When you have very high LDL or other risk factors for heart disease, or when diet and exercise alone have not lowered your cholesterol levels enough, your doctor may decide it is time for you to start taking a cholesterol-lowering medication. Cholesterol-lowering medications, in addition to your healthy lifestyle, will help lower your cholesterol levels to the desired range. Sticking to your diet and exercise plan will let your doctor prescribe the lowest dose of medication possible to reach your cholesterol goals. Here is some basic information on ideal cholesterol levels, how cholesterol-lowering drugs work in your body, and the different types that are available.
What Are Ideal Cholesterol Levels?
There are four main cholesterol numbers that your doctor will monitor:
- Total cholesterol: A desirable total cholesterol level is less than 200 mg/dL. Achieving and maintaining a total cholesterol level less than 200 mg/dL lowers your risk for heart disease.
- LDL ("bad cholesterol"): The lower your LDL levels, the lower your risk for heart disease, heart attack, and stroke. Ideal LDL levels vary among individuals depending on several patient-specific characteristics, such as other risk factors for heart disease. However, according to the American Heart Association, an LDL level of less than 100 mg/dL is considered optimal.
- HDL ("good cholesterol"): The higher your HDL levels, the better. While low HDL levels (less than 40 mg/dL for men; less than 50 mg/dL for women) put you at risk for heart disease, high HDL levels, over 60 mg/dL, may protect you from heart disease.
- Triglycerides: Normal triglyceride levels are usually less than 150 mg/dL, but can vary based on age and sex.
How Do Cholesterol Drugs Work?
Some cholesterol-lowering drugs work in your liver to block the production of cholesterol. Other drugs work in your intestines to prevent cholesterol from being absorbed in your body. There are several different types of cholesterol-lowering medications. Your doctor will decide which medication, or combination of medications, is best for you depending on your cholesterol levels. There are five main classes of cholesterol-lowering medications, and each works differently to lower cholesterol.
- Statins are the most effective and most commonly prescribed cholesterol-lowering class of medications. Statins work in the liver to block the production of cholesterol and are highly effective in lowering LDL levels. They can also help lower triglyceride levels and raise HDL levels. Statins have also been shown to slow the formation of sticky plaque in your arteries, which can cause heart attack and stroke.
- Fibrates, also referred to as fibric acid derivatives, are effective in lowering triglyceride levels and may also increase HDL levels. Fibrates are not effective in lowering LDL levels and may actually cause a slight increase in LDL levels.
- Nicotinic acid, or niacin, is primarily effective in raising HDL levels and lowering LDL and triglyceride levels. Nicotinic acid reduces the production of triglycerides and VLDL, which is converted to LDL in your blood. Nicotinic acid therapy is available in several different forms, both over the counter and by prescription. However, if treatment with niacin is right for you to lower cholesterol, you should only use it under the supervision of your doctor so you can be closely monitored for potential side effects.
- Cholesterol absorption inhibitors lower cholesterol by blocking the absorption of cholesterol in your intestines. Cholesterol absorption inhibitors lower total cholesterol and LDL levels.
- Bile acid sequestrants lower the amount of LDL cholesterol in your blood. Bile acid sequestrants bind with cholesterol-containing bile acids in your intestines, prevent them from being absorbed into the blood, and are eliminated from your body through the stool. Bile acid sequestrants are sometimes prescribed along with statins for certain people with high cholesterol. Bile acid sequestrants are not absorbed from the gastrointestinal tract into the body.
Remember, regardless of which cholesterol-lowering medication you have been prescribed, you must continue taking your medicine to lower your cholesterol and keep it in the recommended range. Cholesterol-lowering drugs control high cholesterol, but do not cure it. Keep taking your medication every day and stick to your diet and exercise plan.