MY CHOLESTEROL GUIDE Take Action. Live Healthy! heart.org/cholesterol
UNDERSTANDING AND MANAGING CHOLESTEROL CONTENTS Understanding Risk...3 Why Am I at Risk?...3 How Will My Risk Factors Be Treated?...4 Understanding Cholesterol...5 What are Cholesterol and Triglycerides?...5 What s Bad About Having High Cholesterol...6 What Should My Total Cholesterol Level Be?...6 What Causes My High Cholesterol?...6 Risk Factors for High Cholesterol That Can Be Managed...7 Risk Factors for High Cholesterol That You Cannot Change 7 Cholesterol Medications....8 What is Cholesterol-Lowering Medication?...8 Taking Statins and What to Expect....9 Lifestyle Changes...11 Eating a Heart-Healthy Diet...11 Getting More Physical Activity...12 Quitting Smoking...13 Losing Weight, If Needed...13 Working with Your Health Care Provider...14 Your Treatment Plan...15 Resources...16 2
UNDERSTANDING RISK YOU MAY HAVE BEEN TOLD that you have high cholesterol, or are at risk for having a heart attack or stroke. You may be feeling a bit overwhelmed by this, but with the right treatment plan and the support of your health care provider, you can live a healthy lifestyle and prevent the likelihood of a heart attack or stroke. WHY AM I AT RISK? Assessing Your Risk Your health care provider may have discussed that you are at higher risk of having a stroke or heart attack. You have heard him or her talk about overall risk of getting cardiovascular disease (CVD). That s a big term that includes heart attack and stroke. Your health care provider will want to know whether you are at risk by 1) reviewing your medical and family history and 2) gauging your overall risk for heart attack or stroke. He or she will want to know: Whether you ve ever had a heart attack or stroke, or blockages in the arteries of your heart, neck, or legs. Your risk factors. Your health care provider will consider your age, whether you have diabetes, and whether you smoke, have high blood pressure, and have high cholesterol. About your lifestyle. Your health care provider will ask about your diet and physical activity levels, other health conditions, any drugs or supplements you ve been taking, and whether someone in your family has high cholesterol or had a heart attack or stroke at an early age. 3
Your health care provider may use a risk calculator to determine your overall risk for CVD. This risk calculator uses your cholesterol levels in addition to other risk factors to estimate your risk for a heart attack or stroke. For example: A 10-year CVD risk estimate of 10% means that of 100 patients with the same risk factors as you, 10 would be expected to have a heart attack or stroke in the next 10 years. In general, as risk for heart attack or stroke increases, the treatment becomes more intensive. If your health care provider determines that you are at a high-enough risk, they will want to talk with you about cholesterol medication therapy and some lifestyle changes. If you re between the ages of 40 and 79, talk to your health care provider about assessing your 10-year risk. HOW WILL MY RISK FACTORS BE TREATED? Your risk for heart disease and stroke is based on your cholesterol levels and other risk factors. These factors include your age, sex, weight, family history, whether you smoke, have diabetes, or have high blood pressure. Instead of focusing on your cholesterol numbers, ask your health care provider about other factors that may affect your overall risk of heart attack or stroke. Even people with normal cholesterol levels can have a high risk of heart attack and stroke and therefore still benefit from cholesterol-lowering medication therapy. Whether your health care provider prescribes medications or not, he or she will still want you to make some changes to your lifestyle, such as heart-healthy eating and increasing physical activity, to help further reduce your risk of heart attack and stroke. Understanding cholesterol and cholesterol-lowering medications is a great place to start. No matter what treatment plan your health care provider and you decide upon, it s very important that you stick to it. A treatment plan can t work the way it s supposed to if it isn t followed, but you can do it! 4
