Cholesterol is a kind of fat in your blood. Your body makes its own cholesterol, but you also get it from the foods you eat, such as meat; foods fried in animal fat, like lard, butter, or margarine; dairy products; or other foods.

Most people do not show any signs of high cholesterol. The only way to know your cholesterol levels for sure is to ask your healthcare provider for a cholesterol test. A cholesterol test can tell you about your:

• LDL (low-density lipoprotein) cholesterol: LDL is commonly called “bad” cholesterol. LDL can clog your arteries, and high LDL levels may make you more likely to have a heart event, such as a heart attack or stroke. A healthy LDL blood level is less than 100 mg/dL.
• HDL (high-density lipoprotein) cholesterol: HDL is sometimes called “good” cholesterol. People with high HDL blood levels may be less likely to have a heart event. A healthy HDL blood level is 60 mg/dL or higher.
• Total Cholesterol (TC): TC includes LDL, HDL, and other kinds of cholesterol. A healthy TC is less than 200 mg/dL.
• Triglycerides: Triglycerides are another type of fat measured as part of the cholesterol test. Triglyceride levels lower than 150 mg/dL are healthy. High triglycerides may increase your chance of having a heart attack or stroke. People with very high triglyceride levels (500 mg/dL or higher) are at risk for other health problems. Very high triglyceride levels are discussed in a separate section below.

Some people have too much cholesterol in their blood. Cholesterol can build up on the inside of the blood vessels in your heart as well as other blood vessels in your body. If too much cholesterol builds up in the blood vessels in your heart, the blood cannot flow through to your heart and may lead to a heart attack. People with high cholesterol, especially high LDL, are more likely to have a heart event, such as a heart attack or stroke, or need surgery or a procedure to open up the blood vessels of the heart (bypass surgery, angioplasty, or stent placement).

A heart-healthy lifestyle may help lower your cholesterol and your chance of having a heart event at all ages. A heart-healthy lifestyle includes reducing the amount of total and saturated fat in your diet, participating in regular aerobic exercise, and losing weight (if you are overweight or obese).

Lowering LDL with certain medicines may decrease your chance of having a heart event. But not everyone with high cholesterol needs medicine. Whether or not you should start a cholesterol-lowering medicine depends on a few things: if you already have heart (cardiovascular) disease, your age, your cholesterol levels, and other factors. Your healthcare provider can help you decide about taking a cholesterol-lowering medicine, such as a statin.

In most cases, if you need to take a cholesterol-lowering medicine, your healthcare provider may consider prescribing a statin first. You can discuss this more with your healthcare provider.

People with very high triglyceride levels (500 mg/dL or higher) may be more likely to develop acute pancreatitis. Acute pancreatitis is swelling and irritation of the pancreas that feels like sudden, severe stomach pain. In some cases, the pain may get better, but in other cases you could have a fever, severe dehydration, and get very sick and need to go to the hospital for care to save your life. The most common causes of acute pancreatitis are gallstones, excess alcohol use, and taking certain medicines. Very high triglycerides may cause acute pancreatitis even in people who do not have gallstones or drink alcohol.

Many things can cause very high triglyceride levels, such as genetic causes (passed down from a parent), uncontrolled diabetes, taking certain medicines, being obese or overweight, alcohol use, pregnancy, and thyroid disease. People with high triglycerides should follow a low-fat diet with a goal of weight loss (if overweight or obese) and should not drink alcohol or take certain medicines. People with diabetes are typically instructed to follow a meal plan and take their diabetes medicine as prescribed to improve control of their blood sugar levels.

Some people may need to take medicine in addition to lifestyle changes (diet and exercise) to lower their triglyceride levels. If you have high triglyceride levels, you should talk to your healthcare provider.

If you have high low-density lipoprotein (LDL) cholesterol, your health care team may prescribe medicine in addition to lifestyle changes to manage your LDL cholesterol level.

What are the types of medicines that treat high cholesterol?

Several types of medicines help lower LDL cholesterol. The chart below describes each type and how it works.

All drugs may have side effects, so talk with your health care team, including your pharmacist, on a regular basis. Once your cholesterol levels have improved, your health care team will monitor them to ensure they stay in a healthy range.

Who needs cholesterol-lowering medicine?

Your treatment plan for high cholesterol will depend on your current cholesterol levels and your overall risk of heart disease and stroke.

