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Updated on March 28, 2025
If a blood test shows you have worrisome levels of cholesterol—a waxy substance found in your blood—your healthcare provider (HCP) may want to put you on treatment. The cholesterol that causes concern is known as low-density lipoprotein, or LDL cholesterol. Sometimes, it’s called the “bad” cholesterol because it is linked to heart disease and other problems.
You might think, “Well, I don’t have any symptoms of these diseases.” But that’s the problem with high LDL: It usually causes no outward symptoms even as it’s silently causing trouble inside.
Your blood test reveals a few important cholesterol-related values. In addition to LDL levels, it also shows your levels of high-density lipoprotein, or HDL cholesterol. HDL is often described as the “good” cholesterol because it clears LDL cholesterol from the blood. While you want to keep your LDL low, a high HDL value is desirable. A third value from the test shows your total cholesterol number.
When should high cholesterol be treated?
Many factors go into deciding if your cholesterol levels should be treated. Along with your levels themselves, your HCP will typically consider your overall health and any heart disease risk factors. Those factors include:
- High blood pressure
- Prediabetes or diabetes
- Being overweight or obese
- Smoking
- Family history of heart disease
Depending on your risk factors, some HCPs may also make decisions based on the specific results from your blood test. For example, HCPs would like to see your total cholesterol number stay lower than 200 mg/dL (milligrams per deciliter of blood). When that total number is high, LDL is the component targeted for lowering, with an optimal LDL number typically less than 100 mg/dL.
Starting with a lifestyle approach
Whether your HCP takes an approach that targets specific numbers or more broadly looks at heart disease risk, you’ll typically begin by making lifestyle changes to try to lower your cholesterol levels. These include:
- Eating a heart-healthy diet, prioritizing fruits, vegetables, whole grains, and lean meats while reducing intake of trans and saturated fats
- Increasing your level of physical activity
- Losing weight
- Quitting smoking
Your HCP may add drugs that lower LDL to your treatment plan if:
- Lifestyle changes don’t reduce your numbers far enough
- Your LDL is particularly high to begin with (typically over 160 mg/dL)
- Your other heart risk factors require more aggressive treatment
Statins are the primary class of drugs that do this work.
How medication can improve your heart health
If you have existing heart disease or a history of a heart attack, you’ll be prescribed a statin. The goal would be getting your LDL less than 70 mg/dL. If you don’t already have heart disease but have a high risk for it, your HCP may still prescribe a statin even if your cholesterol levels are considered “normal.” Studies suggest that treating people with high risk for heart disease, but no existing disease, might help fend off health issues related to LDL.
What does limiting LDL levels do for you?
LDL promotes buildup—of cholesterol, fatty substances, cellular waste products, calcium and clotting materials—on the walls of blood vessels feeding the heart. This disease, which also stiffens and narrows the arteries, is called atherosclerosis. If these buildups, or plaques, become large enough, they can block the blood vessel.
Blocking blood flow to your heart causes a heart attack. In the United States, each year more than 800,000 people have a heart attack, according to the Centers for Disease Control and Prevention (CDC). Many who have heart attacks because of these blockages will die.
Statins and other LDL-lowering drugs slow buildup in blood vessels—and it’s a lifesaving effect. When LDL drops, the risk for heart attack decreases. Taking statins can also greatly reduce the chances of stroke, many of which are caused by blocked blood flow to the brain.
Sticking to your treatment plan
Reducing LDL levels and keeping them down is a lifetime commitment. Medications work faster than changing your eating and exercise habits, but both can be important components to good health. The key is to stick with your treatment plan. When people stop their medications or relapse into unhealthier habits, cholesterol levels will climb again. And with those increasing levels, your risk for stroke, heart attack, and other heart disease climbs, too.
If the benefits of treatment are so significant, why would a person stop?
People discontinue treatment or struggle with keeping their treatment schedule for many reasons. Some factors are financial or relate to access: getting to the pharmacy, maintaining refills, or affording medication. Others are more personal, such as forgetting to take your medication or discontinuing because you feel worse from side effects. You may also feel better or begin to see improvement in your cholesterol numbers and think you don’t need the drugs anymore. And many prescriptions, such as those used for treating cholesterol, can be complicated to understand and follow.
When people stop taking cholesterol-lowering drugs, they often do so because the side effects—such as muscle pain—bother them too much. High cholesterol often causes no symptoms but instead relentlessly and silently promotes disease. So, people taking medications don’t always see the benefits and instead feel only the negatives over the short term.
If you find that you don’t want to take your medication because of side effects, talk to your HCP. There are many options for cholesterol-lowering drugs, including several statins and other classes of medication. Each of them carries its own side-effect profile. Talk to your HCP about what is best for you, and remember to always consult them before making any changes to your medication routine.
