High Cholesterol

NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer

High Cholesterol

Overview

Picture of the cardiovascular system

What is high cholesterol?

Cholesterol is a type of fat (lipid) in your blood. Your cells need cholesterol, and your body makes all it needs. But you also get cholesterol from the food you eat.

If you have too much cholesterol, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis. It is usually a slow process that gets worse as you get older.

To understand what happens, think about how a clog forms in the pipe under a kitchen sink. Like the buildup of grease in the pipe, the buildup of cholesterol narrows your arteries and makes it harder for blood to flow through them. It reduces the amount of blood that gets to your body tissues, including your heart. This can lead to serious problems, including heart attack and stroke.

Your cholesterol is measured by a blood test:

  • High cholesterol is 240 or above.
  • Borderline-high is 200 to 239.
  • Best is less than 200.

What are the different kinds of cholesterol?

  • LDL is the “bad" cholesterol, the kind that can clog your arteries. This is the cholesterol you need to lower, if you have high cholesterol.
  • HDL is the “good" cholesterol. HDL helps clear fat from your blood. A high level of HDL can help protect you from a heart attack.
  • Triglycerides are another type of fat in your blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

What are the symptoms?

High cholesterol doesn't make you feel sick. By the time you find out you have it, it may already be clogging your arteries. So it is very important to start treatment even though you may feel fine.

What causes high cholesterol?

Many things can cause high cholesterol, including:

  • The foods you eat. Eating too much saturated fat, trans fat, and cholesterol can raise your cholesterol. Saturated fat and cholesterol are in foods that come from animals (such as meats, whole milk, egg yolks, butter, and cheese). Trans fats are in many packaged and snack foods, such as cookies, crackers, and chips.
  • Being overweight.
  • Being inactive.
  • Age. Cholesterol starts to rise after age 20.
  • Family history. If family members have or had high cholesterol, you may also have it.
  • Overall health. Diseases such as hypothyroidism can raise cholesterol.

How is high cholesterol diagnosed?

You need a blood test to check your cholesterol. There are several kinds of tests:

  • A fasting cholesterol test is the most complete test because it measures all of the fats in your blood, including LDL and HDL cholesterol, and triglycerides. You cannot have food for 9 to 12 hours before this test.
  • A direct LDL test measures your LDL level only. You can have this test done at any time, even if you recently had a meal or snack.
  • A simple cholesterol test can measure total cholesterol and HDL. You can eat before this test. Sometimes doctors do this test first.

How is it treated?

If you have high cholesterol, you need treatment to lower your risk of heart attack and stroke. The two main treatments are lifestyle changes and medicine.

Some lifestyle changes are important for everyone with high cholesterol. Your doctor will probably want you to:

  • Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and healthy fats like olive oil.
  • Lose weight, if you need to. Losing just 5 lb to 10 lb (2.3 kg to 4.5 kg) can lower your cholesterol. Losing weight can also help lower your blood pressure.
  • Get regular exercise on most, if not all, days of the week. Walking is great exercise that most people can do. A good goal is 30 minutes or more a day.
  • Don't smoke. Quitting can help raise your HDL and improve your heart health.

Changing old habits may not be easy, but it is very important to help you live a healthier and longer life. Having a plan can help. Start with small steps. For example, commit to adding one fruit or one vegetable a day for a week. Instead of having dessert, take a short walk.

If these lifestyle changes don't lower your cholesterol enough, or if your risk of heart attack is high, you may also need to take a cholesterol-lowering medicine, such as a statin. Knowing your heart attack risk is important, because it helps you and your doctor decide how to treat your cholesterol.

To find out your risk, use the Interactive Tool: Are You at Risk for a Heart Attack?