UNDERSTANDING CHOLESTEROL WHAT ARE CHOLESTEROL AND TRIGLYCERIDES? Cholesterol is a waxy, fat-like substance found in your bloodstream. Your body uses cholesterol to make new cells. Your liver makes all the cholesterol your body needs. But some people have too much cholesterol in their bloodstream. This can cause a serious problem, such as a heart attack or stroke, if it is not managed. There are two types of blood cholesterol. Low-density lipoprotein (LDL) is the bad kind of cholesterol. One way to remember this is to think of the L as low, in that you want to keep this kind of cholesterol low. This kind of cholesterol can build up on the insides of your artery walls, creating a thick, hard substance called plaque. VIEW SLIDESHOW here: http://watchlearnlive.heart.org/ CVML_Player.php?moduleSelect=chlscr The good kind of cholesterol is known as high-density lipoprotein (HDL). A good way to remember this is to think of the H in high, as in the type of cholesterol you want to keep high. HDL ( good ) cholesterol helps your body remove the LDL ( bad ) cholesterol from your bloodstream. Triglycerides are the most common type of fat in your body. They come from food, and your body also makes them. They, too, can build up on the insides of your artery walls and cause plaque. 5
WHAT S BAD ABOUT HAVING HIGH CHOLESTEROL When you have too much LDL ( bad ) cholesterol in your blood, it can join with fats and other substances to build up plaque in the inner walls of your arteries. The arteries can become clogged and narrow, which reduces the flow of your blood. If this buildup of plaque breaks loose or ruptures, a blood clot may form at this location or break off and travel in your bloodstream. When this occurs, the blood clot can block the flow of blood to your heart, causing a heart attack. If the blood clot travels to your brain and blocks an artery leading to or in your brain, it can cause a stroke. VIEW SLIDESHOW here: http://watchlearnliveheart.org/ CVML_Player.php?moduleSelect=chlcad WHAT SHOULD MY TOTAL CHOLESTEROL LEVEL BE? In the past, treatment guidelines directed health care providers to focus on treating their patients to target goal levels for total cholesterol, HDL ( good ), LDL ( bad ), and triglycerides. However, current prevention guidelines recommend an approach that goes beyond cholesterol levels alone and considers overall risk assessment and reduction of modifiable risk factors such as diet, activity and smoking. It s still important to know your numbers, but work with your health care provider to modify your risk factors. WHAT CAUSES MY HIGH CHOLESTEROL? Your cholesterol levels can depend on several factors, including your lifestyle, genetics, family history and medical conditions. The body makes cholesterol naturally and a normal level of cholesterol is necessary for good health. Many people get extra cholesterol from the foods they eat, especially from meats and full-fat dairy products. This is called dietary cholesterol. 6
High cholesterol levels can also result from your genetic background. If one or both parents have high cholesterol, it s more likely that you will, too. Additionally, in most people, another common cause of high cholesterol is a hectic and unhealthy lifestyle. Being physically inactive, smoking, and overweight/obesity are risk factors for unhealthy cholesterol levels as well. Risk Factors for High Cholesterol That Can Be Managed Diet: Eating foods that are high in saturated or trans fats can increase your LDL ( bad ) cholesterol. Cholesterol Myths and Facts See page 20 Overweight and Obesity: Carrying too much weight can raise your LDL ( bad ) and triglyceride levels. Smoking: Tobacco smoke also raises your triglyceride levels and lowers your HDL ( good ) levels. Physical Activity: Not getting enough physical activity can contribute to being overweight or obese. Staying active can help you lose weight and lower your LDL ( bad ) levels. Risk Factors for High Cholesterol That You Cannot Change Genes: You can genetically inherit high LDL ( bad ) and triglyceride levels from your parents or grandparents. Age: As people age, they are more likely to have higher levels of cholesterol. 7
CHOLESTEROL MEDICATIONS WHAT ARE CHOLESTEROL-LOWERING MEDICATIONS? There are various medications that can lower blood cholesterol levels. Typically, the first medication prescribed is a statin. These medications lower the amount of cholesterol in the body by preventing cholesterol from forming. Statins are very effective at lowering LDL ( bad ) cholesterol and triglycerides, and raising HDL ( good ) cholesterol. Some statins also reduce the inflammation process caused by high cholesterol within the blood vessels. They ve been proven to lower the risk of a heart attack or stroke. Statins are the medications most often prescribed for people who: Have cardiovascular disease (CVD), such as a heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization. What Are Cholesterol- Lowering Medications? See