How is hyperlipidemia (high cholesterol) treated?
Lifestyle changes that can lower your cholesterol include a
healthy diet, weight loss, and exercise.
You should:
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Choose foods low in trans fats and saturated fats. One
way to do this is to substitute oils such as olive,
sunflower, safflower, and canola for other fats in
cooking.
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Eat more fiber-rich foods, such as oatmeal, apples,
bananas, pears, prunes, kidney beans, chickpeas,
lentils, and lima beans. Soluble fiber reduces your LDL
cholesterol.
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Have fish twice a week. Fatty fish (tuna, salmon,
mackerel, herring, trout) contains omega-3 fatty acids,
which lower your triglycerides. You also can get omega-3
from walnuts, flaxseed, and canola oil.
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Avoid sugary drinks and added sugars.
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Avoid fried and processed meats.
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If you smoke, quit. When you stop smoking, your HDL
(good cholesterol) levels go up. Experts say to quit
smoking, you should focus on your motivation for
quitting, get support, maintain your confidence level,
and learn from past attempts. You can talk to your
doctor about medications that can help.
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Sleep at least 7 hours each night. Poor sleep has been
linked to high blood pressure and heart disease.
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Manage your stress level. High stress is linked to
inflammation in your body, which can raise your blood
pressure and lower your HDL levels. Ways to reduce
stress include meditation, journaling, yoga, exercise,
and counseling.
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Limit your alcohol, too. That means no more than one
drink a day.
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Step up your exercise habits. Aim for about 30 minutes
of moderate-intensity activity, like a brisk walk, most
days of the week. You don't have to do it all at once.
Even 10 to 15 minutes at a time can make a difference.
What medications are used for hyperlipidemia?
If lifestyle changes aren’t enough to treat your
hyperlipidemia, your doctor may prescribe medication.
Statins are the first line medication for hyperlipidemia. If
you cannot tolerate statins or if they do not reduce your
LDL cholesterol enough, mRNA and monoclonal antibody drugs
have been developed recently.
Statins: Drugs that prevent your liver from making
cholesterol are known as statins. They're a popular choice
to lower the amount of cholesterol in your blood. But in
some people, statins cause serious side effects, including
muscle pain, mental confusion, and digestion problems. In
rare cases, they can cause liver damage. Talk to your doctor
about weighing the benefits versus the side effects, if you
have any. Don't just stop your medication.
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atorvastatin (Lipitor)
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fluvastatin (Lescol XL)
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lovastatin (Altoprev)
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pitavastatin (Livalo)
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pravastatin (Pravachol)
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rosuvastatin (Crestor)
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simvastatin (Zocor)
Cholesterol absorption inhibitors: These are a
newer type of drug that blocks cholesterol that you've eaten
from being taken into your body by your intestine. They work
in combination with statins. An example is the drug ezetimibe (Zetia/Nexlizet).
PCSK9 inhibitors: These are also a new class of
drugs. They lower LDL, or “bad,” cholesterol. PCSK9 is a
protein in your liver that can increase your cholesterol
level. These drugs work by blocking the receptors of the
protein, which allows your liver to clear away more
cholesterol. Right now, there are two FDA-approved
medications: alirocumab (Praluent)
and evolocumab (Repatha).
Studies show that PCSK9 inhibitors can actually prevent
heart attacks or strokes.
Nicotinic acid: This also affects how your liver
makes fats. It lowers your LDL cholesterol and triglycerides
and raises your HDL cholesterol.
Bile-acid binding resins: These medications trick
your body into using up cholesterol. They bind to bile, an
acid involved in digestion, so it can't do its job. Your
liver has to make more bile, and for that, it needs
cholesterol. That leaves less cholesterol in your
bloodstream.
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cholestyramine (Prevalite)
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colesevelam (Welchol)
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colestipol (Colestid)
Fibrates: The drugs fenofibrate (Tricor, Fenoglide,
Triglide)
and gemfibrozil (Lopid) lower the amount of very low density
cholesterol (VLDL) your body makes and helps your body
remove triglycerides from your blood. If you take it with a
statin, that increases the risk of statin side effects.
Niacin: (Niacor) This drug limits how much LDL and VLDL
your liver can make. It's been linked to liver damage
and strokes, so your doctor isn't likely to prescribe it
unless you can't take statins.