Your health care team may prescribe medicine if:

• You have already had a heart attack or stroke or have peripheral arterial disease.
• Your LDL cholesterol level is 190 mg/dL or higher.
• You are 40–75 years old and have diabetes and an LDL cholesterol level of 70 mg/dL or higher.
• You are 40–75 years old and have a high risk of developing heart disease or stroke and an LDL cholesterol level of 70 mg/dL or higher.

Talk with your health care team about how you can lower your risk for heart disease.

ACL Inhibitors: What You Should Know

This medicine treats high cholesterol.

Before taking this medicine, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Have gout
• Have tendon problems
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have kidney problems
• Have liver problems

This medicine may affect the way other medicines work, and other medicines may affect how this medicine works. Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your healthcare provider and pharmacist if you take or plan to take other cholesterol-lowering medicines, fluoroquinolones, or cortisone medicines.

Warnings

This medicine may cause serious side effects, including:

• Increased levels of uric acid in your blood. High levels of blood uric acid may lead to gout.
• Tendon rupture or injury.

Common Side Effects

• Common cold symptoms, flu, or flu-like symptoms
• Bronchitis
• Back pain
• Stomach pain
• Abnormal laboratory test for liver function
• Muscle spasms
• Shoulder, arm, or leg pain (mild)
• Anemia
• Increased liver enzymes

Warning Signs

If you are taking an ACL inhibitor, get medical help if you have any of these signs or symptoms:

• Bruising, pain or swelling in an arm, shoulder, or ankle
• Fast or irregular heartbeat
• Joints red, tender, or swollen, severe foot pain
• Sudden joint snapping or “popping” sound
• Unable to move or put weight on joint or limb

Bile Acid Sequestrants: What You Should Know

These medicines treat high cholesterol.

Before taking these medicines, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines.
• Are pregnant or planning to become pregnant. These medicines may interfere with how you absorb vitamins.
• Are breastfeeding or planning to breastfeed. These medicines may interfere with how you absorb vitamins.
• Have pancreas problems. Very high levels of triglycerides (more than 2,000 mg/dL) may increase the risk of pancreatitis.
• Have bleeding problems, chronic constipation, gallbladder problems, heart disease, hemorrhoids, phenylketonuria, previous intestinal surgery or bowel blockage, stomach ulcers, or thyroid disease.
• Bile acid sequestrants can bind to and slow down or reduce the absorption into the bloodstream of many medicines. Talk with your healthcare provider about how to schedule taking your other medicines around taking a bile acid sequestrant.
• To reduce the risk of constipation, drink plenty of fluids and increase the amount of fiber in your diet while using this medicine.
• Avoid slowly sipping or holding cholestyramine-containing liquid in your mouth for prolonged periods of time because it can damage tooth surfaces. Practice good oral hygiene while taking this medicine.

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, herbal supplements, or other nutritional supplements. Especially tell your healthcare provider if you are taking any of the following:

• Birth control pills
• Blood thinners
• Cyclosporine
• Diabetes medicines
• Heart or blood pressure medicines
• Mycophenolic acid
• Phenobarbital
• Phenytoin
• Thyroid hormones

Common Side Effects

• Increased burping
• Heartburn
• Constipation (mild)
• Gas
• Indigestion
• Nausea
• Diarrhea

Warning Signs

If you are taking a bile acid sequestrant, get medical help if you have any of these signs or symptoms:

• Constipation (moderate to severe)
• Prolonged period of time without having a bowel movement
• Abdominal or stomach pain
• Vomiting
• Sudden weight change
• Increased or unusual bleeding

Cholesterol Absorption Inhibitors: What You Should Know

This medicine treats high cholesterol.

Before taking this medicine, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have liver problems
• Experience unexplained muscle pain, tenderness, or weakness

Tell your healthcare provider and pharmacist about any prescription and non-prescription medicines you are taking or plan to take, including natural or herbal remedies.

Warnings

This medicine can cause serious side effects when taken with other cholesterol-lowering medicines, including:

• Abnormal blood tests for liver function
• Serious muscle problems

Common Side Effects

• Diarrhea
• Joint pain
• Feeling tired

Warning Signs

If you are taking ezetimibe, get medical help right away if you have any of these signs or symptoms:

• Allergic reaction, including hives, rash, or swelling in other parts of your body
• Muscle problems, like weakness, tenderness, or pain that happens without a good reason (like exercise or injury)
• Brown or dark-colored urine
• Skin or eyes look yellow

Cholesterol-Lowering Combination Medicines: What You Should Know

These medicines are made up of two different kinds of cholesterol medicines. Some of these medicines appear alone on other lists in this guide. Look for the generic or brand names on the other lists.

