Cholesterol - drug treatment

  • Description
    • Your body needs cholesterol to work properly. But extra cholesterol in your blood causes deposits to build up on the inside walls of your blood vessels. This buildup is called plaque. It narrows your arteries and reduces or stops blood flow. This can lead to heart attack, stroke, or narrowed arteries elsewhere in your body.

      CholesterolPlaque buildup in arteries

      Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.

  • Alternative names
    • Hyperlipidemia - drug treatment; Hardening of the arteries - statin

  • Statins for Cholesterol
    • Statins reduce your risk of heart disease, stroke, and other related problems. They do this by lowering your LDL (bad) cholesterol.

      Most of the time you will need to take this medicine for the rest of your life. In some cases, changing your lifestyle and losing extra weight may allow you to stop taking this medicine.

  • Who Should Take Statins to Lower Cholesterol?
    • Having low LDL and total cholesterol reduces your risk of heart disease. But not everyone needs to take statins to lower cholesterol.

      Your health care provider will decide on your treatment based on:

      • Your total, HDL (good), and LDL (bad) cholesterol levels
      • Your age
      • Your history of diabetes, high blood pressure, or heart disease
      • Other health problems that may be caused by high cholesterol
      • Whether or not you smoke
      • Your risk of heart disease
      • Your ethnicity

      You should take statins if you are 75 or younger, and you have a history of:

      • Heart problems due to narrowed arteries in the heart
      • Stroke or TIA (mini stroke)
      • Aortic aneurysm (a bulge in the main artery in your body)
      • Narrowing of the arteries to your legs

      If you are older than 75, your provider may prescribe a lower dose of a statin. This may help lessen possible side effects.

      You should take statins if your LDL cholesterol is 190 mg/dL or higher. You should also take statins if your LDL cholesterol is between 70 and 189 mg/dL and:

      • You have diabetes and are between ages 40 and 75
      • You have diabetes and a high risk of heart disease
      • You have a high risk of heart disease

      You and your provider may want to consider statins if your LDL cholesterol is 70 to 189 mg/dL and:

      • You have diabetes and a medium risk for heart disease
      • You have a medium risk for heart disease
  • How low Should Your LDL Cholesterol be?
    • Doctors used to set a target level for your LDL cholesterol. But now the focus is reducing your risk for problems caused by narrowing of your arteries. Your provider may monitor your cholesterol levels. But frequent testing is rarely needed.

      Adding other drugs along with statins provides little to no benefit in most cases.

      You and your provider will decide what dose of a statin you should take. If you have risk factors, you may need to take higher doses. Factors that your provider will consider when choosing the dose include:

      • Your total, HDL, and LDL cholesterol levels before treatment
      • Whether you have coronary artery disease (history of angina or heart attack), a history of stroke, or narrowed arteries in your legs
      • Whether you have diabetes
      • Whether you smoke or have high blood pressure

      Higher doses may lead to side effects over time. So your provider will also consider your age and risk factors for side effects.

  • References
    • Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 american diabetes association standards of medical care in diabetes. Ann Intern Med. 2016;164(8):542-552. PMID: 26928912

      Fox CS, Golden SH, Anderson C, Bray GA, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2015;132(8):691-718. PMID: 26246173

      Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.

      Pencina MJ, Navar-Boggan AM, D'Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422-1431. PMID: 24645848

      Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934. PMID: 24239923

      US Preventive Services Task Force. Draft recommendation statement: statin use for the primary prevention of cardiovascular disease in adults: preventive medication. Updated December 2015. Accessed July 29, 2016.