There are many non-statin medications your doctor might prescribe: Bile acid-binding resins, like cholestyramine (Locholest, Prevalite, Questran), colesevelam (WelChol), and colestipol (Colestid) stick to cholesterol-rich bile acids in your intestines and lower your LDL levels.
A low-dose statin like atorvastatin (Lipitor®) is safe for most patients, including those with mild liver enzyme abnormalities.
People who are unwilling or unable to take statins have limited options for other cholesterol-lowering medications. One possible choice is bempedoic acid, which was approved by the U.S. Food and Drug Administration (FDA) in 2020.
Doctors often prescribe a fibrate for patients who can't take a statin. Like the statins, fibrates reduce the body's cholesterol production, but they are less effective in lowering LDL cholesterol levels. In other areas, though, fibrates actually have the edge.
Most people can lower high cholesterol with lifestyle changes, like prioritizing heart-healthy foods, quitting tobacco products, exercising regularly, and sleeping enough. Making changes to lower your cholesterol might mean you don't need to take cholesterol medication anymore (or deal with the side effects).
High cholesterol levels are considered: too high: between 5 and 6.4mmol/l. very high: between 6.5 and 7.8mmol/l. extremely high: above 7.8mmol/l.
If you're taking a statin medication to lower your cholesterol, you will need to keep taking your prescription, or your cholesterol will likely go back up. Stopping your statin can put you at risk of having heart disease and other preventable health problems like stroke and heart attack from high cholesterol.
As a general guide, total cholesterol levels should be: 5mmol/L or less for healthy adults. 4mmol/L or less for those at high risk.
A person is considered at high risk for developing heart disease if their total cholesterol level is higher than 240 mg/dL, LDL levels are higher than 160 mg/dL (190 mg/dL is even higher risk), and if the HDL level is below 40 mg/dL.
A newer drug called Nexletol was approved in 2020 by the FDA to treat high cholesterol, but the new study published in NEJM shows that the drug also reduces the risk of heart disease. Researchers believe this data supports using Nexletol as a safe and effective alternative for many people who cannot take statins.
Fear of side effects and perceived side effects are the most common reasons for declining or discontinuing statin therapy. Willingness to take a statin is high, among both patients who have declined statin therapy and those who have never been offered one.
Patients who refuse to take statins may be concerned about cost. They may be unaware that the most potent statins, rosuvastatin and atorvastatin, as well as many others, are generic medications that cost as little as $4 to $10 per month even without prescription insurance, says Milks.
Ezetimibe is a tablet that lowers cholesterol. It may be prescribed if statins cannot be taken, or alongside a statin for extra cholesterol-lowering. It's a 'cholesterol absorption inhibitor' that limits the absorption of cholesterol in the small intestine.
The new bempedoic acid drug – currently called Nexletol – is being developed by US-based Esperion Therapeutics and will go to the Therapeutics Goods Administration for approval for use in Australia. Professor Nicholls said he expected the drug to be available for Australian patients in the next two years.
By Lauran Neergaard • Published March 6, 2023
shows the cholesterol-lowering drug Nexletol made by Esperion Therapeutics Inc. Drugs known as statins are the first-choice treatment for high cholesterol but millions of people who can't or won't take those pills because of side effects may have another option.
The current recommendation is that you should be offered statins if: there's at least a 1 in 10 chance of you developing CVD at some point in the next 10 years. lifestyle measures, such as exercising regularly and eating a healthy diet, haven't reduced this risk.
And so, in general, although there are some potential side effects long-term for statins, in most cases, if your doctor has identified you as having high cholesterol and needing a statin, the risks greatly outweigh, or sorry, the benefits greatly outweigh the risks.
This is why it is important to eat foods to help lower your cholesterol, such as those high in soluble fiber. Fruits like avocados and apples, and citrus fruits like oranges and bananas are foods that can help lower cholesterol.
Statin use is associated with increased calorie intake and consequent weight gain. It is speculated that statin‐dependent improvements in lipid profile may undermine the perceived need to follow lipid‐lowering and other dietary recommendations leading consequently to increased calorie intake.
If your risk is very low, you probably won't need a statin, unless your LDL is above 190 mg/dL (4.92 mmol/L). If your risk is very high — for example, you've had a heart attack in the past — a statin may be helpful even if you don't have high cholesterol.