pages 22-23 Have been diagnosed with very high LDL ( bad ) cholesterol (190 mg/dl or higher) Are between 40 and 75 years old and have type 2 diabetes with an LDL ( bad ) cholesterol level of 70-189 mg/dl; OR Are above a certain risk level of having a heart attack or stroke in the next 10 years and are between 40 and 75 years old Sometimes a health care provider will recommend a statin, even if cholesterol levels aren t high and you don t fit into one of the categories above. This is because a person s overall risk for heart attack or stroke may be high for other reasons. In other words, your actual cholesterol level is just one piece of information that your health care provider evaluates. Anyone at high-enough risk who can benefit from a statin should be taking one. 8
TAKING STATINS AND WHAT TO EXPECT Most people tolerate statins well. However, statins can have side effects, particularly on muscles, the liver, and other organs. Have an open conversation with your health care provider to consider your personal benefits and risks. Ask about what side effects to expect and what to do if you experience a side effect. Be aware that it might take time to find the right statin and right dose for you to get the best cholesterol-lowering effect you need to reduce your risk. Based on your risk for having a CVD event, your health care provider may choose to put you on higher doses of statins. Your health care provider will work with you to find the one that works best for you. VIEW SLIDESHOW here: http://watchlearnlive.heart.org/ CVML_Player.php?moduleSelect=chldrg 9
For those who don t tolerate statins well or need more help than a statin can provide, there are other medications available that can help lower cholesterol. These can include: Bile acid sequestrants Ezetimibe Fibrates Niacin PCSK9 inhibitors Selective cholesterol absorption inhibitors Cholesterol Drugs See page 19 You can learn more about these medications at http://www.heart.org/heartorg/conditions/cholesterol/ PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_ Article.jsp#.WVUHvIqQzmJ. No matter what your health care provider prescribes for you, it s vital that you take your medications exactly as the instructions say at the same time every day, and follow all instructions on the bottle. Your medications won t work the way they re supposed to unless you take them as they re meant to be taken. You can also use a pill box to help remind you to take your medications when and how you re supposed to. Be sure to refill your prescriptions before you run out. Check with your pharmacy about an auto-refill plan. If medication cost is an issue, be sure to talk to your health care provider about your concerns. 10
LIFESTYLE CHANGES Even if your health care provider prescribes cholesterol-lowering medication for you, it s important that you make healthy lifestyle changes to bring your LDL ( bad ) cholesterol and triglyceride levels down. There are four areas where people typically can make changes to lower their cholesterol: Eating a heart-healthy diet Getting more physical activity Quitting smoking Losing weight, if needed RECIPES TO LIVE BY RECIPES FOR CHOLESTEROL MANAGEMENT http://www.heart.org/heartorg/conditions/cholesterol/ CholesterolToolsResources/Recipes-for-CholesterolManagement_UCM_305655_Article.jsp#.WVUIv4qQzmJ Eating a Heart-Healthy Diet The best way to lower your cholesterol numbers is to cut the amount of saturated fat in your diet. Limit saturated fats as much as possible. You will find saturated fat in meat, poultry, and dairy products, so limit the amount of red meat and full-fat dairy products you consume. Avoid trans fats completely. Here are some additional healthy-eating tips: Get plenty of fruits and multi-colored vegetables into your diet. Include whole grains in your diet. Limit sugary foods and beverages. Watch your daily sodium intake (see Helpful Links, p. 16). Check food labels for sodium amount per serving. 11
Avoid processed or pre-prepared food as much as possible. Eat reasonable portions. Often this is less than you are served, especially when eating out. Watch your calories. To maintain a healthy weight, eat only as many calories as you use up through physical activity. If you want to lose weight, take in fewer calories or increase your physical activity. Look for the Heart-Check mark (see Helpful Links, p. 16) to easily identify foods that can be part of an overall healthy eating pattern. Talk to your health care provider about the DASH diet (Dietary Approaches to Stop Hypertension) and Mediterranean-style eating plans (see Helpful Links, p. 16). Getting More Physical Activity Being active is another key to lowering cholesterol. Physical activity raises HDL ( good ) cholesterol, which helps the body get rid of LDL ( bad ) cholesterol and triglycerides. Getting at least 40 minutes of moderate-intensity aerobic physical activity, three to four times per week, is enough to bring your cholesterol and blood pressure down to healthy ranges. You can break up your physical activity into shorter sessions throughout the day. Try: Brisk walking Swimming Bicycling Dancing 12