Cause

High cholesterol can be caused by:

  • What you eat. Eating too much saturated fat, trans fat, and cholesterol can cause high cholesterol. Saturated fat and cholesterol are in foods that come from animals, such as meats, whole milk, egg yolks, butter, and cheese. Trans fat is found in fried foods and packaged foods, such as cookies, crackers, and chips.
  • Your weight. Being overweight may increase triglycerides and decrease HDL (good cholesterol).
  • Your activity level. Lack of physical activity can lower your HDL.
  • Your age and gender. After you reach age 20, your cholesterol naturally begins to rise. In men, cholesterol generally levels off after age 50. In women, it stays fairly low until menopause. Then it rises to about the same level as in men.
  • Some diseases. Certain diseases may raise your risk of high cholesterol. These include hypothyroidism, chronic kidney disease, and other kidney problems.
  • Your family history. High cholesterol may run in your family. If family members have or had high cholesterol, you may also have it.
  • Cigarette smoking. Smoking can lower your HDL cholesterol.
  • Certain medicines. Some medicines can raise triglyceride levels and lower HDL (good) cholesterol levels. These medicines include thiazide diuretics, beta-blockers, estrogen, and corticosteroids.

Symptoms

High cholesterol does not make you feel sick. It is usually found during a routine blood test that measures cholesterol levels. You may first find out that you have it when you are diagnosed with a problem that is caused in part by high cholesterol, such as a heart condition or a problem with your pancreas.

Some people with rare lipid disorders may have symptoms such as deposits of extra cholesterol in the skin. These deposits can also cause bumps in tendons in the hands or feet.

What Happens

Having high LDL cholesterol or having low HDL cholesterol can lead to the buildup of plaque in artery walls. This buildup is called atherosclerosis, and it can:

  • Narrow your arteries. When enough plaque builds up, it starts to block your arteries. This happens slowly over many years. In time, the plaque can limit blood flow. The parts of your body that depend on the arteries for blood can suffer from lack of oxygen. This is called ischemia. If it's your heart muscle that isn't getting enough oxygen, you may have chest pain (angina).
  • Harden your arteries. A healthy artery can widen (dilate) so that more blood can flow through when needed, such as during activity. When hard plaque forms in the walls of an artery, it can make the artery too stiff to widen. This "hardening" of your coronary arteries can also cause chest pain.
  • Block your arteries. When a blood clot forms around a crack or rupture in the plaque, it can plug the artery. This damages tissues or organs that should receive blood from that artery. Men who smoke, have high cholesterol, or both have a greater chance of having a plaque rupture, causing a heart attack or sudden death.

See a picture of how plaque causes a heart attack.

Atherosclerosis can lead to:

Use the Interactive Tool: Are You at Risk for a Heart Attack?

More information

What Increases Your Risk

Some things that increase your risk for high cholesterol are things you can change, but some are not. It's important to lower your risk as much as possible.

Things you can change include:

  • Eating foods high in saturated fat, trans fat, and cholesterol.
  • Being overweight.
  • Not being active every day.
  • Smoking.

Each of these things can raise your LDL, lower your HDL, or both.

Taking certain medicines can raise your cholesterol, too.

Photo of an older woman

One Woman's Story:

Linda, 56

“Terri’s heart attack scared me to death. I decided that this time, I’m doing the whole package. I’m quitting smoking for good."—Linda

Read more about Linda and how quitting smoking improved her cholesterol.

Things you cannot change include:

  • Family history. If high cholesterol runs in your family, you may have it, and it may be harder to treat.
  • Age and gender. After age 20, cholesterol levels naturally rise. In men, cholesterol levels often level off after age 50. In women, cholesterol levels stay fairly low until menopause. After that, they rise to about the same level as in men.

When to Call a Doctor

High cholesterol usually has no symptoms. Sometimes the first sign that you have high cholesterol or other risk factors for heart disease is a heart attack, a stroke, or a transient ischemic attack (TIA). If you have any symptoms of these, call 911 or other emergency services.

Symptoms of a heart attack include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or uneven heartbeat.

Symptoms of a stroke or TIA include:

  • Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
  • New problems with walking or balance.
  • Sudden vision changes.
  • Drooling or slurred speech.
  • New problems speaking or understanding simple statements, or feeling confused.
  • A sudden, severe headache that is different from past headaches.

