Statins, including atorvastatin Lipitor , simvastatin Zocor , rosuvastatin Crestor , and pravastatin Pravachol , are the mainstay therapy for lowering LDL.

But not all of the benefit of statins can be explained by decreasing LDL alone. Studies show that statins have favorable effects on inflammation, endothelial dysfunction, and plaque stabilization when plaque breaks apart, it can cause a heart attack or stroke.

Statins have been around for about 40 years, so we have quite a bit of information on their short- and long-term safety and effectiveness. Ezetimibe Zetia is a different type of LDL-lowering drug.

Taken as a pill, it lowers cholesterol by inhibiting its absorption in the small intestines. Ezetimibe is mainly used as an add-on medication to statins to achieve further LDL lowering, or on its own in people who cannot tolerate statins.

In older adults, ezetimibe alone was found to reduce cardiovascular events but not stroke. PCSK9 inhibitors are a newer class of cholesterol-lowering drugs.

They work by allowing more LDL receptors to remain in the liver, thus allowing the liver to sweep more LDL cholesterol out of the bloodstream. There are two PCSK9 inhibitors on the market, evolocumab Repatha and alirocumab Praluent , and both must be taken by injection every few weeks.

The clinical benefit of lowering LDL cholesterol in older adults has been a point of contention, because people ages 75 and older are not usually included in large numbers in clinical trials. Some have even argued that the risks of LDL-lowering treatment may outweigh benefits for older adults compared to younger adults.

But the evidence debunks this myth. Meta-analyses and clinical trials indicate that statin use is not associated with increased risk of muscle injury, cognitive impairment, cancer, or hemorrhagic stroke compared with those not using statins, regardless of age.

Likewise, in clinical trials, risk of liver or kidney injury is similar in people taking statins or a placebo, regardless of age. A prospective study evaluating liver safety in very elderly patients found statins to be safe overall in patients ages 80 and older.

Even if one type of statin causes side effects in a person, another statin may not. Statins can raise blood sugars, but this is unlikely to lead to type 2 diabetes in anyone not already at high risk for the condition. Similarly, ezetimibe use is largely safe, with diarrhea and upper respiratory infections being the most common side effects.

Notably, the safety profile for ezetimibe plus statins is the same as for statins alone, even in older adults. And finally, PCSK9 inhibitors have not been found to increase risk of diabetes, neurocognitive disorders, liver injury, or muscle injury.

The question remains: do the benefits of cholesterol-lowering treatments outweigh the risks for older adults? In a systematic review and meta-analysis published in The Lancet , researchers evaluated the clinical benefit of statin and non-statin cholesterol-lowering therapy for older adults.

They did this by extracting and re-analyzing data from previous studies that had evaluated statin and non-statin cholesterol-lowering treatments. The analysis included 21, patients ages 75 and older.

Of these, The analysis above largely represented older patients with existing cardiovascular disease. There are ongoing trials that will help evaluate the utility of statins in older patients as a primary prevention for major cardiovascular events. Follow me on Twitter HannaGaggin.

Davis Kimaiyo, MD , Contributor. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Managing Your Cholesterol offers up-to-date information to help you or a loved one keep cholesterol in check. The report spells out what are healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line.

It covers cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol.

Managing Your Cholesterol can also help you work with your doctor to individualize your treatment. Thanks for visiting. Don't miss your FREE gift.

Self-Measured Blood Pressure SMBP Monitoring Hypertensive Disorders of Pregnancy Medication Adherence Health IT Municipalities Tool Kit. Data Fact Sheets ABCS of Heart Health Cardiac Rehabilitation At A Glance Improving Medication Adherence Among Patients with Hypertension.

Section Navigation. Facebook Twitter LinkedIn Syndicate. Cholesterol Management. Minus Related Pages. On This Page.

Featured Resource About Cholesterol About Statins Tools and Resources References. About Cholesterol. How do statins prevent heart attacks and strokes? View Transcript. References Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al.

J Am Coll Cardiol. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. Bucholz EM, Rodday AM, Kolor K, Khoury MJ, de Ferranti SD. Prevalence and predictors of cholesterol screening, awareness, and statin treatment among US adults with familial hypercholesterolemia or other forms of severe dyslipidemia — Nordestgaard BG, Chapman MJ, Humphries SE, Ginsberg HN, Masana L, Descamps OS, et al.

Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society.

Eur Heart J. Reducing the burden of disease and death from familial hypercholesterolemia: A call to action. Am Heart J. Cholesterol-lowering medicine. Updated October 31, Accessed October 18, Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG.

Vital Signs : Prevalence of key cardiovascular disease risk factors for Million Hearts ® — United States, — Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from participants in 26 randomised trials.

Ganga HV, Slim HB, Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Tobert JA, Newman CB. The nocebo effect in the context of statin intolerance. J Clin Lipidol. Rosenson RS, Baker S, Banach M, Borow KM, Braun LT, Bruckert E, et al.

