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If a blood test shows you have high levels of cholesterol—a waxy substance found in your blood—your clinician 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 cholesterol from the blood. While you want to keep your LDL low, a high HDL value is usually desirable. A third value from the test shows your total cholesterol number.
When should high cholesterol be treated?
A number of factors go into deciding if your cholesterol levels should be treated. Your healthcare provider will typically consider your overall health and any heart disease risk factors you may have in conjunction with your cholesterol levels when deciding whether to recommend treatment.
Those heart risk factors include:
- High blood pressure
- Prediabetes or diabetes
- Overweight or obesity
- Smoking
- Family history of heart disease
Depending on your risk factors, some doctors may also make decisions based on the specific results from your blood test. For example, many doctors 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 doctor takes an approach that targets specific numbers or more broadly looks at heart disease risk, you’ll typically begin by making lifestyle modifications 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
If lifestyle changes don’t reduce your numbers far enough or if your LDL is particularly high to begin with (typically over 150 or 160 mg/dL)—or if your other heart risk factors necessitate more aggressive treatment—your doctor may add another element to your treatment plan: drugs that lower LDL. Statins are the primary class of drugs that do this work.
How medication can improve your heart health
If you have existing cardiovascular disease (CVD) or a history of a heart attack, you’ll likely be prescribed a statin with the goal of getting your LDL as low as 70 mg/dL. If you don’t already have CVD but have a high risk for it, your doctor may still prescribe a statin even if your cholesterol levels are considered “normal.” Studies suggest that treating people with high risk for CVD but no existing disease might help fend off LDL-related poor health outcomes.
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. Statins and other LDL-lowering drugs slow the buildup—and it’s a lifesaving effect. About 15.5 million people in the United States have coronary artery disease—which is characterized by that buildup of cholesterol plaque in the arteries—and about 2,000 people will have a heart attack in the U.S. each day. A third of the people who have heart attacks because of these blockages will die.
For every 40 mg/dL or so you decrease your LDL, the risk for one of these cardiac events drops by 23 percent and mortality drops by 9 percent when your LDL starting point is 100 mg/dL or more. The more intensely a therapy reduces LDL, the steeper these improvements are.
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 discontinue their medications or relapse into unhealthier lifestyles, 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 obvious, why would anyone 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 any more. 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 doctor or pharmacist. 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, so talk to your health professional about what is best for you. And remember to always consult your doctor before making any changes to your medication routine.