Call your doctor for an appointment if you:

  • Think you may have diabetes.
  • Have family members who have high cholesterol, coronary artery disease (CAD), or diabetes.
  • Are concerned about your cholesterol.
  • Are having side effects from your medicines.

Who to See

Any of the following doctors, nurses, or specialists can order a cholesterol test and treat high cholesterol:

A registered dietitian can help you with a diet to lower your cholesterol.

People who have rare lipid disorders, which can be hard to treat, may need to see a specialist, such as a lipidologist or an endocrinologist.

You may need to see a cardiologist if you are diagnosed with heart disease.

Exams and Tests

A simple blood test tells you if you have high cholesterol.

  • A simple cholesterol test can measure total cholesterol and HDL. You can eat before this test. Sometimes doctors do this test first.
  • A lipoprotein analysis, also called a fasting cholesterol test, is a more thorough test. It measures your total cholesterol plus your LDL, HDL, and triglyceride levels. It is called a fasting test because you don't eat for 9 to 12 hours before the test.
  • A direct LDL test measures your LDL level only. You can have this test done at any time, no matter when you last ate.

Your total cholesterol level is important. But your levels of LDL, HDL, and triglycerides help your doctor decide if you need treatment for high cholesterol. Your doctor will also consider your overall health and your risk of heart attack.

What do your cholesterol numbers mean?

The following tables will help you understand the results of your cholesterol tests. All numbers are milligrams per deciliter (mg/dL), but most people just say the numbers.

Total cholesterol

Your total cholesterol number shows if your cholesterol is too high. If you have high cholesterol, your doctor will want to know your LDL and HDL levels before deciding whether you need treatment and what sort of treatment you need.

Total cholesterol
High 240 or above
Borderline-high 200 to 239
Best Less than 200

LDL (bad) cholesterol

You want your LDL level to be low. But how low your LDL should be depends on your risk of heart attack. This table shows the LDL levels for someone with an average risk of heart attack.

LDL cholesterol
Best Below 100
Near best 100 to 129
Borderline-high 130 to 159
High 160 to 189
Very high 190 and above

Your LDL goal may be lower if your heart attack risk is higher than average. (To find out your risk, see the Interactive Tool: Are You at Risk for a Heart Attack?)

Your doctor will help decide what your LDL goal is and if you need any treatment to lower your LDL. The higher your risk of heart attack, the lower your LDL goal.

HDL (good) cholesterol

You want your HDL level to be high. HDL (good) cholesterol goals are different for men and women. But for everyone, the higher your HDL, the better. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. A high HDL number can help offset a high LDL number.

HDL cholesterol
Best 60 or higher protects against heart disease
Good 40 or higher
Bad Below 40

Triglycerides

You want your triglyceride level to be low.

Triglyceride levels
Normal Less than 150
Borderline-high 150 to 199
High 200 to 499
Very high 500 or higher

Your risk level

When you visit your doctor to talk about your cholesterol test, you will talk about other things that increase your risk for heart problems. These include:

If your risk is high, or if you already have heart problems, your doctor will be more likely to prescribe medicine along with lifestyle changes. For more information about heart disease, see the topic Coronary Artery Disease.

Other tests

  • You may need other tests to find out if another health problem, such as hypothyroidism, is causing your high cholesterol.
  • A C-reactive protein (CRP) test may be done for some people who are at risk for getting coronary artery disease. A special type of CRP test, the high-sensitivity CRP test, can help find out your chance of having a sudden heart problem, such as a heart attack. This test may be done even if you have a normal or low level of LDL cholesterol.

More information

Early Detection

Some doctors recommend that everyone older than 20 be checked for high cholesterol. How often you need to be checked depends on whether you have other health problems and your overall chance of heart disease. For more information, see:

Treatment Overview

The goal in treating high cholesterol is to reduce your chances of having a heart attack or stroke.

The two types of treatment for high cholesterol are:

  1. Lifestyle changes, including healthy eating, quitting smoking, losing extra weight, and getting more active.
  2. Daily medicines.