Before taking these medicines, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Experience unexplained muscle pain, tenderness, or weakness
• Have tendon problems
• Have gout
• Have liver problems
• Have kidney problems
• Have thyroid problems
• Have diabetes
• Drink more than two servings of alcohol daily

These medicines may affect the way other medicines work, and other medicines may affect how these medicines work. Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, herbal supplements, or other nutritional supplements. Especially tell your healthcare provider and pharmacist if you are taking medicines for your cholesterol, fluoroquinolones, medicines for any infections, your immune system, heart failure, seizures, diabetes, heartburn or stomach ulcers, birth control pills, or cortisone medicines.

Warnings and Side Effects

The warnings and side effects for these medicines are the same as those listed for each of the generic medicines.

High Blood Pressure and Cholesterol-Lowering Combination Medicines: What You Should Know

This medicine is made up of two different kinds of medicines. This medicine is used to treat both high blood pressure and high cholesterol.

Atorvastatin is a cholesterol-lowering medicine. Look for the other names of atorvastatin on the list of HMG-CoA Reductase Inhibitors (“statins”) above. The warnings and side effects for atorvastatin are the same as those listed earlier for “statins.”

Amlodipine is a blood pressure medicine. Some of the warnings and side effects for amlodipine are listed below.

Before taking this medicine, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have liver or kidney problems
• Have a heart condition
• Have unexplained muscle aches or weakness
• Have diabetes
• Have thyroid problems
• Drink more than two glasses of alcohol daily

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your healthcare provider and pharmacist if you take medicines for:

• Your immune system
• Infections
• Cholesterol
• Hepatitis C virus
• Birth control
• Heart failure
• HIV (AIDS)
• Other viruses

Warnings

This medicine can cause serious side effects, including:

• Serious muscle problems that can lead to kidney problems, including kidney failure.
• Serious liver problems. Your healthcare provider should do blood tests to check your liver before starting this medicine.
• Low blood pressure or dizziness.
• Muscle rigidity, tremor, and abnormal muscle movement.

Common Side Effects

• Diarrhea
• Swelling of your legs or ankles
• Nausea
• Upset stomach
• Muscle and joint pain
• Changes in some laboratory blood tests

Warning Signs

If you are taking a high blood pressure and cholesterol-lowering combination medicine, get medical help right away if you have any of these signs or symptoms:

• Chest pain
• Serious rashes
• Swelling of the face, eyes, lips, tongue, arms, or legs
• Fainting
• Muscle problems like weakness, tenderness, or pain that happens without a good reason (like exercise or injury)
• Skin or eyes look yellow

Fibric Acid Derivatives (Fibrates): What You Should Know

These medicines treat high cholesterol and high triglycerides.

Before taking these medicines, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have liver problems
• Have kidney problems
• Have heart problems
• Have muscle pain or tenderness
• Have gallbladder problems
• Have pancreas problems
• Have had a blood clot, like a DVT or PE

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, herbal supplements, or other nutritional supplements.

Especially tell your healthcare provider and pharmacist if you are taking any medicines that affect your blood clotting (anticoagulants or blood thinners), medicines that suppress your immune system, other cholesterol-lowering medicines, or colchicine.

Warnings

These medicines may cause serious side effects, including:

• Serious muscle injury that can lead to kidney injury
• Abnormal laboratory tests of liver function
• Abnormal tests of kidney function
• Abnormal tests of blood cells
• Changes in other blood tests for cholesterol levels
• Gallstones
• Bleeding, when taken with certain blood-thinning medicines
• Pancreatitis
• Severe allergies
• Blood clots

Common Side Effects

• Abnormal blood tests of liver function
• Runny nose
• Stomach pain
• Back pain
• Headache
• Nausea
• Constipation

Warning Signs

If you are taking a fibrate, get medical help right away if you have any of these signs or symptoms:

• Allergic reaction, including hives, rash, itching, redness, or swelling
• Shortness of breath, chest pain, or coughing up blood
• Warmth, pain, tenderness, swelling, or skin redness in leg or thigh
• Muscle problems like weakness, tenderness, or pain that happens without a reason (like exercise or injury)
• Brown or dark-colored urine
• Skin or eyes look yellow
• Severe and sudden pain in upper abdomen
• Nausea or vomiting (severe)
• Clay-colored stools

Statins: What You Should Know

These medicines treat high cholesterol and high triglycerides. Certain statins have been shown to reduce the risk of some heart problems or procedures in people who have heart disease or are at high risk of heart disease because of other conditions, such as diabetes or high blood pressure. These problems can include heart attack, stroke, or other heart problems requiring hospitalization (including congestive heart failure). Certain statins may reduce the risk of or need for heart procedures, such as bypass surgery, angioplasty, or stent placement. Certain statins have also been shown to reduce the risk of dying from a heart attack, stroke, or other heart event.

