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High cholesterol medications: The Optum Perks guide 

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More than 1 in 3 American adults have high cholesterol, which raises a person’s risk of a heart attack or stroke. Learn what causes this common condition — and the best ways to tackle it head-on.  

Jennifer Thomas

By Jennifer Thomas

Table of contents 

  1. What causes high cholesterol?
  2. How do I know if I have high cholesterol?
  3. How is high cholesterol treated?
  4. What are the cholesterol medications I should know about?
  5. Which lifestyle changes can help manage high cholesterol?

When you think about cholesterol, you might immediately think of it as something bad. But cholesterol is actually a natural — and very necessary — substance that’s made by your liver. Your body needs cholesterol to build cells, make vitamin D and produce hormones.  

“No one would worry about high levels of cholesterol if it didn’t increase risk of the most common form of heart disease — atherosclerosis,” which puts you at risk of a heart attack or stroke, says Ira J. Goldberg, MD. He’s the director of the division of endocrinology, diabetes and metabolism at NYU Grossman School of Medicine in New York City.  

The issue isn’t cholesterol itself. Instead, many people have too much of a certain type of cholesterol called low-density lipoprotein (LDL) — known as “bad” cholesterol — in their blood. LDL cholesterol can build up and form a plaque on the walls of your arteries. That narrows the arteries, increasing your risk of a heart attack or stroke caused by a blockage.

At the same time, some people don’t have enough high-density lipoprotein (HDL) — also known as “good” cholesterol. HDL cholesterol does some important cleanup duty. As it travels through the bloodstream, it picks up extra LDL cholesterol and takes it back to the liver, where it gets broken down and removed from the body. 

The good news: There are many ways to correct cholesterol levels — and protect your long-term health. (Medications are a big one. You could save up to 80% on your prescriptions using the Optum Perks discount card.) Here, get the scoop on cholesterol and the treatments that could save your life. 

What causes high cholesterol? 

There are 2 main reasons that cholesterol levels get out of whack. The first is genetics. Some people inherit genes that cause them to make too much cholesterol. This is called familial hypercholesterolemia. It occurs in about 1 in 250 people, according to the Centers for Disease Control and Prevention (CDC). 

The second is changes to your metabolism. Normally, your body produces all the cholesterol it needs to function at its best. But certain lifestyle behaviors and chronic health conditions can cause the body to produce more LDL cholesterol than it needs. Factors that can put you at increased risk of having high cholesterol include: 

  • Smoking or breathing in secondhand smoke 
  • Being inactive 
  • Drinking too much alcohol 
  • Having diabetes, kidney disease or obesity 
  • Eating a diet that’s full of saturated fats (which can raise LDL cholesterol) and low in plant foods (such as fruits, vegetables and whole grains) 

How do I know if I have high cholesterol? 

High cholesterol usually doesn’t have any symptoms. In fact, most people who have high cholesterol don’t know it until they take a blood test or experience a major problem such as a heart attack or stroke.  

Cholesterol blood tests can be ordered by your doctor and done at a lab. If you’re in between appointments, you can try an at-home cholesterol test instead. 

Starting at age 20, you should have your cholesterol tested every 5 years, according to the CDC. You should be tested more regularly if you have risk factors for heart disease such as high blood pressure or a family history of heart attack or stroke. 

Here’s how to interpret your blood test results: 

  • Total blood cholesterol: Less than 200 mg/dL is considered normal 
  • LDL cholesterol: Less than 100 mg/dL is considered normal 
  • HDL cholesterol: A reading above 40 mg/dL is best for men, and above 50 mg/dL for women 

How is high cholesterol treated? 

Many people can lower their bad cholesterol and raise their good cholesterol with lifestyle changes. That includes making diet tweaks, losing weight, exercising more and quitting smoking. (More on this below.)  

Others may also need to take a cholesterol-lowering medication. There are several types, depending on your needs. In most cases, the doctor will start by prescribing a statin. Statins are the most common medication for high cholesterol. According to a study in JAMA Cardiology, as many as 40 million Americans take one. 

Statins are the go-to cholesterol medication because “there’s a lot of excellent data that proves they can save lives and reduce cardiovascular-related death and illness,” says Ashley Garling, PharmD. She’s a clinical assistant professor at the College of Pharmacy at the University of Texas at Austin. Statins are also inexpensive — and, she adds, they’re generally very safe. 

If a statin alone isn’t enough to lower your bad cholesterol, the doctor may prescribe an additional cholesterol medication for you to take. 

What are the cholesterol medications I should know about? 

Here’s a look at some of the most common cholesterol medications, starting with statins: 

Statins 

What they do: Statins block the enzyme your liver needs to make cholesterol. They also help your liver get rid of more cholesterol, and they can even stabilize and reduce plaque buildup in your arteries. Plus, they’re safe and effective: You can expect a statin to reduce your LDL cholesterol by 30% to 50%, Garling says.  

Who they’re for: Typically, statins are prescribed to people between the ages of 40 and 75 who have high cholesterol that can’t be reduced by lifestyle changes. That includes people who have had a heart attack or stroke, as well as those who have peripheral artery disease.  

Examples:  

Cholesterol absorption inhibitors 

What they do: These medications reduce the amount of cholesterol you absorb from food, Garling says. But that amount is less than what your body makes itself — meaning these medications typically don’t reduce your cholesterol enough to be effective on their own.  