Treating high cholesterol with lifestyle changes

Your doctor may suggest that you make one or more of the following changes:

  • Build good eating habits. Your doctor may suggest that you follow a cholesterol-lowering diet that cuts back on saturated fat while still allowing good fat such as olive and canola oils.
  • Lose weight. If you are overweight, losing just 5 lb to 10 lb (2.3 kg to 4.5 kg) can lower your cholesterol and triglycerides. Losing weight can also help lower your blood pressure.
  • Get more active. Exercise can raise your HDL and may help you lose weight, if you need to.
  • Stop smoking. If you smoke, quitting will also help you raise your HDL.

For more information, see the section Making Lifestyle Changes.

Treating high cholesterol with medicine

Many people try lifestyle changes first. But if lifestyle changes aren't enough, you will need to take medicine too.

Some people need to start taking medicine right away because their risk of heart attack is higher than average.

Know your heart attack risk

Use the Interactive Tool: Are You at Risk for a Heart Attack?

This interactive tool will tell you your level of risk. Your doctor will base your need for medicine on your risk level. After you use the tool, you can learn more about treatment for your risk level.

You are considered at very high risk if you have coronary artery disease and you also smoke or have diabetes, acute coronary syndrome, or metabolic syndrome.

Work with your doctor to treat other diseases that you may have, such as high blood pressure and diabetes. And if you smoke, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

Take your medicine properly

Some people find it hard to take their medicines properly. They may fit into one of these groups:

  • "Why should I bother?" These people don't see why they should take medicines every day when they don't feel sick.
    High cholesterol doesn't make you feel sick. But it's important to treat it, because it damages your blood vessels and eventually your heart, even though you don't have symptoms.
  • "I don't like the side effects." These people stop taking their medicines because they are having side effects from the pills.
    If you're having side effects, tell your doctor. There are many kinds of medicines you can try until you find one that works well with the fewest side effects.
  • "I just can't keep track." Some people find it very hard to keep track of taking two or more pills every day, especially if they need to take them at different times.
    Your doctor may be able to change your pill schedule to make it simpler. You can also organize your pills with a pillbox that holds a week's worth of pills. Some of these boxes have separate compartments for morning, noon, and bedtime pills.

For more information, see:

If you have trouble taking your medicine for any reason, talk to your doctor.

Prevention

You can help prevent high cholesterol by:

  • Eating a diet low in saturated fat, trans fat, and cholesterol.
  • Getting plenty of exercise.
  • Managing your weight.
  • Not smoking.

Because cholesterol levels tend to increase with age, paying attention to diet and exercise is even more important as you get older.

Some people may not be able to prevent high cholesterol with lifestyle changes. Family history or certain conditions that cause the body to make too much cholesterol can raise levels even with lifestyle changes. In these cases, medicine can help.

Remember that high cholesterol is just one of the things that increase your risk for heart attack and stroke. Controlling other health problems, such as high blood pressure and diabetes, can also help reduce your overall risk.

Making Lifestyle Changes

Lifestyle changes are important to help control high cholesterol, especially if you have other risk factors for heart disease and stroke.

Even if your doctor has prescribed medicine for you, you may still need to make changes at home to lower your cholesterol and reduce your risk. Some people can even take less medicine after making these changes.

What changes do you need to make?

Photo of an older woman

One Man's Story:

Joe, 61

“The walking was the easy part for me. I get out every evening for a walk. The food part took some thought. Each week, I added a food that was good for me and took something away that was bad for me."—Joe

Read more about how Joe is improving his cholesterol by making one change at a time.

Make these lifestyle changes to help lower your cholesterol:

More on food

Making healthy eating habits a part of your daily life is one of the best things you can do to lower your cholesterol. Your doctor may recommend the TLC diet. The diet's main focus is to reduce the amount of saturated fat you eat, because saturated fat raises your cholesterol.

Click here to view an Actionset. High Cholesterol: Using the TLC Diet

You could also use the Mediterranean diet. The Mediterranean diet emphasizes eating foods like fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oils. These foods are rich with monounsaturated fats, fiber, and omega-3 fatty acids.

