From the Guidelines
High cholesterol should be managed through lifestyle modifications, including a heart-healthy diet and regular physical activity, and medications such as statins if necessary, to reduce the risk of heart disease and stroke. The goal of treatment is to lower LDL cholesterol levels and reduce the risk of atherosclerotic cardiovascular disease (ASCVD) 1.
Lifestyle Modifications
Lifestyle modifications are the first line of treatment for high cholesterol, including:
- Adopting a heart-healthy diet low in saturated fats and trans fats
- Regular physical activity, aiming for at least 150 minutes of moderate exercise weekly
- Weight management
- Avoiding tobacco
Medications
If lifestyle changes are not sufficient, medications may be necessary. Statins are the most commonly prescribed cholesterol-lowering drugs, including:
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor) Other medications include:
- Ezetimibe (Zetia)
- PCSK9 inhibitors
- Bile acid sequestrants
- Fibrates
Treatment Goals
The treatment goals for high cholesterol are to lower LDL cholesterol levels to:
- < 2.5 mmol/l (< 100 mg/dl) in the absence of ASCVD or other major ASCVD risk factors
- < 1.8 mmol/l (< 70 mg/dl) with imaging evidence of ASCVD alone or other major ASCVD risk factors
- < 1.4 mmol/l (< 55 mg/dl) with clinical ASCVD 1
Monitoring and Follow-up
Regular monitoring of cholesterol levels is essential to adjust treatment as needed. Cholesterol levels should be checked every 4-6 months initially, then annually once stable 1.
Key Considerations
High cholesterol is a significant risk factor for heart disease and stroke, and managing it effectively is crucial to reducing this risk. By prioritizing lifestyle modifications and using medications when necessary, individuals can lower their LDL cholesterol levels and reduce their risk of ASCVD 1.
From the FDA Drug Label
Atorvastatin calcium tablets are used: to reduce the risk of: heart attack, stroke, certain types of heart surgery and chest pain in adults who do not have heart disease but have other multiple risk factors for heart disease. along with diet to reduce low density lipoprotein cholesterol (LDL-C) or bad cholesterol: in adults with primary hyperlipidemia Cholestyramine for Oral Suspension, USP powder is indicated as adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated low density lipoprotein [LDL] cholesterol) who do not respond adequately to diet
High Cholesterol Treatment:
- Atorvastatin calcium tablets are used to reduce the risk of heart attack, stroke, and chest pain in adults with multiple risk factors for heart disease.
- Atorvastatin calcium tablets are used along with diet to reduce low-density lipoprotein cholesterol (LDL-C) or bad cholesterol in adults with primary hyperlipidemia.
- Cholestyramine is used as adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia who do not respond adequately to diet. 2 3
From the Research
High Cholesterol Treatment Options
- The combination of rosuvastatin and ezetimibe has been shown to be effective in treating hypercholesterolemia and dyslipidemia, with a higher proportion of patients achieving recommended LDL-C goals compared to rosuvastatin monotherapy or simvastatin/ezetimibe combination 4.
- A fixed-dose combination of low-intensity rosuvastatin and ezetimibe was found to be more effective in lowering LDL cholesterol and achieving LDL cholesterol goals than moderate-intensity rosuvastatin monotherapy, particularly in patients with low and moderate risk 5.
- Rosuvastatin has been compared to other statins, such as atorvastatin, simvastatin, and pravastatin, and has been shown to be more efficacious in improving lipid profiles in patients with hypercholesterolemia 6.
Dietary Measures to Lower Cholesterol
- Dietary measures to lower LDL-C and triglyceride levels, such as minimizing saturated fats and refined carbohydrates, eliminating trans-fat, and increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids, can help reduce cardiovascular risk 7.
- Adhering to a Mediterranean diet is strongly recommended due to its ability to lower CVD and total mortality 7.
- High-dose omega-3 fatty acids have been shown to lower triglyceride levels, reduce CVD, and prevent coronary plaque progression 7.