Before taking these medicines, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have liver problems
• Have kidney problems
• Have diabetes
• Have unexplained muscle aches or weakness
• Drink more than two glasses of alcohol daily
• Have thyroid problems

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, herbal supplements, or other nutritional supplements. Especially tell your healthcare provider if you are taking medicines for your cholesterol, any infections, your immune system, heart failure, seizures, diabetes, heartburn or stomach ulcers, or birth control pills.

Warnings

Statins can cause serious side effects, including:

• Muscle problems that can sometimes lead to serious kidney problems, including kidney failure.
• Liver problems. Your healthcare provider should do blood tests to check your liver before starting these medicines.

Common Side Effects

• Headache
• Nausea
• Diarrhea
• Constipation
• Muscle pain
• Back pain
• Upset stomach
• Abdominal pain
• Weakness
• Joint pain
• Flatulence
• Stomach pain
• Rash

Warning Signs

If you are taking a statin, get medical help right away if you have any of these signs or symptoms:

• Allergic reaction, including hives, rash, or swelling in other parts of your body
• Brown or dark-colored urine
• Changes in urination
• Muscle problems, like weakness, tenderness, or pain that happens without a known reason (like exercise or injury)
• Skin or eyes look yellow
• Skin rash, itching, or redness (moderate to severe)
• Weakness in part of your body

Niacin: What You Should Know

This medicine treats high cholesterol and high triglycerides.

Before taking this medicine, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have liver problems
• Have stomach ulcers
• Have bleeding problems
• Have diabetes
• Have gout
• Have kidney problems

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, herbal supplements, or other nutritional supplements containing niacin or nicotinamide. Especially tell your healthcare provider and pharmacist if you take other medicines to lower cholesterol or triglycerides, aspirin, blood pressure medicines, medicines that affect your blood clotting (anticoagulants or blood thinners), or drink alcohol daily.

Warnings

This medicine can cause serious side effects, including:

• Severe liver problems
• Unexplained muscle pain, tenderness, or weakness
• High blood sugar levels

Common Side Effects 

• Flushing (redness of the face or neck)
• Diarrhea
• Nausea
• Vomiting
• Cough
• Skin rash or itching

Warning Signs

If you are taking niacin, get medical help if you have any of these signs or symptoms:

• Fast or irregular heartbeat
• Fainting
• Dizziness
• Muscle problems like weakness, tenderness, or pain
• Brown or dark-colored urine
• Skin or eyes look yellow

Omega-3-Acid Ethyl Esters: What You Should Know

These medicines lower very high triglycerides in adults.

Icosapent ethyl is used along with other medicines (statins) to reduce the risk of heart attack, stroke, and certain types of heart issues requiring hospitalization in adults with heart (cardiovascular) disease or diabetes and two or more additional risk factors for heart disease.

Before taking these medicines, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed
• Have diabetes
• Have thyroid problems
• Have a liver problem
• Have a pancreas problem
• Are allergic to fish or shellfish
• Have gout
• Have an irregular heartbeat

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription (over-the-counter) medicines, vitamins, and dietary or herbal supplements. These medicines can interact with certain other medicines that you are taking. Especially tell your healthcare provider if you take medicines that affect your blood clotting (anticoagulants or blood thinners).

Warnings

• These medicines can cause serious side effects, including:
• Heart rhythm problems
• Possible allergic reactions if you are allergic to fish or shellfish
• Bleeding
• Changes in certain blood tests used to check your liver function and cholesterol levels

Common Side Effects

• Burping
• Joint or muscle pain
• Swelling of the hands, legs, or feet
• Constipation
• Gout
• Heart rhythm problems
• Upset stomach
• Change in sense of taste

Warning Signs

If you are taking an omega-3 fatty acid, get medical help right away if you have any of these signs or symptoms:

• Allergic reaction, including hives, rash, or swelling in other parts of your body
• Fast or irregular heartbeat
• Increased or unusual bleeding
• Joints red, tender, or swollen

PCSK9 Inhibitors: What You Should Know

These medicines treat high cholesterol and decrease the chances of having a heart attack, stroke, or certain types of heart problems requiring hospitalization in people with known heart (cardiovascular) disease.