Optimizing cholesterol treatment in patients with muscle complaints. Food and Drug Administration. ZETIA ® ezetimibe tablets drug label.

pdf [PDF — K]. Updated September National Library of Medicine.

When it comes to cholesterol, it's important to know your numbers. Hyperlipidemia means your blood has too many lipids or fats , such as cholesterol and triglycerides. One type of hyperlipidemia, hypercholesterolemia, means you have too much non-HDL cholesterol and LDL bad cholesterol in your blood.

This condition increases fatty deposits in arteries and the risk of blockages. Another way your cholesterol numbers can be out of balance is when your HDL good cholesterol level is too low. With less HDL to remove cholesterol from your arteries, your risk of atherosclerotic plaque and blockages increases.

Atherosclerotic cardiovascular disease ASCVD involves plaque buildup in arterial walls which includes conditions such as acute coronary syndrome and peripheral artery disease , and can cause a heart attack, stable or unstable angina , stroke , transient ischemic attack TIA or aortic aneurysm.

Download Reduce Your Risk of ASCVD PDF Spanish PDF. These factors can combine with high LDL cholesterol or low HDL cholesterol levels to affect your cardiovascular health.

Your doctor may use the ASCVD Risk Calculator to assess your risk of a coronary event in the next 10 years. The good news is, high cholesterol can be lowered, reducing risk of heart disease and stroke. Often, changing behaviors can help bring your numbers into line. Lifestyle changes include:.

From a dietary standpoint, the best way to lower your cholesterol is reduce your intake of saturated fat and trans fat. Reducing these fats means limiting your intake of red meat and dairy products made with whole milk. Choose skim milk, low-fat or fat-free dairy products instead.

It also means limiting fried food and cooking with healthy oils, such as vegetable oil. A heart-healthy diet emphasizes fruits, vegetables, whole grains, poultry, fish, nuts and nontropical vegetable oils , while limiting red and processed meats, sodium and sugar-sweetened foods and beverages.

Many diets fit this general description. For example, the DASH Dietary Approaches to Stop Hypertension eating plan promoted by the National Heart, Lung, and Blood Institute as well as diets suggested by the U. Department of Agriculture and the American Heart Association are heart-healthy approaches.

Such diets can be adapted based on your cultural and food preferences. A sedentary lifestyle lowers HDL cholesterol. Physical activity is important. At least minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure.

And you have lots of options: brisk walking, swimming, bicycling or even yard work can fit the bill. Worse still, when a person with unhealthy cholesterol levels also smokes, risk of coronary heart disease increases more than it otherwise would. Smoking also compounds the risk from other risk factors for heart disease, such as high blood pressure and diabetes.

By quitting, smokers can lower their LDL cholesterol and increase their HDL cholesterol levels. It can also help protect their arteries. Nonsmokers should avoid exposure to secondhand smoke. Learn more about quitting smoking.

Using liquid vegetable oils such as canola, sunflower, safflower, and others in place of butter, lard, or shortening when cooking or at the table helps lower LDL. Apples, grapes, strawberries, citrus fruits.

These fruits are rich in pectin, a type of soluble fiber that lowers LDL. Foods fortified with sterols and stanols. Sterols and stanols extracted from plants gum up the body's ability to absorb cholesterol from food.

Companies are adding them to foods ranging from margarine and granola bars to orange juice and chocolate. They're also available as supplements. Eating soybeans and foods made from them, like tofu and soy milk, was once touted as a powerful way to lower cholesterol. Fatty fish. Eating fish two or three times a week can lower LDL in two ways: by replacing meat, which has LDL-boosting saturated fats, and by delivering LDL-lowering omega-3 fats.

Omega-3s reduce triglycerides in the bloodstream and also protect the heart by helping prevent the onset of abnormal heart rhythms. Fiber supplements. Supplements offer the least appealing way to get soluble fiber. Two teaspoons a day of psyllium, which is found in Metamucil and other bulk-forming laxatives, provide about 4 grams of soluble fiber.

When it comes to investing money, experts recommend creating a portfolio of diverse investments instead of putting all your eggs in one basket. The same holds true for eating your way to lower cholesterol. Adding several foods to lower cholesterol in different ways should work better than focusing on one or two.

A largely vegetarian "dietary portfolio of cholesterol-lowering foods" substantially lowers LDL, triglycerides, and blood pressure. The key dietary components are plenty of fruits and vegetables, whole grains instead of highly refined ones, and protein mostly from plants.

Add margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds. Of course, shifting to a cholesterol-lowering diet takes more attention than popping a daily statin.

It means expanding the variety of foods you usually put in your shopping cart and getting used to new textures and flavors. But it's a "natural" way to lower cholesterol, and it avoids the risk of muscle problems and other side effects that plague some people who take statins.

Just as important, a diet that is heavy on fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check.