Cholesterol is a fatty or waxy substance that circulates in the blood, which the body needs to make hormones and vitamins and build cells. It is not inherently bad, however, too much cholesterol can cause problems. In the human body, cholesterol comes from two sources – some is manufactured in the liver, the rest comes from the food we eat. Some foods like meat, poultry, and dairy are rich sources of cholesterol. Foods that contain saturated and trans fats cause the liver to make more cholesterol. This added production can lead to excessively high cholesterol levels which are unhealthy.

There are two types of cholesterol in the blood – HDL which is good and LDL which is bad. Too much bad cholesterol or too little good cholesterol increases the risk of atherosclerotic disease, a condition in which cholesterol slowly builds up on the inside of arteries that supply blood to the brain and heart. If the cholesterol is high enough for a long enough period, one or more arteries to these vital organs can get completely blocked, cutting off the blood supply and causing a heart attack or stroke. If you are a smoker and/or have diabetes or high blood pressure, your risk is even higher.

As noted, when you have high levels of cholesterol circulating in your blood, your risk of heart disease and stroke is increased. That is why it’s important to have your cholesterol levels checked regularly. If you have high cholesterol, you can make dietary and lifestyle changes to improve your numbers. Your doctor can also prescribe medications to control cholesterol.

Medications for High Cholesterol

Statins are drugs that decrease LDL (bad cholesterol) and triglycerides (a type of fat in the blood that increases the risk of heart disease). These medications also slightly increase HDL (good cholesterol) levels. Examples include atorvastatin (Lipitor), simvastatin (Zocor), pravastatin (Pravachol), lovastatin (Altoprev), fluvastatin (Lescol XL), rosuvastatin (Crestor), and pitavastatin (Livalo).

Cholesterol absorption inhibitors like ezetimibe (Zetia) decrease the absorption of cholesterol from food in the intestines and decrease the delivery of dietary cholesterol to the liver.

Bile acid sequestrants include medications like cholestyramine (Prevalite), colestipol (Colestid), and colesevelam (Welchol) that increase the production of bile acids in the liver. The body uses cholesterol to make bile acids, thereby reducing LDL cholesterol levels in the blood.

Citrate lyase inhibitors decrease bad cholesterol (LDL) by blocking an enzyme that is essential for cholesterol synthesis. Examples include bempedoic acid (Nexletol) and bempedoic acid – ezetimibe combination (Nexlizet).

PCSK9 inhibitors are a class of drugs that are prescribed to people with very high LDL levels due to a genetic condition or those who cannot tolerate statins and other cholesterol-lowering medications. They are administered by subcutaneous injection every 2-4 weeks. Examples include evolocumab (Repatha) and alirocumab (Praluent).

Combination cholesterol-lowering medications include ezetimibe – simvastatin (Vytorin) which decreases LDL and triglycerides and increases HDL. Caduet, which is a combination of amlodipine and atorvastatin, includes a blood pressure-lowering drug and a cholesterol-lowering drug.

Other medications used to lower LDL cholesterol and triglyceride levels and increase HDL levels include fibrates (fenofibrate Lipofen and gemfibrozil Lopid), niacin (Niaspan, Niacor), and omega-3 fatty acids (Omacor, Lovaza).

Over-the-Counter Medications for High Cholesterol

A healthy diet and regular exercise are proven ways to decrease cholesterol. Some over-the-counter supplements can help as well. It is recommended that you speak to your doctor before starting any dietary supplement for high cholesterol. Some of the supplements that can potentially improve your cholesterol numbers include fish oil, garlic, flaxseed, berberine, green tea, niacin, and red yeast rice.

It is important to remember that dietary supplements are not subject to the same regulation as prescription medications by the U.S. Food and Drug Administration (FDA). Some supplements may contain the same active ingredients as prescription medications in unknown or variable quantities and can cause serious side effects. You should also keep in mind that while dietary supplements can help with cholesterol control, they may not be enough and you might need prescription drugs to keep your numbers at a safe level.

Common Side Effects of Cholesterol-Lowering Medications

Statins can cause side effects like muscle aches, increase in blood sugar levels, nausea, diarrhea, constipation, stomachache, cramps, and elevation in liver enzymes.

Potential side effects of cholesterol absorption inhibitors are fatigue, diarrhea, stomach pain, and sore muscles. These medications are not recommended during pregnancy and breastfeeding.

Common side effects of bile acid sequestrants include bloating, gas, nausea, constipation, and heartburn.

Citrate lyase inhibitors can cause possible side effects such as joint pain, muscle spasm, and acute gout.

Side effects of PCSK9 inhibitors include swelling, itching, and pain and bruising at the injection site.

Combination cholesterol-lowering medications can cause side effects like fatigue, gas, stomach pain, cramps, muscle soreness, facial flushing, dizziness, palpitations, increased blood sugar levels, nausea, constipation, and diarrhea.

Side effects of fibrates include muscle aches, stomach ache, and nausea. Niacin can cause facial flushing, itching, increased blood sugar, and upset stomach. Omega-3 fatty acids can cause indigestion, belching, a fishy taste in the mouth, and an increased risk of bleeding.

Common Questions

How do I know if I have high blood pressure?

High blood pressure often does not cause any symptoms. That's why it is important to attend routine check-ups with a primary care physician. It is especially important to keep an eye on your blood pressure if you have a family history (close relative with hypertension).

What type of diet should I follow if I have high blood pressure?

The DASH (Dietary Approaches to Stop Hypertension) diet is an effective way to manage high blood pressure. It involves eating more vegetables, fruits, and low-fat dairy products, as well as whole grains, nuts, and lean meats like fish and poultry. The DASH diet also involves eating less red meats, sugary foods, and fried foods that are high in cholesterol and saturated fats. Last but not least, limiting foods with high salt content is an effective dietary modification outlined in the DASH diet to control blood pressure.

Can I get a discount on high blood pressure medication with BuzzRx?

Yes, you can get discounts on medicines—including high blood pressure—as long as you have a signed prescription from your doctor.

References:
1. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure#.WV4gedPyvMI
2. https://www.cdc.gov/bloodpressure/about.htm
3. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications
4. https://share.upmc.com/2015/06/high-blood-pressure-over-the-counter-medicine-risks/