Cholesterol Management: Treatment & Care

More than 93 million American adults over 20 have total cholesterol higher than 200 mg/dl. While 7% of American adolescents and children struggle with high total cholesterol. 

With high cholesterol, the blood vessels develop fatty deposits. The longer these deposits accumulate, the more difficult it is to maintain proper blood flow. When that happens, the blood pressure can also become unusually high. 

That’s why high cholesterol can turn into a serious health problem. It could cause a stroke, which is the leading cause of death in the U.S. If you want to learn how to manage it, you’ve come to the right place. We prepared practical cholesterol management and treatment guide that will come in handy. 

What Is High Blood Cholesterol?

Cholesterol is a substance with a wax-like consistency. It is in the blood. It moves through the human system while still inside a lipoprotein. The lipoprotein is a spherical particle made of proteins and fat. 

The two most known lipoproteins are high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The LDL lipoprotein makes up most of the cholesterol in the human body. 

The system relies on cholesterol to create healthy cells. However, when the cholesterol numbers are just too high, they make the body susceptible to heart disease. With increased blood cholesterol levels, the body could develop fatty deposits inside the blood vessels. 

The bigger the build-up, the harder it is for the blood to flow. But, it is not uncommon for these deposits to break all of a sudden and create a clot in the arteries. In cases such as these, it can lead to stroke or a heart attack. 

Problems with cholesterol control could be inherited. But, in most people, the unstable cholesterol level is the result of a sedentary lifestyle and bad food choices. In other words, this is mostly a treatable and preventable health problem. 

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How Is Cholesterol Diagnosed?

Before you can start the high cholesterol treatment, you need to know what you are dealing with. That’s where a diagnosis can help. Complete cholesterol screening can determine whether you are experiencing exceedingly high cholesterol and if you need treatment. 

A simple blood test known as a lipid profile or lipid panel can verify the cholesterol and triglyceride level. A physical exam and reports of family and medical history are also important. They will help estimate the possibility of developing a heart attack or other form of heart disease. 

The lipid levels usually report:

  • Total cholesterol – is a measure of the total cholesterol amount in the blood. That includes both LDL and HDL cholesterol. 

  • HDL cholesterol – is the good cholesterol that aids in clearing the arteries. The HDL cholesterol is good for the heart, meaning that a higher count on a cholesterol test is desirable. 

  • LDL cholesterol – is the bad cholesterol known for building up in the arteries. The LDL cholesterol level causes blockages and decreases blood flow.

  • Triglycerides – are lipids or a type of fat in the blood.

To obtain accurate results, patients are advised to refrain from drinking and eating (except water) prior to giving a blood sample, preferably anywhere from 9h to 12h before diagnosis. 

Guideline Levels

In the U.S., cholesterol is measured in mg (milligrams) of dL (cholesterol per deciliter) in the blood. But, to understand what is going on in the system, you need to know how to interpret the cholesterol numbers. Here is a quick overview that can help. 

Best Treatment Option & Care  

If you’ve been diagnosed with hyperlipidemia, then you will need proper treatment. The goal of treatment is to decrease cholesterol and lessen your risk of a heart attack or stroke. 

According to the University of Michigan, your treatment will be based on your current health state and reaction to drugs. Every treatment must be tailored to your needs. So, it’s important to ask for medical advice before adding any changes to your daily routine. Here are the possible treatment opportunities people can go for. 

Lifestyle Changes

When a patient with high cholesterol wants to manage their health issue, the first strategy would be to incorporate a balanced diet, physical activity and stop smoking. These lifestyle changes play a fundamental role in cholesterol management. 

They are non-pharmacological methods clinically proven to manage the health issue. Experts claim these are the first line of cholesterol management. Since lifestyle interventions are aimed at weight control and high nutrient intake, they can improve lipid profiles. Here is how. 

  • Balanced Diet – Eating heart-healthy foods is a crucial strategy. People need to consume meals high in omega 3, soluble fiber, and whey protein. With them, they can lower the LDL and manage blood pressure. Whereas trans fat and saturated fat can increase the LDL level and raise the total cholesterol.

  • Physical Activity – Exercise raises HDL. Working out at least 30 min, 5 times a week, or doing vigorous aerobic for 20 min, 3 times a week, can help improve cholesterol. Most importantly, it can shed excess pounds, which are contributors to high cholesterol. 

  • Stop Smoking – Smoking reduces HDL and elevates LDL. When you quit, you raise the HDL. After just 20 min of quitting, your heart rate and blood pressure can recover. Within a year, your risk of cardiovascular disease becomes half that of a smoker. 


Lifestyle changes, such as healthy eating and enough exercise, are the go-to choice. If the patient has already incorporated adequate lifestyle changes and their cholesterol remains dangerously high, the doctor will suggest medication. 