Knowing which diet to follow can be confusing. A chart with several heart-healthy diets (What is a PDF document?) shows how the TLC and Mediterranean diets compare with other eating plans. If you have questions about which diet to follow, talk to your doctor.

For more information about food and high cholesterol, see:

If high cholesterol runs in your family, these lifestyle changes may not be enough. You may need to take medicine, too. But no matter what treatment you use, you can lower your high cholesterol.

How do you make lifestyle changes?

Photo of an older woman

One Man's Story:

Joe, 61

“I’m just not that type of person who can change everything at once."—Joe

Read more about Joe and how using the TLC plan helped him take charge of his cholesterol.

Making any kind of change in the way you live your daily life is like being on a path. The path leads to success. You get there one step at a time. Here are the first steps on that path:

  1. Have your own reason for making a change. If you do it because someone else wants you to, you're less likely to have success.
  2. Set goals. Include long-term goals as well as short-term goals that you can measure easily.
  3. Measure improvements to your health. For example, keep track of your blood pressure, cholesterol, or blood sugar. Or see how you can shorten the time it takes to walk a mile.
  4. Think about what might get in your way, and prepare for slip-ups.
  5. Get support from your family, your doctor, your friends—and from yourself.

1. Have your own reasons for making a change

Your reason for wanting to make a lifestyle change is really important. Why do you want to lower your cholesterol? To live longer? To be around for your family?

But it's very important that you feel ready to make changes. If you don't feel ready now, learn more about high cholesterol and the damage it can do. When you truly want to make changes, you're ready for the next step.

It's not easy to make changes. But taking the time to really think about what will motivate or inspire you will help you reach your goals.

2. Set goals you can reach

Ask yourself if you feel ready to begin taking steps toward big goals. If you're not ready yet, try to pick a date when you will start making small changes. Any healthy change—no matter how small—is a good start.

When you are clear about your reasons for wanting to make a change, it's time to set your goals:

  • Long-term goals: These are large goals that you want to reach in 6 to 12 months. Your doctor can help you figure out what your long-term goals should be for your cholesterol.
  • Short-term goals: What are the short-term goals that will help you reach your long-term goals? Short-term goals are the small steps you take, week by week, to improve your health.
  • Updated goals: To help you stay motivated, track your progress and update your goals as you move forward.

Tips for setting goals

  • Focus on small goals. This will help you reach larger goals over time. With smaller goals, you'll have success more often, which will help you stay with it.
  • Write down your goals. This will help you remember, and you'll have a clearer idea of what you want to achieve. Use a personal action plan (What is a PDF document?) to record your goals. Hang up your plan where you will see it often. It will be a reminder of what you're trying to do.
  • Make your goals specific. Specific goals help you measure your progress. For example, setting a goal to eat one additional fruit and one additional vegetable each day for a week is better than a general goal to "eat more vegetables."
  • Focus on one goal at a time. By doing this, you're less likely to feel overwhelmed and then give up.
  • As soon as you reach a goal, set a new one.

3. Measure how your health has improved

Before you make lifestyle changes, ask your doctor to write down your cholesterol levels for you. You may also want to record your blood pressure and your weight. Then, as you make changes and have your cholesterol level, blood pressure, and weight checked again, you will begin to see improvement.

4. Prepare for slip-ups

Photo of an older woman

One Man's Story:

Joe, 61

“I've learned to not beat myself up [when I slip up]. Instead, I refocus on my plan and get right back to eating healthy food. What keeps me going is the results—I've lost weight, my cholesterol's getting better, and I feel younger every day."—Joe

Read more about how Joe is controlling his cholesterol.

It's perfectly normal to try to change a habit, go along fine for a while, and then have a setback. Lots of people try and try again before they reach their goals.

What are the things that might cause a setback for you? If you have tried to make lifestyle changes before, think about what helped you and what got in your way.

By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.