Before taking these medicines, tell your healthcare provider if you:

• Have any allergies, including allergies to medicines
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and non-prescription (over-the-counter) medicines, vitamins, and herbal supplements.

Warnings

These medicines can cause serious side effects, including:

• Serious allergic reactions

Common Side Effects

• Back pain
• Common cold symptoms, or flu or flu-like symptoms
• Redness, itching, swelling, pain, or bruising at the injection site
• Runny nose
• Sore throat

Warning Signs

If you are taking a PCSK9 inhibitor, get medical help right away if you have any of these signs or symptoms:

• Allergic reaction, including hives, rash, or swelling in other parts of your body
• Trouble breathing or swallowing

If you are concerned about your cholesterol, talk to your health care team about steps you can take to manage your cholesterol.

Take Your Medicine as Directed

If you take medicine to treat high low-density lipoprotein (LDL) cholesterol, heart disease, stroke, or diabetes, follow your health care team’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist.

Make Healthy Lifestyle Changes

You can take steps to lower your high LDL cholesterol levels by making healthy changes to your lifestyle, such as choosing foods lower in saturated and trans fats and maintaining a healthy weight.

Talk with Your Health Care Team

You and your health care team can work together to prevent or treat diabetes and ensure that it doesn’t lead to high LDL cholesterol. Discuss your treatment plan regularly, and bring a list of questions to your appointments.

Check Your Cholesterol Regularly

You may need to have your cholesterol levels checked at least once every 4 to 6 years if you do not have heart disease. Some people need to get their cholesterol checked more often or less often. Talk with your health care team about the timeline that is best for you.

What is cholesterol?

Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol travels through the blood on proteins called lipoproteins. One type, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are the treatments for high cholesterol?

If you have high cholesterol, lifestyle changes can help you to lower your cholesterol level. But sometimes the lifestyle changes are not enough, and you need to take cholesterol medicines. You should still continue with the lifestyle changes even though you are taking medicines.

Who needs cholesterol medicines?

Your health care provider may prescribe medicine if:

• You have already had a heart attack or stroke, or you have peripheral arterial disease
• Your LDL (bad) cholesterol level is 190 mg/dL or higher
• You are 40-75 years old, you have diabetes, and your LDL cholesterol level is 70 mg/dL or higher
• You are 40-75 years old, you have a high risk of developing heart disease or stroke, and your LDL cholesterol level is 70 mg/dL or higher

What are the different types of medicines for cholesterol?

There are several types of cholesterol-lowering drugs available, including

• Statins, which block the liver from making cholesterol
• Bile acid sequestrants, which decrease the amount of fat absorbed from food
• Cholesterol absorption inhibitors, which decrease the amount of cholesterol absorbed from food and lower triglycerides.
• Nicotinic acid (niacin), which lowers LDL (bad) cholesterol and triglycerides and raises HDL (good) cholesterol. Even though you can buy niacin without a prescription, you should talk to your health care provider before taking it to lower your cholesterol. High doses of niacin can cause serious side effects.
• PCSK9 inhibitors, which block a protein called PCSK9. This helps your liver remove and clear LDL cholesterol from your blood.
• Fibrates, which lower triglycerides. They may also raise HDL (good) cholesterol. If you take them with statins, they may increase the risk of muscle problems.
• Combination medicines, which include more than one type of cholesterol-lowering medicine

There are also a few other cholesterol medicines (lomitapide and mipomersen) that are only for people who have familial hypercholesterolemia (FH). FH is an inherited disorder that causes high LDL cholesterol.

How does my health care provider decide which cholesterol medicine I should take?

When deciding which medicine you should take and which dose you need, your health care provider will consider

• Your cholesterol levels
• Your risk for heart disease and stroke
• Your age
• Any other health problems you have
• Possible side effects of the medicines. Higher doses are more likely to cause side effects, especially over time.

Medicines can help control your cholesterol, but they don't cure it. You need to keep taking your medicines and get regular cholesterol checks to make sure that you cholesterol levels are in a healthy range.