What Medications Are Used To Reduce Ldl Cholesterol
There are several classes of drugs prescribed for high LDL. These include:
- Statins: These drugs inhibit the activity of enzymes in the liver that produce cholesterol, lowering LDL, while raising HDL. The most commonly prescribed types include Lipitor , Lescol , and Advicor , among many others.
- Cholesterol absorption inhibitors: This type of drug, most commonly available as Zetia and Vytorin , prevents the intestines from absorbing cholesterol.
- Bile acid sequestrants: By spurring the intestine to shed more cholesterol, drugs like Colestid , Welchol , and Questran help lower LDL levels.
- PCSK9 inhibitors: This newer class of cholesterol-lowering drug, available as Repatha and Praluent , has shown great promise in lowering LDL. These monoclonal antibodies inhibit proprotein convertase subtilisin/kexin 9 , a protein that regulates cholesterol levels.
- Adenosine triphosphate-citrate lyase inhibitors: In adults with genetic high cholesterol, or those with heart disease, ACL inhibitors like Nexletol and Nexlizet may be prescribed. These are combined with statins and lifestyle changes to improve LDL levels.
- Fibrates: Drugs of this type, such as Lopid andfenofibrate , primarily moderate triglyceride levels, though they can also lower LDL.
What Are Ldl And Hdl
LDL and HDL are two types of lipoproteins. They are a combination of fat and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:
- LDL stands for low-density lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
- HDL stands for high-density lipoproteins. It is sometimes called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
How To Lower Ldl Cholesterol
Lifestyle and diet changes are the main ways to prevent or lower high LDL. A trial of eating a low-fat diet, regular aerobic activity, maintaining a healthy weight, and smaller waist circumference is an appropriate first step. It is best to set a timeline to achieve your goals with your doctor. In some cases, if those lifestyle changes are not enough, your physician may suggest a cholesterol lowering medication, such as a statin. If you are considering over-the-counter herbal or ayurvedic medications for cholesterol, please discuss those with your physician first as well.
Rarely, very high LDL is genetic and passed down in families. This is called familial hypercholesterolemia and is caused by a genetic mutation that decreases the livers ability to clear excess cholesterol. This condition can lead to very high LDL levels, and heart attack or stroke at a young age in multiple generations. Those individuals may require special medical treatment for prevention and treatment of atherosclerotic cardiovascular disease.
Remember, knowledge is the first step. If you dont know your cholesterol levels, get tested. That will give you and your physician a starting point for lifestyle changes and medications if needed. In the meantime, adopt a heart-healthy lifestyle, and do it with friends and family no matter their ages. Theres no time like the present to prevent heart disease.
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When Should I Get My Cholesterol Checked
How often you have your cholesterol level checked depends on your age, family history and what other risk factors for heart disease you have.
If you have no cardiovascular risk factors, routine screening most often starts at the age of 40 for men and 50 for women.
If your cholesterol is up, as with an FH diagnosis, your family doctor can also advise you when to have follow-up cholesterol levels done.
What Factors Affect Cholesterol Levels
A variety of factors can affect your cholesterol levels. They include:
- Diet: Saturated fat, trans fat and cholesterol in the food you eat increase cholesterol levels. Try to reduce the amount of saturated fat, trans fat and cholesterol in your diet. This will help lower your blood cholesterol level. Saturated and trans fat have the most impact on blood cholesterol.
- Weight: In addition to being a risk factor for heart disease, being overweight can also increase your triglycerides. Losing weight may help lower your triglyceride levels and raise your HDL.
- Exercise: Regular exercise can lower total cholesterol levels. Exercise has the most effect on lowering triglycerides and raising HDL. You should try to be physically active for 30 minutes on most days of the week.
- Age and sex: As we get older, cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, however, womens LDL levels tend to rise and HDL can drop.
- Heredity: Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
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When Should You Contact Your Healthcare Provider About Your Cholesterol Levels
In truth, your healthcare provider will probably talk to you about your numbers first. As always, contact your provider if you have any new or worsening pain or other uncomfortable feelings. Make sure you know what medications you take and what they are expected to do. Call the provider if you have a reaction to the medicine.
Before you go to the office, and after you have had a cholesterol test, it helps to have a list of questions prepared about your test results and any proposed treatment.
A note from Cleveland Clinic
When considering cholesterol numbers, its important to remember that you really have the ability to make those numbers go in your favor. What you choose to eat, how much you are able to move and how you deal with lifes ups and downs are things that you can influence.
Last reviewed by a Cleveland Clinic medical professional on 07/31/2020.
How Is It Made
Your liver, other organs, and other cells in your body produce about 80 percent of the cholesterol in your blood.
The other 20 percent of the cholesterol in your body is affected by the foods you eat. Foods high in trans and saturated fats can contribute to unhealthy cholesterol levels.