Quitting Smoking If you smoke, it s very important that you quit. Smoking not only lowers HDL ( good ) cholesterol, it damages the arteries and raises your risk for heart disease and stroke. Talk with your health care provider about getting help with quitting. There are effective medications and support groups available to help smokers quit. You can also get support from the Quit Line at 1-800-QUIT-NOW. If you don t smoke, don t start and avoid secondhand smoke, as well. Losing Weight, If Needed Finally, if you re overweight or obese, take steps to lose weight. Excess weight raises LDL ( bad ) cholesterol and lowers HDL ( good ) cholesterol. Losing just 10 percent of your current weight can help reverse that trend. Healthier eating and adding physical activity to your days are great places to start. 13
WORKING WITH YOUR HEALTH CARE PROVIDER Your health care provider is there to help you reach your health goals, including keeping your cholesterol at healthy levels. Work closely with your health care provider to make the best decisions for you, and then stick to the plan. Making decisions together is the best way to create a treatment plan that you ll be more likely to stick to. Take part in making decisions about your health together with your health care provider by asking the right questions. If you don t understand something, ask for further clarification. Here is a list of questions that you can print out and take to your next appointment. Follow the agreed-upon treatment plan carefully and work closely with your health care team to solve any problems. That way you can keep your cholesterol levels in a healthy range and reduce your risk for heart disease and stroke. Questions for Your Doctor See page 18 14
YOUR TREATMENT PLAN Work with your health care provider on an agreed upon plan that works best for you and your family. For support, encourage your whole family to join you in your heart healthy lifestyle. This includes: Making sure you understand what cholesterol is and how to manage it. Knowing your risks for heart disease and stroke and how to reduce your risk. Eating a heart-healthy diet. Getting enough physical activity. Your Treatment Plan See page 21 Keeping your weight in check. Take your medications safely: Follow your health care provider s instructions. Never stop taking your medications unless your health care provider instructs you to. If you find yourself missing or not using your meds, talk to your health care provider. Take your medications at the same time each day. Read the labels on your medication bottles carefully. Use a pill calendar or reminder app. Quitting smoking Talk to your health care provider about your blood pressure and blood sugar to make sure they are in check or managed properly. 15
Resources Helpful Links: Heart.org/cholesterol Check. Change. Control. Calculator: http://www.heart.org/ccccalculator The FH Foundation*: https://thefhfoundation.org/ Million Hearts*: https://millionhearts.hhs.gov/ DASH diet (Dietary Approaches to Stop Hypertension)*: https://www.nhlbi.nih.gov/health/ resources/heart/hbp-dash-week-dash-html Hypertension: https://healthyforgood.heart.org/eat-smart/infographics/7-salty-sodiummyths-busted-infographic Mediterranean-style eating plans: http://www.heart.org/heartorg/healthyliving/ HealthyEating/Nutrition/Mediterranean-Diet_UCM_306004_Article.jsp#.WTa5NOvyvIU Heart-Check mark: http://www.heart.org/heartorg/healthyliving/healthyeating/heart- CheckMarkCertification/Heart-Check-Mark-Certification_UCM_001179_SubHomePage.jsp Watch your daily sodium intake: https://sodiumbreakup.heart.org/ Learn more about cholesterol medications at: http://www.heart.org/heartorg/conditions/cholesterol/ PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp#. WVUHvIqQzmJ * The links with asterisks provided above are for convenience only, and are not an endorsement of either the linked-to entity or any product or service. 16