Here's one person's list of barriers to taking a brisk 30-minute walk every day, along with some possible solutions:

Barriers

Solutions

"I might be too busy."

  • My backup plan will be to break my usual 30-minute walk into two 15-minute walks or three 10-minute walks.

"I might get bored."

  • I'll listen to music or a podcast while I walk.
  • I'll get my neighbor to walk with me.

"It might rain."

  • My backup plan will be to use an exercise DVD or a treadmill in front of my TV when the weather's bad.

Use a personal action plan (What is a PDF document?) to write down your barriers and backup plans.

There will be times when you slip up and don't make your goal for the week. When that happens, don't get mad at yourself. Learn from the experience. Ask yourself what got in the way of making your goal. Positive thinking goes a long way when you're making lifestyle changes.

Click here to view an Actionset. Positive Thinking: Stopping Unwanted Thoughts

4. Get support

The more support you have for making lifestyle changes, the easier it is to make those changes.

You can use this personal action plan (What is a PDF document?) to organize your support system.

Tips for getting support

  • Get a partner. It's motivating to know that someone is trying to make the same lifestyle change that you're making, like being more active or changing your eating habits. You have someone who is counting on you to help him or her succeed. That person can also remind you how far you've come.
  • Get friends and family involved. They can exercise with you or encourage you by saying how they admire you. Family members can join you in your healthy eating efforts. Don't be afraid to tell family and friends that their encouragement makes a big difference to you.
    Click here to view an Actionset. Healthy Eating: Getting Support When Changing Your Eating Habits
    Click here to view an Actionset. Quitting Smoking: Getting Support
  • Join a class or workout group. People in these groups often have some of the same barriers you have. They can give you support when you don't feel like staying with your plan. They can boost your morale when you need a lift. You'll also find a number of online support groups for people with high cholesterol.
  • Give yourself positive reinforcement. When you feel like giving up, don't waste energy feeling bad about yourself. Remember your reason for wanting to change, think about the progress you've made, and give yourself a pep talk and a pat on the back.
  • Get professional help. A registered dietitian can help you make your diet healthier while still allowing you to eat foods that you enjoy. An exercise physiologist can help design an exercise program that is fun and easy to stay on. A psychiatrist, psychologist, social worker, or your doctor can help you overcome hurdles, reduce stress, or quit smoking.

Medications

Statins are the medicines used the most often to treat high cholesterol, and they often work the best. They can reduce the risk for heart attack, stroke, and early death in people who are at high risk for a heart attack or stroke. Other medicines also lower cholesterol, and some may be used to lower triglycerides or raise HDL.

Doctors may also prescribe aspirin therapy if you have had a heart attack or a stroke, or you have a high risk for heart attack or stroke.

Do you need to take medicine? That depends. The decision to use medicine to treat high cholesterol is usually based on your LDL level and your risk for heart attack and stroke.

Medicine is always used along with a diet and exercise plan, not instead of it.

You and your doctor will decide if you will take medicine for high cholesterol. For more information, see:

Click here to view a Decision Point. High Cholesterol: Should I Take Statins?
Photo of a man

One Man's Story:

Tony, 57

“I don’t mind taking a pill a day. As long as it’s doing me some good. And I no longer have any doubts about that."—Tony

Read more about Tony and how medicine helps him keep his cholesterol low.

Side effects are more likely and may be worse when you use higher doses of statins. Talk to your doctor if side effects bother you. You may be able to take a different medicine or a different dose.

Be sure to tell your doctor everything you take for high cholesterol, even herbs or other supplements or treatments. Sometimes they can interact with other medicines and cause problems.

Medication Choices

The following medicines can be used to lower LDL and triglyceride levels in the blood and to raise HDL. These are not complete lists of all medicines that are available.

Statin medicines
Generic names Brand names How they work
atorvastatin, lovastatin, pravastatin, simvastatin, fluvastatin, rosuvastatin

Lipitor, Altoprev, Pravachol, Zocor, Lescol, Crestor

Reduce how much cholesterol your body makes

Some statins are combined with another medicine into one pill.

