Heart attacks are the number one cause of death in the United States, ahead of cancer, accidents, and liver or lung disease.
This statistic can be worrisome if heart disease runs in your family or if you have already had a heart attack.
The good news is that many of these events can be prevented with cholesterol-lowering medications. Every year in the U.S., nearly 100,000 nonfatal heart attacks, 65,000 strokes, and tens of thousands of heart bypass surgeries could be avoided.
Statins: Your Ally Against Cholesterol
Statins are the most commonly prescribed medications to lower low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol.
"Statins block an enzyme called HMG-CoA reductase, which plays an important role in cholesterol production. A high dose of statins can lower bad cholesterol by 40% to 50%," says Anita Wokhlu, MD, a cardiologist and associate professor at the University of Florida.
Besides lowering "bad" LDL cholesterol, statins also offer heart-protective benefits, known as "pleiotropic effects." They lower inflammation in the arteries, improve blood vessel health, and lower the chance of blood clots.
Statins can also help raise high-density lipoprotein (HDL) cholesterol, known as "good" cholesterol.
"HDL protects the cardiovascular system by removing excess cholesterol from the body," Wokhlu says.
There are many statin medications. Talk to your doctor about possible side effects. These are usually mild and go away as your body gets used to the medication, Wokhlu says.
Some of the most common statins are:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol XL)
- Lovastatin (Altoprev)
- Pitavastatin (Livalo)
- Pravastatin (Pravachol)
- Rosuvastatin calcium (Crestor)
- Simvastatin (Zocor)
If you're pregnant or have liver problems, it's important to talk to your doctor before starting statins.
Ezetimibe: An Effective Way to Help Manage Cholesterol
Unlike other cholesterol-lowering medications, ezetimibe (Zetia) works by blocking cholesterol absorption in your gut.
Ezetimibe acts differently from statins but can work well alongside them. This is why doctors often combine it with statins when cholesterol or heart risk is high. Taken alone, it can also help lower "bad" cholesterol.
Its combined use with other cholesterol-lowering medications (such as bile acid sequestrants, nicotinic acid, or fibrates) hasn't been studied, so using them together isn't recommended.
Alternatives to Statins
About 5% to 10% of people who take statins to lower cholesterol have to stop due to side effects that affect the muscles, like pain or weakness.
When this happens, other options are available, such as citrate lyase inhibitors, PCSK9 inhibitors, bile acid sequestrants, and statins combined with other medications.
Citrate lyase inhibitors. These are relatively new medications that help lower LDL cholesterol. They block a liver enzyme called citrate lyase, which the body uses to make cholesterol. When this enzyme is blocked, the liver makes less LDL cholesterol. This lowers the chance of heart disease. Examples are bempedoic acid (Nexletol) and the bempedoic acid-ezetimibe combination tablet (Nexlizet).
PCSK9 inhibitors. These medications block a protein called PCSK9. This helps the liver remove more LDL cholesterol from the blood. Examples are alirocumab (Praluent), evolocumab (Repatha), and inclisiran (Leqvio). They also lower triglycerides and raise HDL cholesterol.
Bile acid sequestrants. These medications help the gut get rid of some cholesterol through bile, a fluid made in your liver that helps digestion. Examples are cholestyramine (Prevalite), colesevelam (Welchol), and colestipol (Colestid).
Statin combinations. Some medications mix statins with other drugs to help them work better and make treatment easier with a single pill. They include:
- Amlodipine + atorvastatin (Caduet), which combines a calcium channel blocker (for blood pressure) with a statin
- Ezetimibe + simvastatin (Vytorin), which lowers cholesterol absorption in the gut and blocks production in the liver
Keep Triglycerides Under Control
When you eat, your body turns calories you don't use right away into triglycerides, which are stored in fat cells. Later, hormones release them for energy between meals. Your doctor usually checks triglycerides as part of a lipid panel or lipid test.
Triglycerides and cholesterol are two types of lipids (fats) that travel through your bloodstream.