Glossary Cholesterol: A waxy, fat-like substance found in your bloodstream. Cardiovascular disease: Heart disease and stroke. Coronary arterial revascularization: Restoring blood flow through a coronary artery by unblocking obstructions or through surgical replacement of the artery. Diabetes: A condition in which the body doesn t make enough insulin, the cells don t use the insulin the body makes as they should, or both. Dietary cholesterol: The cholesterol that comes from the foods you eat, particularly animal products. Ezetimibe: A selective cholesterol absorption inhibitor that lowers cholesterol in the bloodstream. Fibrates: A type of cholesterol-lowering medicine that tend to raise HDL cholesterol and lower triglycerides. Heart attack: The cutoff of blood flow to the heart, usually caused by a blockage in a coronary artery and resulting in damage to the heart muscle. Also known as myocardial infarction. High-density lipoproteins (HDL): The good type of cholesterol. HDL cholesterol helps the body rid itself of LDL cholesterol. Hypertension (high blood pressure): A condition in which the blood pumps with too much force inside the artery walls. Low-density lipoproteins (LDL): The bad type of cholesterol. Too much LDL cholesterol in the bloodstream can cause plaques to form in the artery walls. Niacin (nicotinic acid): A cholesterol-lowering medicine that limits the production of blood fats in the liver. Omega-3 fatty acid ethyl esters: A type of medicine or dietary supplement that lowers triglyceride levels. PCSK9 inhibitors: A newer type of cholesterollowering medication that binds a specific protein in order to lower cholesterol. Peripheral artery disease: Reduced blood flow to the limbs, typically the legs and feet, caused by atherosclerosis. Plaque: The thick, hard buildup of cholesterol and other substances inside the walls of the arteries. Resins (bile acid sequestrants): A type of cholesterol-lowering medicine that causes the intestine to get rid of more cholesterol. Saturated fat: A type of dietary fat found in meats and dairy products, among other sources, that causes LDL cholesterol levels to go up. Selective cholesterol absorption inhibitor: A type of cholesterol-lowering medicine that keeps the intestine from absorbing cholesterol. Stable angina: A type of chest pain caused by coronary heart disease that is typically predictable. It usually occurs during exertion. Statin: A type of cholesterol-lowering medicine that causes the liver to produce less cholesterol. Stroke: The cutoff of blood flow to the brain, usually caused by a blockage in a carotid artery and potentially resulting in brain damage. Trans fat: A type of dietary fat found in many processed and commercially baked foods, as well as tub margarines. Trans fats also cause LDL cholesterol levels to go up. Transient ischemic attack: A temporary blockage of blood flow to the brain, caused by a blood clot. Also known as a mini-stroke. Triglycerides: Another type of fat found in the bloodstream. Like LDL cholesterol, triglycerides can help cause plaques to form in the artery walls. Unstable angina: A type of chest pain caused by coronary heart disease that is typically unpredictable. It usually occurs at rest. 17
QUESTIONS FOR YOUR DOCTOR This list of common questions about cholesterol will help you discuss test results, risk factors and lifestyle changes (including medication) with your doctor. TAKE THIS SHEET TO YOUR NEXT APPOINTMENT AND USE THE SPACE PROVIDED TO WRITE DOWN YOUR DOCTOR S COMMENTS. QUESTIONS COMMENTS What do my cholesterol numbers mean? Do I have a cholesterol goal? How long will it take to reach a healthier cholesterol level? How often should I have my cholesterol levels checked? Do you think my cholesterol levels are due to my lifestyle or to heredity, or a combination of both? How do my lifestyle choices affect my cholesterol levels? Are there other risk factors I need to watch or control because of my cholesterol levels? What type of foods should I eat or avoid? Do I need to lose weight and, if so, how much? Will I need cholesterol-lowering medicine? What resources are available to help me make lifestyle changes? When would you like to see me next? Learn more about cholesterol at: heart.org/cholesterol 18