Statin combinations
Generic names Brand names How they work

atorvastatin with amlodipine

Caduet

Lower how much cholesterol your body makes and lower blood pressure

lovastatin with niacin

Advicor

Raise good (HDL) cholesterol and lower bad (LDL) cholesterol

simvastatin with ezetimibe

Vytorin

Lower how much cholesterol your body makes and the amount of cholesterol your body absorbs

simvastatin with niacin

Simcor

Raise good (HDL) cholesterol and lower bad (LDL) cholesterol

Your doctor may prescribe other medicines. Some are used with a statin.

Drugs that may be used with a statin

Type of drug

Generic names Brand names How they work

Bile acid sequestrants

cholestyramine, colestipol, colesevelam Questran, Colestid, Welchol Lower the amount of LDL cholesterol in your blood

Fibric acid derivatives

gemfibrozil, fenofibrate Lopid, Tricor Lower triglycerides and can raise good (HDL) cholesterol. LDL may go up slightly.

Nicotinic acid

niacin Niacor, Niaspan Raise HDL cholesterol and lower triglycerides and LDL

Cholesterol absorption inhibitors

ezetimibe Zetia Lower how much cholesterol your body can absorb

What to think about

If you do take medicine, it is important to use it the right way. See the topic Taking Medicines as Prescribed.

To help you decide whether medicine to lower cholesterol is right for you, see:

Click here to view a Decision Point. High Cholesterol: Should I Take Statins?

Other Treatment

Some plant products can help lower high cholesterol. But don't use them to replace your doctor's treatment. Whether or not you use such products, be sure to continue your diet, exercise, and prescription medicines.

As with any new form of treatment, make sure to talk with your doctor first. This is especially important if you take statins. Combining statins and some supplements can cause dangerous side effects.

Psyllium

Psyllium is an ingredient in some dietary supplements—Metamucil, for example. It's a fiber from fleawort and plantago seeds.

Doctors aren't sure how it helps cholesterol levels. It may make the small intestine absorb less cholesterol, so less of it enters your blood.

Psyllium is approved by the Federal Drug Administration (FDA). The main side effect is increased bowel movements.

Sterol or stanol esters

Sterol and stanol esters are used in cholesterol-lowering margarine spreads.

Sterol esters might limit how much cholesterol the small intestine can absorb.

Red yeast rice

Red yeast rice contains a natural form of lovastatin, a statin medicine. This supplement may keep your body from producing too much cholesterol. But this supplement can cause dangerous side effects.

Talk to your doctor before you try red yeast rice. Serious side effects include rhabdomyolysis and hepatitis. Red yeast rice is not regulated by the FDA. So you cannot be sure of the amount of red yeast in a supplement. So you cannot be sure of its dose and safety.

If you take red yeast rice, call your doctor right away if you have a bad reaction to it such as severe muscle pain or symptoms of hepatitis.

Do not take red yeast supplements if you are taking statins. Combining them can cause dangerous side effects.

Not recommended for lowering cholesterol

  • Garlic. Eating lots of garlic or taking garlic supplements does not effectively lower cholesterol. And eating too much garlic can have side effects, including allergic reaction, gas, heartburn, garlic odor from the skin, interference with some drugs, and longer blood-clotting time.
  • Very low-fat diets. Although very low-fat diets may indeed lower cholesterol levels, they are not recommended. Very low-fat diets usually allow less than 15% of total calories from fat. In comparison, a cholesterol-reducing diet allows 25% to 35% of calories to come from total fat, with 7% from saturated fat. A diet with less than 25% of its calories from fat can increase triglycerides and decrease HDL (good) cholesterol. Such a diet may deplete your body of other important nutrients and vitamins.
  • Policosanol. Policosanol, which is made from sugar cane, has not been shown to lower cholesterol.