As you take in more of these fats, your liver compensates by reducing its own production of cholesterol and removing excess cholesterol. However, not everyone makes and removes cholesterol with the same efficiency.
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Why Is It Important
The importance of the analysis of non-HDL-C as a predictor and target for the treatment of cardiovascular disease is that other highly atherogenic lipoproteins are included as the remnants of VLDL, which, being small and dense molecules. The potential use of non-HDL cholesterol to predict the risk of death due to cardiovascular disease has been demonstrated by different studies, however, there are few studies where it has been evaluated as a predictor of the risk of cardiovascular disease development. On the other hand, Non-HDL cholesterol has been shown to be a predictor of mortality in men and women, as good as LDL cholesterol.
How Can I Lower My Ldl Cholesterol Without Medications
The first step in managing any case of high LDL is through adopting healthy, therapeutic lifestyle changes . The key to TLC is:
- Adjusting diet: Adopting specific, heart-healthy eating habits, such as the TLC diet, Mediterranean diet, or the Dietary Approaches to Hypertension eating plan can dramatically improve LDL levels. These limit intake of trans fats, salt, and cholesterol, while boosting healthy, unsaturated fats.
- Managing weight: If you’re overweight or obese, even moderate reductions in weight can help lower LDL. Incorporating healthier lifestyle habits, such as improving diet, sleep quality, and level of physical activity can make a big difference.
- Staying active: Ensuring that you’re getting enough physical activity will also help reduce LDL levels. Aiming for a bare minimum of 30 minutes a day of moderate exercise, such as taking daily walks or cycling, can help a great deal.
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What Happens If High Cholesterol Goes Untreated
High blood levels of LDL cholesterol and triglycerides have been linked to the development of CVDs, along with other factors such as hypertension and diabetes mellitus. The risk of damage to the vascular walls and the formation of deposits and blockages increases when there is more bad and less good cholesterol in our blood. The good news is that the reduction in total cholesterol by 1% leads to a 2% reduction in the risk of developing cardiovascular disease.
Increased cholesterol levels may be caused by a familial predisposition as well, as is the case in about 3% of people. Usually, blood cholesterol is high from an early age and is unaffected by the diet. In these cases, specialists recommend taking lipid-lowering agents such as statins from a younger age. These drugs are prescribed and taken under medical supervision.
However, it is a myth that lipid-lowering medication can be stopped as soon as your results are within the cholesterol and triglycerides normal range. The levels may be lowered, but if you stop taking the drug, the cholesterol, and especially LDL, will rise again. You should consult your doctor about any change in your treatment.
In about20% of the population, high LDL cholesterol levels are associated with another underlying condition such as:
- increased adrenal function
Comparing And Contrasting A Direct Ldl Cholesterol Test And A Total Cholesterol Test
A total cholesterol test measures the sum of all kinds of cholesterol in a blood sample. In this way, total cholesterol includes the amount of good HDL cholesterol as well as bad types of cholesterol, including LDL cholesterol.
A test of total cholesterol alone does not measure how much LDL cholesterol is present. If a total cholesterol test includes a measurement of HDL cholesterol, it may enable a calculated estimate of LDL cholesterol.
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How To Lower Cholesterol: Know Your Fats
The American Heart Association recommends that just 25% to 35% of your daily calories come from fats such as those found in fish, nuts, and vegetable oils. For healthy people, saturated fat should comprise no more than 7% of your total calories. On a 2,000 calorie-a-day diet, that’s about 140 calories worth of saturated fat. If you need to lower your LDL cholesterol, limit saturated fat to 5% to 6% of calories, or about 11 to 13 grams of saturated fat on a 2,000-calorie diet. Reduce trans fats to less than 1% of your total daily calories. This means avoiding fried foods and many junk foods.
Role In The Innate Immune System
LDL interfere with the quorum sensing system that upregulates genes required for invasive Staphylococcus aureus infection. The mechanism of antagonism entails binding apolipoprotein B to a S. aureusautoinducer pheromone, preventing signaling through its receptor. Mice deficient in apolipoprotein B are more susceptible to invasive bacterial infection.
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How Do You Prepare For A Cholesterol Test
In most cases, youll need to fast for nine to 12 hours before the test. Make sure you tell the person drawing your blood how long it has been since you ate or drank anything that wasnt water.
There are some cases when a cholesterol test is done without fasting. This is true for tests done at health screenings and may be true for people younger than 20 or for people who are unable to fast.
Some medical societies believe that fasting is not necessary to get a true picture of lipid levels in the blood, while other associations stand by the belief that fasting gives a better idea of a persons heart disease risk. You should be clear on whether or not you need to fast, and for how long, before you go for the blood test.
Comparing And Contrasting A Direct Ldl Cholesterol Test And A Lipoprotein Test
Lipoprotein is not a type of cholesterol. Instead, it is a specific kind of particle that can carry cholesterol. Research has found that the amount of lipoprotein particles is an independent risk factor that can contribute to cardiovascular disease.