CHOLESTEROL DRUGS PEOPLE WITH HIGH CHOLESTEROL are often prescribed medications by their doctors to help lower their cholesterol. The most common cholesterollowering drugs are called statins. Statins disrupt the production of cholesterol by blocking a specific enzyme inside cholesterol-producing liver cells. This results in less cholesterol being released into the bloodstream. Some statins also reduce the inflammatory process caused by elevated cholesterol within blood vessel walls. When the body has a reduced reaction to the invading cholesterol, fewer macrophages are allowed to travel into the artery walls, where they would have formed foam cells and plaque. When plaque stops growing inside an artery, the fibrous outer coating remains strong and less likely to rupture. This is called a stable plaque. Statins help to lower cholesterol and maintain the integrity of arteries. Statins interrupt cholesterol assembly within the liver cells, reducing cholesterol output from the liver. More LDL (bad cholesterol) returns to the liver to be digested. SOME STATINS: Reduce smooth muscle cell changes Reduce friction in bloodflow Stabilize the endothelium Reduce inflammatory cells inside plaque Learn more about cholesterol at: heart.org/cholesterol 19
CHOLESTEROL: MYTHS VS. FACTS Myth: You don t need your cholesterol checked until you ve reached middle age. Fact: Guidelines recommend getting your cholesterol and other risk factors checked beginning at age 20, and at least every 4-6 years after that. Myth: Only overweight and obese people have high cholesterol. Fact: People of any body type can have high cholesterol. Being overweight or obese increases your chances of having high cholesterol, but being thin doesn t protect you from the problem. Regardless of your weight, diet, and level of physical activity, you should have your cholesterol checked on a regular basis. Myth: Having high cholesterol is only a man s problem. Fact: Cholesterol levels tend to rise as people age or gain weight, regardless of gender. It s true that premenopausal women tend to have higher levels of estrogen, which raises the levels of HDL ( good ) cholesterol. But women going through menopause or who are postmenopausal tend to have higher levels of LDL ( bad ) cholesterol, as estrogen levels have declined as a result. Myth: If your health care provider hasn t mentioned your cholesterol levels, you re OK. Fact: You are responsible for your own health. Once you ve turned 20, ask your health care provider to conduct a cholesterol test, assess your risk factors, and determine your risk for heart attack or stroke. If you re between 40 and 79, ask your health care provider to assess your 10-year risk. Myth: Your cholesterol level is a result of your diet and physical activity level. Fact: True, diet and physical activity affect your cholesterol, as well, but they re not the only factors. Getting older and being overweight or obese also impact your cholesterol level. Some people are born with high cholesterol levels that they ve inherited from their parents. Regardless, it s very important to eat a heart-healthy diet and get plenty of moderate-intensity physical activity in order to reduce your risk of heart attack or stroke. Myth: Taking cholesterol medicines means you don t have to make diet and lifestyle changes. Fact: It s important to take your medicines exactly as they re prescribed. But the best ways to reduce your risk of heart disease and stroke are to eat a heart-healthy diet and get at least 40 minutes of moderate to intense aerobic exercise three to four times per week. Myth: If the Nutrition Label shows no cholesterol, the food is heart healthy. Fact: Many no cholesterol or even low fat foods are high in other types of bad fats, such as saturated and trans fats. Be sure to check the food label for saturated fat, trans fat, and total calories. Also, be aware that the serving size that those numbers are based on may be smaller than the entire package. Myth: Switching from butter to margarine will help lower cholesterol. Fact: Not necessarily. Butter is high in saturated fat and has some trans fat in it, too, but some types of margarine are even higher in both of those types of fat. Liquid margarines and soft margarines in a tub tend to be lower in bad fats, but check the Nutrition Label for the exact information you need. Myth: Children don t need to worry about cholesterol. Fact: Children can have high cholesterol levels, just like adults. This is particularly true for children who inherit high cholesterol levels from one or both parents, a condition called familial hypercholesterolemia (FH). These children are at high risk for premature heart attack or stroke. Early diagnosis and treatment is critical in these cases. Learn more about cholesterol at: heart.org/cholesterol 20