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


Food and Drug Administration (FDA): Consumer Health Information
10903 New Hampshire Avenue
Silver Spring, MD  20993
Phone: 1-888-INFO-FDA (1-888-463-6332)
Web Address: www.fda.gov/consumer/default.htm
 

This Web site has health information for people of all ages. Topics include the following: medicines, food and nutrition, medical devices, cosmetics, and animal health. Spanish materials are also available.


HeartHub for Patients
Web Address: www.hearthub.org
 

HeartHub for Patients is a website from the American Heart Association. It provides patient-focused information, tools, and resources about heart diseases and stroke. The site helps you understand and manage your health. It includes online tools that explain your risks and treatment options. The site includes articles, the latest news in health and research, videos, interactive tools, forums and community groups, and e-newsletters.

The website includes health centers that cover heart rhythm problems, cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart failure, high blood pressure, peripheral artery disease, and stroke.

HeartHub for Patients also links to Heart360.org, another American Heart Association website. Heart360 is a tool that helps you send and receive medical information with your doctor. It also helps you monitor your health at home. It gives you access to tools to manage and monitor high blood pressure, diabetes, high cholesterol, physical activity, and nutrition.


KidsHealth for Parents, Children, and Teens
10140 Centurion Parkway North
Jacksonville, FL  32256
Phone: (904) 697-4100
Fax: (904) 697-4220
Web Address: www.kidshealth.org
 

This website is sponsored by the Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This website offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly emails about your area of interest.


National Cholesterol Education Program (NCEP)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov/about/ncep
 

The National Cholesterol Education Program (NCEP) provides education and tips for patients about how to lower high cholesterol. The NCEP provides clinical practice guidelines for health professionals to treat high cholesterol. The goal of the NCEP is to help people lower high cholesterol because this can lower their risk of coronary artery disease. The NCEP is part of the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH).


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Other Works Consulted

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  • Brunzell JD, Failor RA (2006). Diagnosis and treatment of dyslipidemia. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 6. New York: WebMD.
  • Buckley DI, et al. (2009). C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(7): 483–495.
  • Centers for Disease Control and Prevention (2009). Prevalence of abnormal lipid levels among youths—United States, 1999–2006. JAMA, 303(10): 930–933.
  • Genest J, Libby P (2008). Lipoprotein disorders and cardiovascular disease. In P Libby et al., eds., Braunwald's Heart Disease, 8th ed., vol. 1, pp. 1071–1092. Philadelphia: Saunders Elsevier.
  • Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
  • Kavey RW, et al. (2003). American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation, 107(11): 1562–1566.
  • Krummel DA (2008). Medical nutrition therapy for cardiovascular disease. In LK Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, 12th ed., pp. 833–864. St. Louis: Saunders Elsevier.
  • Maron DJ, et al. (2008). Risk factors for which interventions have proved to lower risk of coronary heart disease section of Preventative strategies for coronary heart disease. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1208–1217. New York: McGraw-Hill.
  • McCrindle BW, et al. (2007). Drug therapy of high-risk lipid abnormalities in children and adolescents. A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. Circulation, 115(14): 1948–1967.
  • Mosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262.
  • National Heart, Lung, and Blood Institute (2005). Your Guide to Lowering Your Cholesterol With TLC (NIH Publication No. 06-5235). Available online: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.
  • Red yeast rice (2009). Medical Letter on Drugs and Therapeutics, 51(1320): 71–72.
  • Roger VL, et al. (2010). Heart disease and stroke statistics 2011 update: A report from the American Heart Association. Circulation, 123(4): e18–e209.
  • Sacks FM, et al. (2006). Soy protein, isoflavones, and cardiovascular health: An American Heart Association science advisory for professionals from the Nutrition Committee. Circulation, 113(7): 1034–1044. Also available online: http://circ.ahajournals.org/cgi/content/full/113/7/1034.
  • U.S. Preventive Services Task Force (2008). Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 148(11): 846–854.
  • U.S. Preventive Services Task Force (2009). Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
  • U.S. Preventive Services Task Force (2009). Aspirin for the Prevention of Cardiovascular Disease. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Carl Orringer, MD - Cardiology, Clinical Lipidology
Last Revised April 22, 2011

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