There are several types of medications 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) cholesterol.
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 when:
- 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 two other risk factors for heart disease.
- Your LDL cholesterol is 100 mg/dL or higher AND you have either diabetes or two other risk factors for heart disease.
- 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 here.)
Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College; Private Practice specializing in Cardiovascular Disease in Greenwich, CT. Review provided by VeriMed Healthcare Network.
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