The type of cholesterol medication you use will vary based on your health state, age, individual risk factors, and side effects. Here is a comprehensive guide to some of the most widely used cholesterol drugs.

Statin Medication  

Statins can decrease cardiovascular mortality by 30% and stroke incidence by 20%. A statin drug is meant to block the substance in the liver that requires cholesterol. This forces the liver to get rid of the high cholesterol. 

With statin drugs, people can help their bodies reabsorb the cholesterol from the deposits in the walls of the arteries. Thus, most likely reversing coronary artery disease. These statin drugs are:

  • Altoprev (lovastatin)

  • Crestor (rosuvastatin)

  • Lescol XL (fluvastatin)

  • Lipitor (atorvastatin)

  • Livalo (pitavastatin)

  • Pravachol (pravastatin)

  • Zocor (simvastatin)


Injectable medication is another alternative. These are the newest drugs referred to as PCSK9 inhibitors. Designed to assist with liver absorption, they can help stabilize the cholesterol level. According to experts, the PCSK9 inhibitor has brought a new era of lipid-lowering therapy. 

Patients with very high LDL cholesterol and a genetic condition (ex. familial hypercholesterolemia) usually take Praluent (Alirocumab) and Repatha (evolocumab). Familial hypercholesterolemia is a genetic illness recognized by high cholesterol, particularly dangerously high LDL levels. 

The PCSK9 inhibitor can also be recommended for patients with a history of coronary heart disease or intolerance to statin drugs. The only real drawback is the cost. To become a cost-effective strategy, the current price should reduce by 60% to 65%. Otherwise, it puts an excessive financial burden. 

Cholesterol Absorption Inhibitor 

The cholesterol from your diet gets absorbed by the small intestine and released into the bloodstream. Medications like Zetia (ezetimibe) can limit dietary cholesterol absorption and decrease blood cholesterol levels. 

Clinical trials show that ezetimibe effectively reduces LDL by 15% to 20%. The inhibitor is often paired with a statin drug. This combination of treatments provides a solid management approach for hypercholesterolemic patients. With properly managed cholesterol, people can reduce their risk of cardiovascular disease. 

Bice-Acid-Binding Resin 

The liver needs cholesterol to create bile acid. This is a key substance necessary for digestion. Medications like Colestid (colestipol), Welchol (colesevelam), and Prevalite (cholestyramine) can indirectly lower cholesterol levels. 

They bind to bile acids and prompt the liver to use its excess cholesterol and create more bile acid. As a result, the bile acid sequestrants effectively decrease the level of cholesterol in the blood. 

According to prevention trials, these drugs have resulted in an overall reduction of LDL (20.3%) and total cholesterol level (13.4%). These reductions were also linked to a 19% decrease in the incidence of coronary heart disease. 

That’s not all. These meds can boost glycemic control in people with type 2 diabetes mellitus. The therapy can decrease LDL by 28% and mean plasma glucose levels by 13%. This is more than enough to keep the metabolic illness in check. 


Medication tolerance varies from person to person. For example, statin therapy is very effective and well-tolerated for treating and preventing cardiovascular disease. But, it comes with plenty of side effects. Like diabetes, myopathy, myalgia, muscle damage, muscle pain, increased blood sugar, and more. 

The problem is, patients often discontinue their statin therapy without medical advice. The moment they experience side effects, they abruptly stop the treatment. However, this could do more harm than good. Research shows that discontinuing treatment without expert help can increase the risk of heart problems. 

In case of an intolerance, doctors can suggest changing the dose, switching to a different drug, or alternative medicine. 

Alternative Medicine

Sometimes people need an alternative. Something that can replace statin medication. If someone is struggling with very high triglycerides, then they might have to take the following medications.


Niacin (a generic name for nicotinic acid) limits the liver’s capability to create LDL and VLDL(very low-density lipoprotein) cholesterol. 

Studies show that nicotinic acid can reduce the high cholesterol level, especially LDL, by 10% to 20%. It can also lessen triglycerides by 20% to 50% and raise HDL by 15% to 35%. Hot flashes are a typical side effect of the drug. 

But, this medication doesn’t offer extra benefits over statins. In some cases, the drug has been linked to cardiovascular disease (particularly stroke and heart attack) and liver damage. That’s why experts only recommend it to patients who can’t handle statins. 


Medications like Fenoglide and TriCor can decrease the liver’s production of VLDL. They can also speed up triglyceride removal from the human body. Pairing them with statin drugs can increase the odds of adverse statin effects. 

Nutritional and Herbal Supplements

Those who want to take a more natural approach prefer nutritional and herbal supplements. Although they may not be as effective as typical medication, they could prove useful for cholesterol control. Here is a list of the nutritional supplements people go for. 

Red Yeast Rice

Red yeast rice makes for a great addition to a healthy diet. According to experts, the extract of red yeast rice is the most effective nutraceutical for reducing cholesterol on the market. The key to its effectiveness lies in the amount of monacolin K it contains. There is 10mg a day of monacolin K in the extract. 

