Cholesterol - drug treatment
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 reduces or stops blood flow. This can lead to heart attack, stroke, or narrowed arteries elsewhere in your body.
Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.
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 doctor 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 doctor 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 or higher. You should also take statins if your LDL cholesterol is between 70 and 189 mg/dL 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 doctor may want to consider statins if your LDL cholesterol is 70 to 189 mg/dL and:
- You have diabetes and a medium risk for heart disease
- You have a medium risk for heart disease
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 doctor may monitor your cholesterol levels. But frequent testing is rarely needed.
Adding other drugs along with statins provides little to no benefit in most cases.
You and your doctor will decide what dose of a statin you should take. If you have risk factors, your doctor may prescribe higher doses. Factors that your doctor will consider when choosing the dose 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 doctor will also consider your age and risk factors for side effects.
Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz N, Lloyd-Jones DM, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. JACC. In press.
Stone NJ, Robinson JG, Lichtenstein AH, Goff DC Jr, Lloyd-Jones DM, Smith SC Jr, et al. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med. 2014 Mar 4;160(5):339-43.
Pencina MJ, Navar-Boggan AM, D'Agostino RB Sr, Williams K, Neely B, Sniderman AD, Peterson ED. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014 Apr 10;370(15):1422-1431. Epub 2014 Mar 19.
American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37 Suppl 1:S14-S80.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.