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Cholesterol - drug treatment

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Your body needs cholesterol to work properly. But extra cholesterol in your blood causes deposits to build up on the inside walls of your blood vessels. This buildup is called plaque. It narrows your arteries and can reduce or stop blood flow. This can lead to heart attack, stroke, and narrowing of the arteries elsewhere in your body.

Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.

Alternative names

Hyperlipidemia - drug treatment; Hardening of the arteries - statin

Statins for Cholesterol

Statins reduce your risk of heart disease, stroke, and other related problems. They do this by lowering your LDL (bad) cholesterol.

Most of the time you will need to take this medicine for the rest of your life. In some cases, changing your lifestyle and losing extra weight may allow you to stop taking this medicine.

Who Should Take Statins to Lower Cholesterol?

Having low LDL and total cholesterol reduces your risk of heart disease. But not everyone needs to take statins to lower cholesterol.

Your health care provider will decide on your treatment based on:

• Your total, HDL (good), and LDL (bad) cholesterol levels
• Your age
• Your history of diabetes, high blood pressure, or heart disease
• Other health problems that may be caused by high cholesterol
• Whether or not you smoke
• Your risk of heart disease
• Your ethnicity

You should take statins if you are 75 or younger, and you have a history of:

• Heart problems due to narrowed arteries in the heart
• Stroke or TIA (mini stroke)
• Aortic aneurysm (a bulge in the main artery in your body)
• Narrowing of the arteries to your legs

If you are older than 75, your provider may prescribe a lower dose of a statin. This may help lessen possible side effects.

You should take statins if your LDL cholesterol is 190 mg/dL (4.92 mmol/L) or higher. You should also take statins if your LDL cholesterol is between 70 and 189 mg/dL (1.81 to 4.90 mmol/L) and:

• You have diabetes and are between ages 40 and 75
• You have diabetes and a high risk of heart disease
• You have a high risk of heart disease

You and your provider may want to consider statins if your LDL cholesterol is 70 to 189 mg/dL (1.81 to 4.90 mmol/L) and:

• You have diabetes and a medium risk for heart disease
• You have a medium risk for heart disease

If you have a high risk for heart disease and your LDL cholesterol stays high even with statin treatment, your provider may consider these drugs in addition to statins:

• Ezetimibe
• PCSK9 inhibitors, such as alirocumab and evolocumab (Repatha)

How low Should Your LDL Cholesterol be?

Doctors used to set a target level for your LDL cholesterol. But now the focus is reducing your risk for problems caused by narrowing of your arteries. Your provider may monitor your cholesterol levels. But frequent testing is rarely needed.

You and your provider will decide what dose of a statin you should take. If you have risk factors, you may need to take higher doses. or add other types of drugs. Factors that your provider will consider when choosing your treatment include:

• Your total, HDL, and LDL cholesterol levels before treatment
• Whether you have coronary artery disease (history of angina or heart attack), a history of stroke, or narrowed arteries in your legs
• Whether you have diabetes
• Whether you smoke or have high blood pressure

Higher doses may lead to side effects over time. So your provider will also consider your age and risk factors for side effects.

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Angioplasty and stent placement - peripheral arteries
Peripheral artery bypass - leg
Carotid artery disease
Angina - discharge
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Butter, margarine, and cooking oils
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Fast food tips
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Angina - what to ask your doctor
Cholesterol - what to ask your doctor
Heart failure - what to ask your doctor
High blood pressure - what to ask your doctor
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Angioplasty and stent placement - peripheral arteries - discharge
Angioplasty and stent placement - carotid artery - discharge
Aortic aneurysm repair - endovascular - discharge
Atrial fibrillation - discharge
Carotid artery surgery - discharge
Peripheral artery bypass - leg - discharge
Abdominal aortic aneurysm repair - open - discharge

References

American Diabetes Association Professional Practice Committee. Erratum. 10. Cardiovascular disease and risk management: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S144-S174. PMID:35255117 pubmed.ncbi.nlm.nih.gov/35255117/.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. Epub 2019 Mar 17. PMID: 30879355; PMCID: PMC7734661 pubmed.ncbi.nlm.nih.gov/30879355/.

Fox CS, Golden SH, Anderson C, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2015;38(9):1777-1803. PMID: 26246459 pubmed.ncbi.nlm.nih.gov/26246459/.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24): 3234-3237. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.

U.S. Preventive Services Task Force. Final recommendation statement: statin use for the primary prevention of cardiovascular disease in adults: preventive medication. www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/statin-use-in-adults-preventive-medication. Updated November 13, 2016. Accessed April 29, 2022.

U.S. Preventive Services Task Force recommendation summary. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. www.uspreventiveservicestaskforce.org/uspstf/document/ClinicalSummaryFinal/statin-use-in-adults-preventive-medication. Updated November 13, 2016. Accessed April 29, 2022.

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Review Date: 2/23/2022  

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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