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Stephanie Watson

6 Treatment Options for High Cholesterol

Cholesterol is a fatty substance that moves through your body in your blood. Your body needs some cholesterol to build healthy cells and make hormones, but if you have too much of a certain type of cholesterol, it collects inside your arteries and blocks the flow of blood.


There are two main types of cholesterol:

  • Low-density lipoprotein (LDL) cholesterol: This is the unhealthy kind that builds up inside your arteries.

  • High-density lipoprotein (HDL) cholesterol: This is the healthy kind that helps clear LDL cholesterol from your blood.


Having untreated high LDL cholesterol can increase your risk of heart disease, heart attack, and stroke.


If your LDL or total cholesterol levels are too high, your doctor can recommend lifestyle changes and medications to improve them.


6 tips to help lower your cholesterol


Here are some tips to help bring your cholesterol numbers into a healthy range.


Understand all your risks for heart disease

High cholesterol might not be the only threat to your heart. Having any of these risk factors can increase your chances of having a heart attack or stroke:

  • a family history of heart disease

  • high blood pressure

  • smoking

  • a lack of physical activity

  • obesity

  • diabetes


If you have any of these risk factors, talk with your doctor about ways to manage them.


Set your cholesterol goals

Ask your doctor how much you need to lower your LDL cholesterol and raise your HDL cholesterol. According to the Centers for Disease Control and Prevention (CDC), the following levels are optimal:

  • Total cholesterol: close to 150 milligrams per deciliter (mg/dL)

  • LDL cholesterol: close to 100 mg/dL

  • HDL cholesterol: 40 mg/dL in males and 50 mg/dL in females or higher


Your target cholesterol levels may be slightly lower or higher depending on your age, sex, and heart disease risks, per the CDC.


Modify your diet

Making a just few changes to your diet can help bring your cholesterol numbers to healthy levels. Avoid or limit foods that contain these types of fats:

  • Saturated fats: Animal-based products may increase LDL cholesterol. Red meat, whole fat dairy, eggs, and vegetable oils like palm and coconut oil are all high in saturated fat. Alternatives include lean meats and poultry without skin, prepared without added saturated or trans fat.

  • Trans fats: Manufacturers produce these artificial fats through a chemical process that turns liquid vegetable oil into a solid. Foods high in trans fats may be low in nutrition and raise your LDL cholesterol. These foods may include:

  • fried foods

  • highly processed foods

  • doughnuts

  • cakes

  • pie crusts

  • biscuits

  • frozen pizza

  • cookies

  • crackers

  • stick margarine


Many of the foods listed above are also high in cholesterol, including red meat and whole-fat dairy products.


Consider following the Mediterranean-style diet. This is a way of eating based on foods from the Mediterranean areas of the world. This eating pattern includes lots of delicious options, featuring:

  • fresh fruits and vegetables

  • whole grains like oats and barley

  • beans and legumes

  • low fat or fat-free dairy

  • fish and poultry


A 2023 review of studies found that compared to people following an omnivorous diet, individuals following a vegetarian diet had a significant reduction in their total cholesterol, LDL cholesterol, and other types of cholesterol.


Specific foods may help lower cholesterol levels. These foods include:

  • nuts and seeds

  • avocados

  • beans

  • healthy oils, like sunflower, safflower, avocado, and olive oil

  • fatty fish, like salmon, mackerel, and herring

  • soy

  • fruits, like apples, pears, and berries

  • products fortified with sterols and stanols, like orange juice


Get more active

A fast walk or bike ride each day can boost your HDL cholesterol, which helps remove excess LDL cholesterol from your bloodstream. Try to get in at least 30 minutes of moderate intensity aerobic exercise 5 days per week.


Extra fat around your middle section can increase your LDL cholesterol and lower your HDL cholesterol. If it’s right for you, losing just 5–10% of your total body weight may help improve some cholesterol numbers and reduce some risk factors for heart disease. Better nutrition and regular exercise can help you lose extra weight.


A healthcare professional can guide you on whether losing weight might benefit you and healthy ways to do so.


Quit smoking

In addition to raising your risk of cancer and chronic obstructive pulmonary disease (COPD), smoking can negatively affect your cholesterol levels. People who smoke cigarettes tend to have high total cholesterol, high LDL, and low HDL.


Quitting is easier said than done, but you have many options if you smoke and want to quit. If you’ve tried a few methods that haven’t worked for you or if you’re not sure where to begin, ask your doctor to recommend a new strategy to help you stop smoking.


Take prescription cholesterol-lowering medications if needed

Prescription medication is an option if lifestyle changes alone haven’t improved your cholesterol levels.


Speak with your doctor about the best options for you. They will consider your heart disease risks and other factors when deciding whether to prescribe one of these cholesterol-lowering medications.


