Managing your cholesterol levels

Older man stretching outdoors.

From lifestyle changes to statin medications

High blood cholesterol is a major risk factor for heart disease — the number one killer in America. As blood cholesterol levels rise, so does the risk for heart disease. But not all cholesterol is bad.

There are two types of cholesterol and the difference is significant. Good cholesterol that decreases heart disease risk is known as HDL, and bad cholesterol that increases heart disease risk is known as LDL.

Here are a few lifestyle changes that can help keep cholesterol levels balanced:

  • Eat healthy: Choose a diet rich in fresh fruits and vegetables, and low in salt, fat, and cholesterol.
  • Know your fats: Saturated fat, trans fat, and dietary cholesterol raise LDL levels. Saturated fats come from animal fats and dairy products, and trans fats are found commonly in baked goods.
  • Eat the right fats: Choose good fats from seeds, nuts, oily fish, and olive oil as part of a healthy diet.
  • Lose extra weight: Losing as little as 5% to 10% of body weight can significantly reduce LDL levels.
  • Exercise: Regular physical activity raises HDL levels. Thirty minutes of aerobic activity, such as brisk walking or jogging, three to five days a week can help one's body produce more HDL.
  • Stop smoking: Cigarette smoking decreases the good HDL cholesterol.

Understanding drug therapy options

Lifestyle changes are the main way to control cholesterol and should be continued even with drug therapy. But when diet and exercise aren’t enough, drug therapy may help.

Drugs such as niacin are effective in raising HDL levels. Fibrates, bile acid resins, and ezetimibe are effective in lowering LDL cholesterol levels. But the main treatment for elevated LDL levels is statins.

Statins are the only class of medications that not only lower LDL cholesterol levels, but also are proven to reduce the risk of cardiovascular events. A 10% decrease in total blood cholesterol levels can reduce the chance of heart disease by up to 30%.1

Statin side effects: Weighing the benefits and risks

Statins can have side effects. Muscle pain is the most common side effect reported in 5% to 15% of people. In these cases a lower dose of the same medication, a change to another drug in the same category, or a change in how often it’s taken can help. A doctor or pharmacist can help with managing side effects.

Statins have also been found to increase the chance of developing type 2 diabetes in some people. However, studies have not shown a direct cause and effect relationship. Other factors such as weight, family history, and ethnicity also may contribute to the risk of developing diabetes. For the vast majority of people, doctors agree that the benefits of statins far outweigh the diabetes risk.

Our pharmacists are here to help

If you have any questions about statins or any other medications you’re taking, Express Scripts® Pharmacy pharmacists are available 24/7 by phone. We also have pharmacists in our Cardiovascular Therapeutic Resource Center who counsel patients on maintaining healthy cholesterol levels and, if needed, proper medication management.

1 Centers for Disease Control and Prevention, State Heart Disease and Stroke Prevention Programs Address High Blood Cholesterol (accessed August 17, 2021):

Posted date: September 24, 2021

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