Consuming it on a daily basis can reduce the LDL plasma levels from 15% to 25% in a span of 6 to 8 weeks. It leads to a similar reduction in total cholesterol. These effects are linked with significant improvements in endothelial function. 

The endothelium is a very thin membrane that lines with the inside of the blood vessels and heart. Compared to typical medication, this one can cause minimal risks like mild myalgia, for example. 


Half or one garlic clove a day can lower cholesterol by 9%, reports the National Institutes of Health. But, it can only be used as a short-term strategy. Other reports suggest that garlic could prolong blood clotting and bleeding time. So, people shouldn’t take it raw or in supplements before surgery, especially if they are taking blood thinners. 

Omega-3 Fatty Acids Supplements

Fatty acids can keep triglycerides in check. You can obtain them as an over-the-counter or prescription medicine. But, it is important to point out that these supplements can interact with other meds. So, you should only take them if your doctor believes they can help. 


Research indicates that soluble fibers decrease LDL and total cholesterol levels. Consuming 3g of soluble fiber from oats can reduce LDL and total cholesterol by 0.13 mmol/L. Although that’s not a significant drop in levels, it is a viable long-term strategy. 

Therefore, increasing the soluble fiber can add a small but valuable contribution to your dietary cholesterol reduction therapy. 


Policosanol is a chemical found in sugar cane. Other plants, like wheat, can also make it. Scientists found that policosanol can effectively reduce high cholesterol. But, most supplements that contain this chemical usually extract the policosanol from beeswax instead of sugar cane. 

According to a controlled study, Cuban policosanol could improve lipid profile and blood pressure. Since it can be beneficial for high cholesterol, it could also enhance HDL functionality. However, more large-scale research is necessary.

Experts need to evaluate whether any kind of policosanol can be useful for high cholesterol. Right now, the research is limited and more studies are necessary to determine its safety and effectiveness. 

Other Herbal Supplements, Products, or Extracts

Options like yarrow, artichoke leaf extract, fenugreek leaves, and seeds, and holy basil might be a good option for managing the high cholesterol. Spices like turmeric, rosemary, and ginger, could also come in handy. 

Even though they can’t create half the effects medication does, they can make a great addition to your healthy meals. Research shows that all of these products, supplements, and extracts can keep the heart-healthy. This is something you need when dealing with regular high cholesterol. So, they are definitely worth a try. 

Is There a Way to Prevent High Cholesterol?

If you have a genetic predisposition, then you can’t avoid the problem. But, lifestyle factors can help you manage it. To reduce the possibility of having high cholesterol, you can:

  • Exercise on a day to day basis

  • Avoid dangerous habits, like smoking and excessive drinking.

  • Maintain proper body weight.

  • Eat foods packed with nutrients, vitamins, and minerals. 

If you are at risk of developing unstable cholesterol, then talk with your doctor. They might suggest a routine screening just to make sure that your body is in tip-top shape. The doctor can also encourage you to test the cholesterol regularly to avoid any mishaps. This is a practical strategy for those who can’t really prevent the problem. 


If left unmanaged, elevated cholesterol can become a serious health issue. Luckily, various treatment options can help. And many of these options can aid people in avoiding complications. 

The trick for managing the issue would be to learn more about it. Identifying the cholesterol levels can help you diagnose the problem. All you have to do is consult with a doctor. After which, they will recommend lifestyle changes paired with medication or alternative medicine. With some dedication and work, you can get your health back on track. 

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  1. Benjamin Wedro. (2020). Cholesterol Management.
    Rahul Chaudhary. (2017). PCSK9 inhibitors: A new era of lipid lowering therapy. National Institutes of Health.
  2. W. Virgil Brown. (2003). Cholesterol absorption inhibitors: Defining new options in lipid management. National Institutes of Health.
  3. Bart Staels. (2010). Bile Acid Sequestrants for Lipid and Glucose Control. National Institutes of Health.
  4. Peter P. Toth. (2018). Management of Statin Intolerance in 2018: Still More Questions Than Answers. National Institutes of Health.
  5. Waris Qidwai. (2013). Role of Garlic Usage in Cardiovascular Disease Prevention: An Evidence-Based Approach. National Institutes of Health.
  6. L Brown. (1999). Cholesterol-lowering effects of dietary fiber: a meta-analysis. National Institutes of Health. Red Yeast Rice for Hypercholesterolemia. National Institutes of Health.
  7. Kyung-Hyun Cho. (2018). Consumption of Cuban Policosanol Improves Blood Pressure and Lipid Profile via Enhancement of HDL Functionality in Healthy Women Subjects: Randomized, Double-Blinded, and Placebo-Controlled Study. National Institutes of Health.

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