholesterol is greater than 70 mg/dL AND you have had a recent
heart attack or have known heart disease along with diabetes, current cigarette
smoking, poorly controlled high blood pressure, or the metabolic syndrome
(high triglycerides, low HDL, and obesity).
After the publication of official guidelines in 2001, major clinical studies
have suggested that the LDL goal of less than 70 mg/dL is practical and should
be extended to anyone with heart disease or diabetes. The goal of 100 mg/dL
should likewise be extended to anyone with just two risk factors.
If your doctor has established that diet, exercise, and weight control are
not sufficient and that medication is needed, it is possible that you will
need to be on the medication for the rest of your life. That is because high
cholesterol returns quickly once the effective therapies are taken away.
If you need medication, your physician will prescribe the one best suited
to your condition. Remember to take your medication consistently.
In some cases, especially if your triglycerides are high or your HDL is low,
your health care provider may prescribe more than one cholesterol-lowering
drug. (For more information on combination drug therapy, click
Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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