High cholesterol levels may require more than lifestyle and habit changes for some people to bring them down to a level in the typical healthy range. For these people, medications can play a helpful role in reducing their risk of heart attack and stroke.

Cholesterol medication can help lower a person’s cholesterol levels when lifestyle changes have not been successful. In doing so, these medications can help to reduce a person’s risk of having a heart attack, stroke, or other health complications due to high cholesterol.

This article reviews when a person may need to take cholesterol medication and the types of medications that are available.

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Not everyone with elevated cholesterol levels needs medications.

Doctors may start treatment by suggesting lifestyle changes, which can include changes to diet, exercise and activity levels, weight, and smoking cessation. If these changes are enough to lower levels, a person likely will not need medication.

However, a doctor will typically assess a person’s risk factors for cardiovascular events, such as heart attack and stroke.

People with additional risk factors may find that their doctor prescribes them cholesterol medication as a first-line treatment. Some risk factors include:

  • high blood pressure
  • previous heart attack or stroke
  • being a smoker
  • age
  • family history
  • having diabetes

Based on these risk factors, a doctor will likely prescribe cholesterol medication if the person:

  • had a previous heart attack or stroke
  • has peripheral arterial disease
  • is 40 to 75 years old with a high risk of developing heart disease or stroke and also has an LDL cholesterol level of 70 mg/dL or higher
  • has an LDL cholesterol level of 190 mg/dL or higher
  • is aged 40 to 75 and living with diabetes, alongside having an LDL cholesterol level of 70 mg/dL or higher

Lifestyle changes, such as diet and exercise, can help lower cholesterol in some people. However, they are not the only factors that affect a person’s cholesterol levels.

According to the American Heart Association (AHA), factors such as age and genetics can affect a person’s overall cholesterol levels.

For some, these factors may outweigh any changes to diet, exercise, smoking status, or weight a person may make as part of their treatment plan.

If a person cannot lower their cholesterol with lifestyle changes, their doctor will likely recommend medications to help lower their cholesterol levels. Some available medications are described below.

Statins work by slowing the liver’s production of cholesterol. They can also help to reduce the amount of LDL cholesterol already circulating in the blood. They are a prescription medication that comes in pill or tablet form.

Though most people typically tolerate them well, statins do pose some risk of muscle-related side effects and an increased risk of developing type 2 diabetes.

A person should also check with their doctor before taking statins to make sure they will not interact with their other medication or supplements.

A person’s doctor may advise the use of different medications or switching the other medications.

Bile acid sequestrants help to reduce cholesterol levels in the blood by preventing cholesterol absorption in the intestines and reducing the amount of bile reabsorption.

They are one of the oldest available medications for cholesterol control and are typically less effective than other forms of medication.

A doctor may prescribe one of three types of bile acid sequestrants in the United States. They come in pill or tablet form. Available bile acid sequestrants include colesevelam (Welchol) and colestipol (Colestid).

The biggest risk involved in taking bile acid sequestrants is potential interactions with other medications, supplements, and hormones.

Bile acid sequestrants can prevent the absorption of these medications or supplements, which can lead to ineffective levels in the body.

Fibrates lower a person’s triglyceride levels.

Triglycerides are the most common form of fat in the body. They help store the excess energy a person intakes through their diet. Together with LDL cholesterol, they can help increase a person’s risk of having a heart attack or stroke.

A doctor can prescribe one of three different types of fibrates, including:

  • gemfibrozil (Lopid)
  • clofibrate (Atromid-S)
  • fenofibrate (Antara, Lofibra, Tricor, and Triglide)

Though generally well tolerated, fibrates can cause some side effects and adverse reactions. Some possible side effects include:

  • leg or abdominal cramping
  • deranged AST and ALT levels (due to interaction in the liver)
  • not generally recommended for use with statins

Niacin can help lower a person’s LDL cholesterol, total cholesterol, and triglyceride levels while elevating HDL cholesterol levels.

Niacin comes as both a prescription and over-the-counter (OTC) supplement. The AHA warns that a person should not take OTC niacin without doctor supervision due to the risk of developing serious side effects.

Side effects can include:

A newer form of treatment comes as an injectable medication that people know as PCSK9 inhibitors. PCSK9 inhibitors work by binding to a protein found on cells in the liver that produce LDL cholesterol.

This form of medication can help lower cholesterol and most commonly gets prescribed to people with familial hypercholesterolemia, a genetic condition that causes high levels of LDL cholesterol.

The most common side effect is a reaction at the injection site with flu-like symptoms following. These symptoms may include back and joint pain, nausea, or fever.

Ezetimibe is the most common medication for cholesterol that is not a statin. They work by blocking the absorption of cholesterol in the small intestines.

A doctor can prescribe it to people who have primary hyperlipidemia, mixed hyperlipidemia, familial hypercholesterolemia, or homozygous sitosterolemia. A person can take the medication once daily with or without a meal.

The most common side effects can include runny nose, headache, and sore throat. Certain people may need to avoid it, including those who are breastfeeding or pregnant.

A person should discuss their outlook with their doctor.

If a medication helps to reduce cholesterol levels to a typical level, it may be possible for a person to stop taking medication if their doctor feels that lifestyle changes may be enough to keep their cholesterol levels under control.

However, many people will need to continue to take one form of medication or another for the rest of their lives to help them control their cholesterol levels. They will also likely need to continue lifestyle changes to help manage their cholesterol levels.

Not all people with high cholesterol will need medications. They may be able to control it with diet, exercise, and other lifestyle changes.

However, people with additional risk factors for heart disease or who cannot lower their cholesterol levels with lifestyle changes will likely need medication to help control their cholesterol levels and reduce their risk of cardiovascular events.