Cholesterol Archive

Statins are among the most-prescribed drugs in the United States, but some people are concerned about side effects. Lifestyle changes involving diet and exercise can help lower cholesterol enough to take a statin break

Most people don't need to fast before a lipid test because the difference between LDL cholesterol values when fasting or not fasting is very small. But people who have had high triglyceride levels should fast prior to the test.

Having an extremely low LDL level from aggressive cholesterol-lowering therapy was not associated with cognitive impairment, according to a 2024 study.

High levels of Lp(a)—a fatty particle similar to LDL cholesterol—may double or triple a person's risk of a heart attack. About one in five adults may have elevated levels, which also raises the risk of stroke and aortic stenosis. Unlike LDL, which rises with age and is influenced by diet and exercise, Lp(a) remains largely constant over a person's lifetime, so a one-time test suffices for screening. Lp(a) testing is becoming more common now that five promising new Lp(a) therapies are in development.

The two main side effects caused by statins are muscle aches (which disappear once the drug is stopped) and a higher risk of diabetes (which is most common in people with obesity and prediabetes).

About 5% of Americans have low-density lipoprotein (LDL) values of 190 mg/dL or higher. Their risk of heart disease is five times higher than people with near-optimal values (less than 130 mg/dL). Some have familial hypercholesterolemia, a genetic condition that can lead to LDL values up to 350 mg/dL (or even higher in some cases). Known as FH, it's a common cause of early heart attacks.

People who have stable angina despite taking medications can be treated with stents or bypass surgery. The best choice depends on the location and complexity of the artery blockages and other health conditions.

High levels of lipoprotein(a), or Lp(a)—a variant of LDL (bad) cholesterol— may triple the risk of a heart attack, even among healthy people with no other known risks for heart disease.

The scientific understanding of HDL cholesterol has evolved in recent years, and many cardiologists now believe that HDL may be more of a bystander rather than a "good guy" that helps lower heart disease risk. While some types of HDL are great at plucking excess cholesterol from LDL and artery walls (a process referred to as reverse cholesterol transport) other types of HDL don't do this. In clinical trials, medications to raise HDL levels—including a drug specifically designed to improve reverse cholesterol transport—have not succeeded in lowering heart attacks and strokes.

People can reduce their LDL cholesterol in three ways. One strategy involves dietary changes, such as eating more fiber-rich foods and swapping saturated fats for unsaturated fat. Another is to take one of several dietary supplements, including psyllium, plant sterols, or red yeast rice. The third entails taking a prescription medication, such as a statin. Many factors can affect whether these different strategies are advisable or useful, including a person's age and other risk factors for heart disease, their current dietary habits, and the quality of the supplements they take.