Who they’re for: Cholesterol absorption inhibitors are usually prescribed to people who can’t tolerate statins, or to those who are already taking the highest statin dose and need more help reducing their LDL cholesterol, says Avni J. Patel, PharmD. She’s a professor of pharmacy practice at Wilkes University Nesbitt School of Pharmacy in Wilkes-Barre, Pennsylvania.  

Example: ezetimibe (Zetia®) 

PCSK9 inhibitors 

What they do: These medications are fairly new. They work by lowering the amount of PCSK9 your liver makes, which is a protein that controls the amount of LDL cholesterol in your blood. When there’s less PCSK9 in your body, more cholesterol gets removed from your bloodstream. 

Who they’re for: They can be prescribed to people who aren’t responding well to statins, either because the statins aren’t lowering the person’s cholesterol enough or because the side effects aren’t tolerable. While PCSK9 inhibitors are an exciting new treatment option, they can be pricey, costing as much as $6,000 per year out of pocket, says Garling. 

Examples:  

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ACL inhibitors 

What they do: ACL inhibitors work by blocking the production of cholesterol in the liver. They’re meant to be taken alongside a statin. 

Who they’re for: These medications are mainly for people who have a high risk of heart disease or those who have inherited high cholesterol, Garling says. “In this group, you see younger heart attacks and strokes because of that hereditary component.” ACL inhibitors and statins can work together to help reduce the risk of these deadly conditions.  

Example: bempedoic acid (Nexletol®

Bile acid sequestrants 

What they do: These medications bind to bile acids in the intestines. Bile is the fluid the liver makes to help the body digest food. When you eat food with cholesterol, the binding effect prevents some cholesterol from getting into the bloodstream. Bile acid sequestrants usually can’t lower cholesterol enough on their own, says Garling. So they may be prescribed as an add-on to statins. But they’re not prescribed very often anymore, she adds.  

Who they’re for: People who are already taking the highest level of statin and need more help lowering their cholesterol. They can also be used while pregnant, which is not the case with statins, Dr. Goldberg says. 

Examples:  

Which lifestyle changes can help manage cholesterol? 

While you can’t change your genetics, there are plenty of lifestyle changes you can make to help lower your cholesterol. These are changes you should make even if you’re already taking a cholesterol medication. Doing so can reduce your risk of heart disease. Here’s how. 

#1: Eat less saturated fat 

The American Heart Association recommends getting just 5% to 6% of your daily calories from saturated fat. You can eat less saturated fat by: 

  • Eating less red meat and processed meats, such as beef, pork, hot dogs and bacon 
  • Removing the skin from poultry 
  • Choosing low-fat or nonfat dairy products over whole-fat options 
  • Cooking with oils that are lower in saturated fat, such as canola oil and olive oil 
  • Eating more healthy fats, such as those found in nuts, olives, avocados, seeds and fatty fish (salmon, herring, mackerel) 

The DASH diet is an overall healthy eating plan that’s been shown to lower high blood pressure and high cholesterol.  

#2: Pack your plate with fiber 

Eating more fiber is a great way to help get your cholesterol in a better place. A specific type of fiber called soluble fiber dissolves in water as it passes through the digestive system. It turns into a thick gel that slows down digestion and binds to fats along the way. That reduces the absorption of cholesterol into your bloodstream. 

Aim to get between 25 and 35 grams of fiber per day, which should include about 14 grams of soluble fiber per 1,000 calories. Foods that are high in soluble fiber include: 

  • 2 Tbsp. psyllium seeds: 7.1 grams 
  • 1 apple, with the skin: 4.2 grams 
  • ½ cup cooked green peas: 3.2 grams 
  • ½ cup cooked kidney beans: 2.9 grams 
  • 1 medium sweet potato, peeled: 2.7 grams 
  • 1 cup cooked oatmeal: 2.4 grams 
  • 1 medium banana: 2.1 grams 
  • 1 orange: 2.1 grams 
  • ¼ cup sunflower seeds: 1.1 grams 

#3: Amp up your exercise 

Being active has been shown to raise your good HDL cholesterol. And this, in turn, can help lower your bad cholesterol, according to the American Heart Association. 

A 2019 study found that the more time people spent being active, the higher their HDL cholesterol was. Try to get at least 150 minutes of moderate exercise (brisk walking, gardening) or 75 minutes of vigorous exercise (swimming laps, running) a week. 

#4: Lose (a little bit of) weight  

You don’t have to be overweight to have high cholesterol, and not all overweight people have high cholesterol. Still, losing weight can lower your bad cholesterol.  

Having excess weight can change how the body functions, including how it makes and uses cholesterol. Losing 10 pounds can reduce bad cholesterol by as much as 5% to 8%, according to the National Heart, Lung and Blood Institute. 

#5: Quit smoking 

Smoking can make your bad cholesterol stickier, which means it’s more likely to cling to your artery walls. It can also lower the amount of good cholesterol you have. Fortunately, your cholesterol can start to improve within just 90 days of quitting smoking.  

Have you tried smoking cessation products such as gums, lozenges or patches? They can really help some people cut ties with cigarettes. And if you need prescription medication, you can find coupons anytime, anywhere with the Optum Perks prescription discount app

 

Additional sources 
Familial hypercholesterolemia: Centers for Disease Control and Prevention 
When to have your cholesterol checked: Centers for Disease Control and Prevention 
Statin use statistics: JAMA Cardiology (2017). “National trends in statin use and expenditures in the US adult population from 2002 to 2013” 
Preventing high cholesterol: American Heart Association 
Exercise and HDL cholesterol: PLoS One (2019). “Association of objectively measured sedentary behavior and physical activity with cardiometabolic risk markers in older adults”