High triglyceride levels may be related to genetic factors, such as hypertriglyceridemia, a condition that affects lipid metabolism.
It can be passed down, meaning a person is born with changes in their genes that cause the body to make or store too many triglycerides. But other things can also play a role, such as:
- Obesity and lack of exercise
- Poorly controlled type 2 diabetes
- Heavy drinking
- Eating too much sugar and refined carbs
- Hypothyroidism
- Kidney or liver disease
- Certain medications (beta-blockers, corticosteroids, estrogens)
Diets that are very low in fat can also be a non-genetic cause of high triglycerides. When you don't eat enough fat, your body relies more on simple carbs for energy. This extra sugar turns into triglycerides in the liver, which raises the triglyceride levels in your blood.
Adopting healthy habits is the first step to lowering triglycerides. These are five habits that can help:
Exercise regularly. Exercising 30 minutes most days can lower triglycerides and raise "good" cholesterol.
Avoid sugar and refined carbs. Sweets and white flours raise triglycerides.
Lose extra weight. Extra calories turn into triglycerides, so cutting them helps lower levels.
Choose healthier fats. Swap fatty meats for omega-3-rich fish, and use oils like olive or canola.
Limit alcohol. It has sugar and lots of calories and can significantly raise triglycerides.
If lifestyle changes aren't enough to manage your triglycerides, your doctor may recommend:
Statins. Besides lowering LDL cholesterol, they may be used if you have diabetes, a history of blocked arteries, or uncontrolled cholesterol. Examples are atorvastatin (Lipitor) and rosuvastatin (Crestor).
Fibrates. They help control triglycerides and slightly lower LDL cholesterol. They work by reducing very low-density lipoprotein, or VLDL (a particle made in the liver that carries triglycerides throughout the body). Examples are clofibrate (Atromid-S), fenofibrate (Fibricor, Lofibra, TriCor), and gemfibrozil (Lopid). They are not recommended for people with serious liver or kidney disease.
Omega-3 (fish oil). Prescription doses work better than most over-the-counter supplements to lower triglycerides. Ask your doctor before taking these because high doses can affect blood clotting.
Niacin. Also called nicotinic acid, it lowers triglycerides and LDL cholesterol.
Never take supplements on your own. They can cause side effects and interact with other medications. Always check with your doctor.
Make a Personalized Plan With Your Doctor
If your goal is to lower cholesterol – especially after a heart attack – Wokhlu recommends working with your cardiologist to go over your numbers and create a personalized plan.
"When it comes to cholesterol, the first step is starting medication and changing your eating habits. As your health improves, your care team will ease restrictions and help you return to your usual activities," she says.
It's common to have uncomfortable side effects when starting treatment.
"We know it can be hard to get used to medications and new routines. That's why it's important to lean on your support network – family, friends, and health care professionals – to stay on track," says Wokhlu.
Recovery is different for everyone, so don't compare your progress to that of others. And remember, these medications could save your life.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Anita Wokhlu, MD, cardiologist, associate professor, University of Florida, Gainesville.
National Center for Health Statistics, CDC: "Leading Causes of Death."
Johns Hopkins University: "Tens of Thousands of Heart Attacks and Strokes Could Be Avoided Each Year if Cholesterol-Lowering Drugs Were Used According to Guidelines."
American Heart Association: "Cholesterol Medications," "Prescription omega-3 medications work for high triglycerides."
Mayo Clinic: "Cholesterol medications: Consider the options," "Triglycerides: Why do they matter?"
Baylor University Medical Center Proceedings: "Ezetimibe (Zetia): A New Type of Lipid-Lowering Agent."
Harvard Health: "Statin alternative lowers heart-related deaths."
National Library of Medicine (NIH): "PCSK9 Inhibitors."
National Lipid Association: "Acids."
Stanford Medicine: "Fish Oil and Triglycerides Study."
Cleveland Clinic: "Fibrates," "Ezetimibe Tablets," "Niacin Capsules or Tablets," "Hypertriglyceridemia."
