You’ve probably heard that lifestyle changes are your first line of defense against high cholesterol. And for good reason: Adopting a healthy lifestyle can drop high cholesterol by as much as 10%.

The American Heart Association (AHA) recommends following a diet featuring whole grains and plenty of produce while reducing your intake of meat and sugar. Nutritional meals plus regular exercise, avoiding tobacco and maintaining a healthy weight, will go a long way to protecting your heart and arteries.

However, some patients will need additional help to manage their cholesterol levels, and their doctor may recommend additional medical intervention.

Cholesterol-lowering treatments

Methods for lowering high cholesterol have come a long way, says cardiologist Eugenia Gianos, MD, director of Women’s Heart Health at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health. 

“Even as early as five years ago, there was only so much we could do for certain patients, and they’d still end up in the emergency room,” Dr. Gianos says. “They’d need repeated stents and bypass surgery or suffered from multiple heart attacks or strokes.”

High levels of LDL cholesterol can lead to fatty deposits in the walls of arteries. That’s how heart disease can begin; as those deposits grow, they can impede blood flow and lead to blockages in arteries, resulting in heart attacks or strokes. Most cholesterol-lowering therapies are aimed at reducing LDL.

“To prevent heart disease, we must get patients’ LDL as low as possible,” Dr. Gianos says, and adds, “Thankfully, now we’re in an era of prevention when we can offer far more advanced therapies.”

These medications are the first medical option for patients trying to lower their cholesterol. The drugs are most effective when patients combine them with a healthy lifestyle.

Statins: By slowing the liver’s production of cholesterol while also increasing the ability of the liver to clear cholesterol, statins can reduce LDL levels by as much as 55 percent in some patients. Statins may play a role in reducing inflammation, as well, which can also help prevent strokes and heart attacks.

Ezetimibe: Another common cholesterol medication, ezetimibe interferes with the body’s ability to absorb cholesterol in the gut, and it can lower levels between 15-20 percent. Patients can take this drug alone or with a statin to gain additional cholesterol-lowering benefits. Using the two types of therapies together after a heart attack may reduce the likelihood of another cardiovascular event.

Cholesterol-lowering injections

A more recent development, injections can be for patients who didn’t get adequate results from daily medications or they may provide an option that’s easier for patients to adhere to since the shots only need to be given once every few weeks or months.

PCSK9 inhibitors: Patients get this injection every two to four weeks. The inhibitors can reduce the risk of heart attacks, strokes and death. This option can be more expensive and is limited to patients for whom statins and ezetimibe have been less effective.

Inclisiran: Another new injectable sold under the name Leqvio, inclisiran may work better for certain patients. It can lower cholesterol and may work well for patients who have trouble adhering to a medication schedule; the maintenance injections are given every six months.

Finding the right therapy will require a discussion with a cardiologist, Dr. Gianos says. Sometimes cost, side effects and the ease of taking a medication may have an impact on a patient’s treatment.

“For some patients, we may be able to connect them with something new in a clinical trial,” she says. “For others, we may need to take a larger perspective and conduct genetic tests and find out what role their family history may play in their treatment. It’s key for patients to understand how these factors, along with cholesterol levels, affect their cardiovascular health.”