Lipoprotein levels may be a consideration when determining the optimal medical approach for people with elevated levels of LDL cholesterol.
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Medical History And Physical Exam
Your doctor will ask about your eating habits, physical activity, family history, medicines you are taking, and risk factors for heart or blood vessel diseases.
During your physical exam, your doctor will check for signs of very high blood cholesterol, such as xanthomas, or signs of other health conditions that can cause high blood cholesterol.
What Foods Help Lower Ldl Cholesterol
A heart-healthy diet that is high in fiber and plant-based foods can help lower total and LDL cholesterol levels. Mainly vegetarian or vegan diets have been shown to reduce cholesterol levels and the risk of blocked arteries. Foods that can help lower LDL cholesterol include:
If diet, exercise, and lifestyle changes are not enough to lower your cholesterol to healthy ranges, then your doctor may prescribe medication. The type of cholesterol lowering medication depends upon your levels of LDL, HDL, and triglycerides and any current medications you are currently taking, and your overall health.
Medication options to reduce cholesterol include statins, niacin, and fibric acid agents . Your doctor may prescribe one or several types of these drugs to reduce your cholesterol levels to a healthy range.
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How Low Should We Decrease Ldl
The association between blood cholesterol and cardiovascular disease has been consistently demonstrated in epidemiological studies within all ranges of studied cholesterol levels.1 Statins have been the mainstay therapy for low-density lipoprotein-cholesterol reduction and subsequent prevention of CV events. In fact, after the first year of statin use, each 1 mmol/L of reduction in LDL-C leads to a 20-25% relative reduction of global CV risk, including a 20% decrease in coronary mortality.2,3
Whereas this degree of relative risk reduction is largely independent of baseline characteristics,2,4,5 the net benefit or absolute risk reduction achieved with lowering LDL-C levels is highly dependent on baseline CV risk. As an example, a reduction in LDL-C of 1 mmol/L and subsequent 25% relative reduction in CV risk will translate into 1% versus 5% absolute risk reduction in patients with a 10-year estimated risk of 4% and 20%, respectively. For this reason, guidelines across the globe recommend CV risk assessment and tailoring the aggressiveness of lipid lowering therapies to such risk.6-10
When Should I Get Ldl Cholesterol Testing
LDL cholesterol testing may be used to assess your risk of cardiovascular disease or monitor changes in cholesterol over time.
Doctors will take factors such as age, family history, and other medical conditions when determining how often you should check your levels of LDL cholesterol. Examples of common screening recommendations are outlined below:
|With or without risk factors||Annually|
Having your cholesterol levels checked at regular intervals gives doctors a chance to notice any changes that could become harmful to your health. High or increasing cholesterol levels are a risk factor for heart disease, diabetes, or stroke, among other conditions.
Doctors may want to test your cholesterol levels more regularly if you or your family have a history of heart disease, smoking, high blood pressure, type 2 diabetes, obesity, a sedentary lifestyle, or a diet high in saturated fat.
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New Information On Accuracy Of Ldl
Low-density lipoprotein-cholesterol remains of utmost clinical importance it is positioned in clinical trials as a treatment target and is emphasized in worldwide guidelines as the primary cholesterol target. The gold standard of LDL-C measurement has been preparative ultracentrifugation, but given its time requirements and expenses, other methods have been developed as alternatives to estimate LDL-C.
The Friedewald equation was developed in 1972 and estimates LDL-C as: total cholesterol minus high-density lipoprotein-cholesterol minus triglycerides /5, with the latter term serving as an estimate for very low-density lipoprotein-cholesterol .1 Originally developed for research purposes from a sample of just 448 individuals, the Friedewald equation has been widely adopted in clinical practice for several decades.
However, the equation is prone to inaccuracy at low LDL-C and/or high TG levels, where errors in estimating VLDL-C are magnified given its use of a fixed factor of 5 to describe the relationship between TG and VLDL-C. This results in marked underestimation of LDL-C.
In the era when the Friedewald equation was introduced, inaccuracies were tolerated because the VLDL-C estimate was a relatively small proportion of the equation. Lower LDL-C levels were not achievable or strongly recommended as statins and other modern pharmacotherapies were not available. In fact, only 35 individuals in Friedewalds derivation sample had an LDL-C < 100 mg/dL.1
Can You Get Rid Of Cholesterol Deposits
Researchers are working on ways to eliminate plaque from coronary arteries. One method that has been proposed involves using combinations of medicines in healthy people aged 25 to 55 years. It is suggested that getting the levels of cholesterol down very low will allow arteries to clear up and heal up.
Several researchers believe that the way to reverse heart disease, and to prevent it in the first place, is found in a whole food, plant-based diet. Studies have been done that have shown that limiting nutrition to whole foods that are plant-based have been successful in reducing blood cholesterol and even, in some cases, lessening plaque buildup.
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