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Financial Assistance Documents — Florida. Financial Assistance Documents — Minnesota. Follow Mayo Clinic. If you have CVD, your health care provider can talk to you about the different ways to manage your cholesterol and which approach is best for your situation.

Some patients cannot tolerate statins, but there are several other classes of drugs that can lower LDL cholesterol. People without CVD — People without a history of CVD also benefit from cholesterol-lowering therapy, although the goal is generally not as aggressive as in people with CVD.

The decision of whether to start treatment is based on your individual risk for developing heart disease. Calculators are available that can estimate this risk based on your age, sex, medical history, and other characteristics see "Patient education: High cholesterol and lipids Beyond the Basics ", section on 'Calculating your risk of cardiovascular disease'.

Some clinicians recommend treatment at a particular level of risk such as a 7. Sometimes a calcium score test is done to see if plaque is present in the heart arteries; if so, then treatment is recommended.

As with people who already have known CVD, when the decision is made to start medication, the first choice is usually a statin. See 'Statins' below. People with high triglyceride levels — Triglycerides, like cholesterol, are a type of lipid.

High triglycerides called "hypertriglyceridemia" are also associated with an increased risk of heart disease. These need to be assessed on a fasting blood test because eating any food prior to the test will increase the levels. Dietary interventions and exercise are usually effective in lowering triglycerides.

The dietary interventions include limiting intake of refined carbohydrates, excess calories, and alcohol. For reducing cardiovascular risk, the first step is to reduce the LDL to below the target level see 'Statins' below and then check the fasting triglyceride level.

See 'Omega-3' below. People who have already had triglyceride-related pancreatitis may be treated at lower levels. In these situations, a class of medication called fibrates are usually the first line of treatment.

People with diabetes — People with diabetes type 1 or 2 are at high risk of heart disease. A moderate- or high-intensity statin is recommended in most adults with diabetes, regardless of their baseline LDL cholesterol level. See "Patient education: Type 2 diabetes: Overview Beyond the Basics ".

Older adults — The decision to treat high cholesterol levels in a person over the age of 75 depends upon the individual's "chronologic age" age in years as well as their "physiologic age" which takes into account their health and fitness level.

A person with a limited life span and underlying illness may not need to receive drug therapy. On the other hand, an otherwise healthy older adult should not be denied drug therapy simply on the basis of age alone. In general, the treatment goals discussed above apply for people of all ages. These patients often have a genetic factor that leads to a change in how cholesterol is processed in the body, and they have high levels of cholesterol from birth.

As such, their risk of developing heart disease is much higher. These patients are recommended for treatment regardless of the risk score, with treatment often started in late teenage years.

You can help lower your lipid levels with lifestyle changes, medications, or a combination of both. In certain cases, a health care provider will recommend a trial of lifestyle changes before recommending a medication. The best approach for you will depend on your individual situation, including your lipid levels, health conditions, risk factors, medications, and lifestyle.

Lifestyle changes — If you have high low-density lipoprotein LDL cholesterol, you should try to make some changes in your day-to-day habits, including reducing the amount of total and saturated fat in your diet, losing weight if you are overweight or obese , getting regular aerobic exercise, and eating plenty of fruits and vegetables see "Patient education: Exercise Beyond the Basics " and "Patient education: Diet and health Beyond the Basics ".

A plant-based diet is an effective strategy to lowering LDL cholesterol. The benefits of these lifestyle changes usually become evident within 6 to 12 months. However, the success of lipid lowering with lifestyle modification varies widely, and health care providers sometimes recommend beginning medication sooner.

Medications — There are many medications available to help lower elevated levels of LDL cholesterol. Each category of medication varies in how it works, how effective it is, and how much it costs. Your health care provider will recommend a medication or combination of medications based on your blood lipid levels and other individual factors.

Statins — Statins are one of the best-studied classes of medications and the most commonly used drugs for lowering LDL cholesterol.

They are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death. Available statins include atorvastatin former brand name: Lipitor , rosuvastatin former brand name: Crestor , and several other similar medications table 1.

Statins decrease the body's production of cholesterol and increase removal of cholesterol by the liver, so they reduce LDL cholesterol levels by as much as 25 to 55 percent.

In addition, they can lower triglycerides. Statins may also reduce inflammation and may prevent heart attacks and strokes through this mechanism. While most people tolerate statins well, there are some potential side effects, mainly muscle pain, aches, or weakness. Use of statins may also increase the risk of developing diabetes, although the risk is seen mostly in those with prediabetes, and the benefit in reduction on heart attack and stroke is about four times that of the risk of developing diabetes.

Changing statins and using low doses often can avoid these issues, but if not, non-statin medications can be used to lower LDL cholesterol. It is important to closely follow the dosing instructions for when to take statins; some are more effective when taken before bedtime while others should be taken with a meal.

In addition, some foods, such as grapefruit or grapefruit juice, can increase the risk of side effects of statins. Most manufacturers recommend that people who take lovastatin, simvastatin, or atorvastatin consume no more than one-half of a grapefruit or 8 ounces of grapefruit juice per day.

Ezetimibe — Ezetimibe brand name: Zetia blocks the body's ability to actively transport cholesterol from food as well as cholesterol that the body produces internally. It lowers LDL cholesterol levels by 20 to 25 percent and has relatively few side effects. It is usually prescribed in combination with a statin but is also used alone in patients who cannot tolerate a statin.

When used in combination with a statin after an acute coronary syndrome eg, heart attack , ezetimibe provides a small additional reduction in the risk of having another cardiovascular event.

PCSK9 inhibitors — PCSK9 monoclonal antibody inhibitors are another class of drugs that lower LDL cholesterol levels sample brand names: Praluent, Repatha table 1 ; they are given by injection under the skin every two to four weeks.

They reduce cardiovascular events such as heart attack or stroke and potentially death. Aside from mild skin reactions at the site of injection, they have few side effects. Inclisiran brand name Leqvio is a PCSK9 inhibitor that is given by injection once, 90 days later, and then every six months.

However, they are expensive and their use is limited to patients treated with maximal tolerated statins who have persistent elevations of LDL cholesterol.

Bile acid sequestrants — The bile acid sequestrants include colesevelam brand name: Welchol , colestipol brand name: Colestid , and cholestyramine sample brand names: Prevalite, Questran table 1.

These medications bind to bile acids in the intestine, reducing the amount of cholesterol the body absorbs from foods. They are used only occasionally. They lower LDL cholesterol only modestly 10 to 15 percent.

Side effects can be bothersome and may include nausea, bloating, cramping, and liver damage. Taking psyllium a fiber supplement, such as Metamucil can sometimes reduce the dose required and the side effects. Madelyn Fernstrom, Ph. D is NBC News Health and Nutrition Editor.

Follow her on Twitter drfernstrom. Fernstrom is a professor of psychiatry, epidemiology and surgery at the University of Pittsburgh Medical Center and a board certified nutrition specialist from the American College of Nutrition. She is the founding director of the UPMC Weight Management Center.

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