Statins

Statin drugs block a substance your body needs to make cholesterol. These medications decrease LDL cholesterol and increase HDL cholesterol:

  • atorvastatin (Lipitor)

  • fluvastatin (Lescol XL)

  • lovastatin (Altoprev)

  • pitavastatin (Livalo)

  • pravastatin (Pravachol)

  • rosuvastatin (Crestor)

  • simvastatin (Zocor)


Common side effects of statins can include:

  • muscle pain and soreness

  • high blood sugar levels

  • low blood platelet count

  • nausea

  • headaches

  • digestive symptoms (diarrhea, constipation, indigestion, gas)

  • stomach cramps


Bile acid sequestrants

Bile acid sequestrants block bile acids in your stomach from being absorbed into your blood. To make more of these digestive substances, your liver has to pull cholesterol from your blood, which lowers your cholesterol levels.


These drugs include:

  • cholestyramine (Prevalite)

  • colesevelam (Welchol)

  • colestipol (Colestid)


Side effects of bile acid sequestrants can include:

  • constipation

  • stomach pain

  • bloating

  • vomiting

  • heartburn

  • loss of appetite

  • indigestion

  • upset stomach


Cholesterol absorption inhibitors

Cholesterol absorption inhibitors lower cholesterol by blocking its absorption in your intestines.


There are two drugs in this class. One is ezetimibe (Zetia). The other is ezetimibe-simvastatin, which combines a cholesterol absorption inhibitor and a statin.


Side effects of ezetimibe (Zetia) may include:

  • headache

  • runny nose

  • sore throat

  • body aches

  • back pain

  • chest pain

  • diarrhea

  • joint pain

  • fatigue

  • weakness


Side effects of ezetimibe-simvastatin may include:

  • high transaminase levels

  • myopathy

  • rhabdomyolysis


Niacin

Niacin is a B vitamin that can help lower your triglycerides and LDL cholesterol, according to the American Heart Association (AHA). Prescription niacin brands are Niacor and Niaspan.

Per the AHA, side effects of niacin can include:

  • flushing

  • itching

  • stomach upset

  • liver toxicity

  • high blood sugar levels


Protein blockers: PCSK9 inhibitors

These newer medications block a protein called PCSK9 to aid in lowering LDL cholesterol levels in the blood.


Doctors may prescribe PCSK9 inhibitors to individuals with other conditions that affect cholesterol levels, such as heterozygous FH, homozygous familial hypercholesterolemia, or atherosclerotic cardiovascular disease (ASCVD), in which LDL cholesterol has not been reduced even with lipid-lowering therapy.


PCSK9 inhibitors include:

  • alirocumab (Praluent)

  • evolocumab (Repatha)


Side effects may include mild injection-site reactions and nasopharyngitis (inflammation of the nasal passages and pharynx).


Fibrates

Fibrates lower triglycerides in your blood and may also slightly lower HDL cholesterol, according to the AHA.


Examples of fibrates include:

  • fenofibrate (Tricor)

  • gemfibrozil (Lopid)


Side effects may include:

  • leg cramps

  • abdominal pain

  • myopathy

  • gallstones

  • venous thrombosis

  • increased creatinine and homocysteine levels

  • liver inflammation


ATP citrate lyase (ACLY) inhibitors

ACLY inhibitors prevent your liver from processing cholesterol to aid in lowering LDL cholesterol. People with familial hypercholesterolemia and ASCVD may benefit from taking these medications.


Examples of ACLY inhibitors are bempedoic acid (Nexletol) and ezetimibe (Nexlizet).


Side effects of ACLY inhibitors may include:

  • gout

  • gallstones

  • increases in creatinine, uric acid, and hepatic-enzyme levels in the blood


Frequently asked questions


How can I lower my cholesterol quickly?

According to the AHA, limiting saturated fat to less than 6% of daily caloriesTrusted Source and avoiding trans fats are the most effective dietary ways to lower cholesterol.


Medications like statins may lower your cholesterol levels in around 4 weeks, while diet and exercise may take weeks to months to be effective.


What can I drink to flush out my cholesterol?

While there’s no way to “flush” cholesterol from your blood, certain drinks may help lower your cholesterol levels, such as:

  • green tea

  • tomato juice

  • berry juice or berry and plant milk smoothies (like oat, soy, or almond)


What foods clean up cholesterol?

Foods that are low in saturated fats, high in fiber, and high in plant sterols or stanols can all help lower cholesterol levels. In addition to an overall healthy diet, some foods that may help lower your cholesterol levels include:

  • oats and oatmeal

  • beans

  • fish like tuna, salmon, and trout

  • nuts

  • soybeans

  • wheat germ

  • some fresh fruits (like apples, strawberries, and prunes)


Takeaway

A variety of lifestyle changes can help you manage high cholesterol levels. This includes eating a heart-healthy diet, exercising regularly, and maintaining a moderate weight.


If those changes aren’t enough, speak with your doctor about prescription medications that can help treat high cholesterol.

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