Omega-3 supplements: Your doctor can prescribe
these, or you can buy them over the counter. They can
help lower
triglycerides. But check with your doctor before you
start taking them; they might interact with other
medicines.
Other supplements: Many supplements are touted
as good for treating high cholesterol. They include
berberine, flaxseed, garlic, green tea, red yeast rice,
C 15:0, and nattokinase. The evidence that these
supplements work varies. If you want to try one, talk to
your doctor about it first.
New medications for high cholesterol
Inclisiran
Inclisiran is a new drug using mRNA technology. It has
been approved in Europe but not yet in the United States.
Clinical trials in 2020 showed the drug could cut levels of
LDL cholesterol by 50 percent in people who are either
intolerant or resistant to standard statin medications.
Inclisiran is the pioneer cholesterol drug in what’s called
“small interfering RNA therapy.” This is a type of drug that
blocks, or interferes with, the function of an RNA messenger
(mRNA). An mRNA is a molecule that carries code for making a
particular protein.
In the case of Inclisiran, the drug blocks, or interferes
with, the production of an enzyme called PCSK9 (proprotein
convertase subtilisin kexin type 9). This enzyme causes
problems with the LDL receptors in the liver that are
necessary for the uptake of LDL cholesterol by liver cells.
By blocking PCSK9 activity, Inclisiran helps the body reduce
the amount of LDL cholesterol. The drug is intended for
hyperlipidemia treatment in adults whose high LDL
cholesterol persists even while they’re on a maximum
tolerated dose of statin therapy.
Bempedoic acid (Nexlitol) and ezetimibe (Nexlizet)
The two drugs Nexlitol and Nexlizet, approved by the FDA in
2020, are the first new non-statin cholesterol drugs
approved by the FDA since 2002.
Nexlitol contains bempedoic acid, which has been shown in
clinical trials to inhibit cholesterol. It’s designed to be
taken in combination with the maximum tolerable dosage of
statins.
Nexlizet contains ezetimibe, which lowers cholesterol by
preventing the body from absorbing cholesterol from foods.
It’s also designed to be taken along with statins.
Both Nexlitol and Nexlizet can cause serious side effects.
Your doctor can help you decide if one of these drugs would
benefit your treatment plan.
Alirocumab (Praluent)
Praluent (alirocumab) was approved by the FDA in 2021 as an
add-on treatment for familial hypercholesterolemia. This is
a genetic condition that causes severely high cholesterol.
Praluent was originally approved by the FDA in 2015 for
treating heart disease and primary inherited hyperlipidemia.
It was then the first PCSK9 inhibitor approved by the FDA.
PCSK9 inhibitor drugs work by attaching to the PCSK9 gene to
prevent it from degrading LDL receptors in the liver that
help lower LDL cholesterol in the body. This differs from
the new mRNA drug Inclirisan, in that inhibitors attach to
the PCSK9 gene, whereas the mRNA drug prevents PCSK9 from
being produced.
Alirocumab, the active drug in Praluent, is a monoclonal
antibody. This is a protein synthesized in a laboratory that
behaves like antibodies made by the human body.
Praluent comes as a liquid solution in a prefilled pen. You
deliver it as an injection every 2 to 4 weeks, which can be
done at home. It has a number of reported possible side
effects, so be sure to discuss with your doctor whether it
would suit your treatment plan.
Because hyperlipidemia affects so many people.
researchers continue to look for new ways to treat it.
One new drug, called inclisiran, works by interfering
with your body's production of PCSK9, rather than just
blocking reception of it.
If your doctor prescribes a drug to control your
cholesterol, you'll likely have to take it long-term to
keep your levels in check.
Are there side effects of hyperlipidemia (high cholesterol) treatment?
Any medication can have side effects, but the benefits of statins far
outweigh the risks of minor side effects. Let your provider know if you
aren’t doing well on your medicine so they can develop a plan to manage
your symptoms.
How soon will the hyperlipidemia (high cholesterol) treatment start
working?
Your provider will order another blood test about two or three months
after you start taking hyperlipidemia medication. The test results will
show if your cholesterol levels have improved, which means the medicine
and/or lifestyle changes are working. The risk of cholesterol causing
damage to your body is a long-term risk, and people usually take
cholesterol-lowering treatments for a long time.