A blood test known as a lipid panel or lipid profile is used to assess cholesterol levels, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, which are a type of blood fat. Typically, a fasting period of nine to twelve hours, involving only water consumption, is advised before the test; however, some tests can be done without fasting based on medical guidance. Cholesterol measurements are reported in milligrams (mg) of cholesterol per deciliter (dL) of blood in the US, and in millimoles per liter (mmol/L) in Canada and many European nations. To interpret the results, general guidelines are used. In the US, children are recommended to undergo one cholesterol screening between ages 9 and 11, followed by testing every five years; more frequent or earlier testing might be advised for children with a family history of early–onset heart disease or personal obesity/diabetes history.
When lifestyle changes like exercising and a healthy diet don’t sufficiently lower high cholesterol, doctors may suggest medication. The choice depends on factors like risk, age, and health. Options include:
- Statins: Statins work by inhibiting a necessary liver component involved in cholesterol production. This prompts the liver to eliminate cholesterol from the bloodstream. Various options are available including atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
- Cholesterol absorption inhibitors: The small intestine absorbs dietary cholesterol, releasing it into the bloodstream. Medications like ezetimibe reduce blood cholesterol by restricting the absorption of dietary cholesterol. This approach can be combined with other treatments, such as statins.
- Bempedoic acid: This recent medication functions similarly to statins but has a lower likelihood of inducing muscle pain. Supplementing a maximum statin dose with this compound can effectively reduce LDL levels. Furthermore, there is a combination pill consisting of this compound and another available.
- Bile–acid–binding resins: The liver employs cholesterol to create bile acids essential for digestion. Drugs like cholestyramine, colesevelam, and colestipol indirectly lower cholesterol by binding to bile acids. This spurs the liver to utilize surplus cholesterol for additional bile acid production, consequently reducing blood cholesterol levels.
- PCSK9 inhibitors: These medications enhance the liver’s uptake of LDL cholesterol, thereby reducing the cholesterol present in the bloodstream. They might be prescribed to individuals with a genetic condition causing elevated LDL levels or those with a history of coronary disease who cannot tolerate statins or other cholesterol drugs. Administration involves subcutaneous injections every few weeks, and these treatments tend to be costly.
For high triglycerides, options are:
- Fibrates: Fenofibrate and gemfibrozil decrease VLDL cholesterol and triglycerides.
- Niacin: It limits LDL and VLDL cholesterol but is recommended only if statins can’t be used.
- Omega–3 supplements: These help lower triglycerides, but consult your doctor due to potential interactions.
Medication tolerance varies. Statin side effects include muscle pain, memory issues, and elevated blood sugar. Regular liver function tests might be needed. Children with high cholesterol focus on diet and exercise; some with extreme levels might need statins.