When LDL levels are high, a buildup of fatty substances in arteries may occur, sometimes leading to a heart attack or stroke. However, you can take steps to protect yourself from high LDL levels, including lifestyle strategies or medications.
When you hear the term “good” cholesterol, it refers to high-density lipoprotein (HDL) that carries LDL to the liver, which will then break it down for removal. You can boost your HDL levels to help keep your cholesterol levels healthy.
How to lower LDL levels
Eating a balanced diet and getting a good amount of exercise can help to prevent and lower high LDL levels, but sometimes you may need medication. The most common of these medicines are statins, which slow the liver’s cholesterol production and help break down existing LDL.
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Atorvastatin
Atorvastatin, typically combined with a healthy diet, works by reducing the amount of LDL and fat stored in cells (known as triglycerides) and increasing HDL amounts.
The Food and Drug Administration (FDA) approves this medication for preventing heart attack, stroke, and angina.
It’s most commonly prescribed if you have a coronary heart disease diagnosis and other conditions, including high cholesterol. It’s also used to reduce the risk of hospital admissions for those who may experience nonfatal heart attacks or strokes.
Rosuvastatin
Like atorvastatin, rosuvastatin reduces the amount of blood cholesterol and is also used to prevent heart disease.
Doctors may also offer you this drug if you have the following:
- kidney disease
- diabetes
- a family history of rheumatoid arthritis
However, the FDA has not commented on prescribing rosuvastatin for these conditions.
Lovastatin
The body makes enzymes (types of protein) to speed up some processes, like making cholesterol. Statins work by blocking a specific enzyme (HMG Co-A reductase) that your body uses to create cholesterol, helping to lower LDL levels. This is how lovastatin and other statins work.
A doctor may also recommend this medication for managing the risk of stroke and heart-related complications during specific surgeries and for strokes not involving the heart. However, this is not yet FDA approved and is therefore considered “off-label” use.
Pravastatin
Pravastatin works the same way as other statins by blocking the enzyme HMG Co-A reductase.
Your doctor may also prescribe this drug off-label to help stop blood vessels in the brain from going into spasms, preventing blood flow. These types of spasms often occur after a specific type of brain hemorrhage.
Simvastatin
Simvastatin also works in the same way as lovastatin and pravastatin, by blocking MHG Co-A reductase. It, like all statins, is also used alongside a healthy diet and exercise regimen.
In some instances, doctors may also prescribe this medication off-label to prevent irregular heart rhythm (atrial fibrillation) and negative effects on the heart and blood vessels following sudden heart-related hospitalizations. The use of simvastatin in this way does not yet have FDA approval.
Fluvastatin and fluvastatin ER
Fluvastatin reduces LDL and triglycerides while increasing HDL, helping you manage your total cholesterol.
Fluvastatin extended release (ER) is the same drug, but the dosage releases over time, keeping the effects stable for longer.
Common statins side effects
Statins can have some common side effects, including:
- headaches and dizziness
- nausea
- tiredness or weakness
- constipation or diarrhea
- indigestion or passing gas
- painful muscles
- difficulty sleeping
- low levels of blood platelets
Some rare side effects include:
- muscle weakness (myopathy)
- tingling hands and feet
- tendon-related symptoms
Other medications
Other types of drugs treat high LDL levels, including:
- Bile acid sequestrants: These medications work by helping the body remove cholesterol from the bloodstream. Examples include:
- Niacin: Niacin, a B vitamin, helps reduce overall cholesterol, while nicotinic acid increases HDL levels. You will find niacin in common foods, including:
- chicken breast
- brown rice
- whole wheat bread
- PCSK9 inhibitors: These injectable medications lower the amount of LDL in the bloodstream. Examples include:
- alirocumab (Praluent)
- evolocumab (Repatha)
- inclisiran
- Fibrates: These drugs reduce fat stored in cells within the blood. Known as triglycerides, these fatty cells form and remain in place when you consume more calories than you burn. Some examples include:
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