YOUR TREATMENT PLAN WORK WITH YOUR HEALTH CARE PROVIDER on an agreed upon plan that works best for you and your family. For support, encourage your whole family to join you in your heart healthy lifestyle. This includes: Making sure you understand what cholesterol is and how to manage it. Knowing your risks for heart disease and stroke and how to reduce your risk. Eating a heart-healthy diet. Getting enough physical activity. Keeping your weight in check. Take your medications safely: Follow your health care provider s instructions. Never stop taking your medications unless your health care provider instructs you to. If you find yourself missing or not using your meds, talk to your health care provider. Take your medications at the same time each day. Read the labels on your medication bottles carefully. Use a pill calendar or reminder app. Quitting smoking Talk to your health care provider about your blood pressure and blood sugar to make sure they are in check or managed properly. Learn more about cholesterol at: heart.org/cholesterol 21
WHAT ARE CHOLESTEROL-LOWERING MEDICATIONS? If your doctor has decided that you need to take medicine to reduce high cholesterol, it s because you re at high risk for heart disease or stroke. Usually the treatment combines healthy lifestyle changes including diet and physical activity, and medicine. Most heart disease and many strokes are caused by a buildup of fat, cholesterol and other substances called plaque in the inner walls of your arteries. The arteries can become clogged and narrowed, and blood flow is reduced. If a blood clot forms and blocks blood flow to your heart, it causes a heart attack. If a blood clot blocks an artery leading to or in the brain, a stroke results. By following your doctor s advice, you can help prevent these diseases. What type of medicine may I be prescribed? Various medications can lower blood cholesterol levels. Statins are recommended for most patients because they are the only cholesterol-lowering drug class that has been directly associated with reduced risk for heart attack and stroke. Statins (HMG-CoA reductase inhibitors) prevent the production of cholesterol in the liver. Their major effect is to lower LDL cholesterol. Some names are lovastatin, pravastatin, simvastatin, fluvastatin and atorvastatin. You should talk to your doctor about the risks and benefits of statin therapy if you fall into one of the following groups: Adults with known cardiovascular disease, including stroke, caused by atherosclerosis Adults with diabetes, aged 40-75 years with an LDL (bad) cholesterol level 70-189 mg/dl Adults with LDL (bad) cholesterol level of greater than or equal to 190 mg/dl Adults, aged 40 75 years, with LDL (bad) level of 70-189 mg/dl and a 7.5% or greater 10-year risk of developing cardiovascular disease from atherosclerosis Some people who do not fall into these four major categories may also benefit from statin therapy. Learn more about cholesterol at: heart.org/cholesterol Page 1 of 2 22
WHAT ARE CHOLESTEROL-LOWERING MEDICATIONS? What other medications may be prescribed? Your healthcare provider will monitor your progress with your statin therapy and recommended lifestyle changes. If you are having serious side effects or don t have the desired response to statin therapy and lifestyle changes alone, he or she may consider other medications as well. Bile acid binders (resins) cause the intestine to get rid of more cholesterol. Some names are cholestyramine, cholestipol and colesevelam. Fibrates are especially good for lowering triglyceride (blood fat) levels and, to a lesser extent, raising HDL (good) cholesterol levels. Some names are gemfibrozil, clofibrate and fenofibrate. Niacin (nicotinic acid) is a B vitamin that limits the production of blood fats in the liver. Take this only if your doctor has prescribed it. It can lower total cholesterol, LDL (bad) cholesterol and triglyceride (blood fat) levels. It can also raise HDL (good) cholesterol levels. PCSK9 Inhibitors bind to and inactivate a protein in the liver in order to lower LDL (bad) cholesterol. They can be given in combination with a statin. Some names are alirocumab and evolocumab, Selective cholesterol absortion inhibitors, like ezetimibe, work by preventing cholesterol from being absorbed in the intestine. Your doctor will work with you to decide which medicine, or combination of medicines, is best for you. Always follow your doctor s instructions carefully, and let the doctor know if you have any side effects. Never stop taking your medicine on your own! How do I know if my medicine is working? Your doctor will test your blood cholesterol level when needed. Together with your doctor, set a goal and ask how long it may take to reach that goal. Learn more about cholesterol at: heart.org/cholesterol Page 2 of 2 23