Lifestyle changes are the first line of treatment for hyperlipidemia. If these are insufficient, your doctor may prescribe medications to help manage your high cholesterol.
Lifestyle changes are often key to managing hyperlipidemia at home. Even if your hyperlipidemia is inherited (familial combined hyperlipidemia), lifestyle changes are still an essential part of treatment.
These changes alone may be enough to reduce your risk of complications like heart disease and stroke.
If you’re already taking medications to manage hyperlipidemia, lifestyle changes can improve their cholesterol-lowering effects.
Eat a heart healthy diet
Making changes to your diet can lower your LDL cholesterol levels and increase your HDL cholesterol levels. Here are a few changes you can make:
- Choose healthier fats. Avoid saturated fats that are found primarily in red meat, bacon, sausage, and full-fat dairy products. Choose leaner proteins like chicken, turkey, and fish when possible. Use monounsaturated fats like olive, avocado, and canola oil for cooking.
- Cut out the trans fats. Trans fats are found in fried food and processed foods, like cookies, crackers, and other snacks. Check the ingredients on product labels. Skip any product that lists “partially hydrogenated oil.”
- Eat more omega-3s. Omega-3 fatty acids have many heart benefits. You can find them in some types of fish, including salmon, mackerel, and herring. They can also be found in some nuts and seeds, like walnuts and flaxseeds.
- Increase your fiber intake. All fiber is heart healthy, but soluble fiber, which is found in oats, bran, fruits, beans, and vegetables, can lowerTrusted Source your LDL cholesterol levels.
- Learn heart healthy recipes. Check out the American Heart Association’s recipe pageTrusted Source for tips on delicious meals, snacks, and desserts that won’t raise your cholesterol.
- Eat more fruits and veggies. They’re high in fiber and vitamins and low in saturated fat.
Maintain a healthy-for-you weight
If you have high body weight or obesity, losing weight may help lower your total cholesterol levels.
Losing weight starts with figuring out how many calories you’re taking in and how many you’re burning. For a typical adult, it takes cutting 3,500 calories from your diet to lose about a pound.
You don’t have to start this process alone, though. You can work with a doctor or registered dietitian to create an eating plan that works for you, along with increasing physical activity so you’re burning more calories than you’re eating.
Get active, if you can
Physical activity is important for overall health, weight loss, and cholesterol levels. When you aren’t getting enough physical activity, your HDL cholesterol levels go down. This means there isn’t enough “good” cholesterol to carry the “bad” cholesterol away from your arteries.
You only need 40 minutes of moderate to vigorous exercise 3 or 4 times a week to lower your total cholesterol levels. The goal should be 150 minutes of total exercise each week.
This can look like anything you enjoy doing, but some of the following can help you add exercise to your daily routine:
- Try biking to work.
- Take brisk walks with your dog.
- Swim laps at the local pool.
- Join a gym (and use it!).
- Take the stairs instead of the elevator.
- If you use public transportation, get off a stop or two sooner.
Seek strategies to stop smoking
Smoking lowers your “good” cholesterol levels and raises your triglycerides. Even if you haven’t been diagnosed with hyperlipidemia, smoking can increase your risk of heart disease.
Talk with your doctor about quitting, or try the nicotine patch. Nicotine patches are available at the pharmacy without a prescription.
If lifestyle changes aren’t enough to treat your hyperlipidemia, your doctor may prescribe medication.
Statins are the first line medication for hyperlipidemia. If you cannot tolerate statins or if they do not reduce your LDL cholesterol enough, mRNA and monoclonal antibody drugs have been developed recently.
Common cholesterol- and triglyceride-lowering medications include:
- statins, such as:
- atorvastatin (Lipitor)
- fluvastatin (Lescol XL)
- lovastatin (Altoprev)
- pitavastatin (Livalo)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
- simvastatin (Zocor)
- bile-acid-binding resins, such as:
- cholestyramine (Prevalite)
- colesevelam (Welchol)
- colestipol (Colestid)
- cholesterol absorption inhibitors, such as ezetimibe (Zetia/Nexlizet)
- injectable alternatives to statins, such as alirocumab (Praluent) or evolocumab (Repatha)
- fibrates, like fenofibrate (Fenoglide, Tricor, Triglide) or gemfibrozil (Lopid)
- niacin (Niacor)
- omega-3 fatty acid supplements
- other cholesterol lowering supplements
New medications for high cholesterol
Inclisiran is a new drug using mRNA technology. It has been approved in Europe but not yet in the United States.
Clinical trials in 2020 showed the drug could cut levels of LDL cholesterol by 50 percent in people who are either intolerant or resistant to standard statin medications.
Inclisiran is the pioneer cholesterol drug in what’s called “small interfering RNA therapy.” This is a type of drug that blocks, or interferes with, the function of an RNA messenger (mRNA). An mRNA is a molecule that carries code for making a particular protein.
In the case of Inclisiran, the drug blocks, or interferes with, the production of an enzyme called PCSK9 (proprotein convertase subtilisin kexin type 9). This enzyme causes problems with the LDL receptors in the liver that are necessary for the uptake of LDL cholesterol by liver cells.
By blocking PCSK9 activity, Inclisiran helps the body reduce the amount of LDL cholesterol. The drug is intended for hyperlipidemia treatment in adults whose high LDL cholesterol persists even while they’re on a maximum tolerated dose of statin therapy.
Bempedoic acid (Nexlitol) and ezetimibe (Nexlizet)
The two drugs Nexlitol and Nexlizet, approved by the FDA in 2020, are the first new non-statin cholesterol drugs approved by the FDA since 2002.
Nexlitol contains bempedoic acid, which has been shown in clinical trials to inhibit cholesterol. It’s designed to be taken in combination with the maximum tolerable dosage of statins.
Nexlizet contains ezetimibe, which lowers cholesterol by preventing the body from absorbing cholesterol from foods. It’s also designed to be taken along with statins.
Both Nexlitol and Nexlizet can cause serious side effects. Your doctor can help you decide if one of these drugs would benefit your treatment plan.
Praluent (alirocumab) was approved by the FDA in 2021 as an add-on treatment for familial hypercholesterolemia. This is a genetic condition that causes severely high cholesterol.
Praluent was originally approved by the FDA in 2015 for treating heart disease and primary inherited hyperlipidemia. It was then the first PCSK9 inhibitor approved by the FDA.
PCSK9 inhibitor drugs work by attaching to the PCSK9 gene to prevent it from degrading LDL receptors in the liver that help lower LDL cholesterol in the body. This differs from the new mRNA drug Inclirisan, in that inhibitors attach to the PCSK9 gene, whereas the mRNA drug prevents PCSK9 from being produced.
Alirocumab, the active drug in Praluent, is a monoclonal antibody. This is a protein synthesized in a laboratory that behaves like antibodies made by the human body.
Praluent comes as a liquid solution in a prefilled pen. You deliver it as an injection every 2 to 4 weeks, which can be done at home. It has a number of reported possible side effects, so be sure to discuss with your doctor whether it would suit your treatment plan.