High LDL Cholesterol? Understanding Your Treatment Options

High cholesterol is more than a number on your lab report. Over time, high LDL cholesterol can contribute to plaque buildup in your arteries and increase your risk of heart attack and stroke.

Lifestyle plays an important role in heart health. Good nutrition, regular exercise, a healthy body composition, avoiding tobacco, and managing blood pressure and blood sugar can all lower cardiovascular risk. Genetics also strongly influence cholesterol, so healthy habits are not always enough.

Fortunately, we now have more ways than ever to lower LDL and protect long-term heart health.

Why We Care About Cholesterol at Flow Wellness

At Flow Wellness, longevity means helping you stay healthier longer.

Cardiovascular disease often develops quietly for years before symptoms appear. Finding risk early gives us an opportunity to address it before it becomes a bigger problem.

For that reason, we may look beyond a standard cholesterol panel. Tests such as LDL, ApoB, Lp(a), triglycerides, blood sugar, and insulin can provide a more complete picture. We also consider blood pressure, family history, lifestyle, and body composition. For some patients, a coronary artery calcium (CAC) scan can show whether calcified plaque has already formed in the arteries of the heart.

Our goal goes beyond improving your lab results. We want to reduce your lifetime risk of cardiovascular disease.

Statins

Statins are usually the first medications considered when LDL needs to come down. Common options include rosuvastatin (Crestor®) and atorvastatin (Lipitor®).

Depending on the medication and dose, statins can lower LDL by approximately 20% to more than 50%. Decades of research also show that statins can reduce heart attacks and strokes in people who benefit from treatment.

Experiencing side effects does not always mean statins are completely off the table. A lower dose or a different statin may work better.

Ezetimibe

Ezetimibe (Zetia®) lowers the amount of cholesterol your digestive tract absorbs.

This once-daily pill can lower LDL by around 18% when used alone. Combining it with a statin can lower LDL even further.

Because ezetimibe is available as an inexpensive generic and is generally well tolerated, it can be a useful option for people who cannot tolerate statins or need additional LDL lowering.

PCSK9 Inhibitors

Repatha® (evolocumab) and Praluent® (alirocumab) help your liver remove more LDL from your bloodstream.

These injectable medications can lower LDL by approximately 50% to 60%. Providers may consider them for people with cardiovascular disease, inherited high cholesterol, very high cardiovascular risk, or LDL that remains elevated despite other treatment.

Inclisiran

Inclisiran (Leqvio®) also targets PCSK9, but it uses a different approach to reduce LDL.

Treatment starts with an injection, followed by another dose three months later and then approximately every six months.

LDL reductions of around 50% make inclisiran an appealing option for some patients who need significant cholesterol lowering without taking a daily medication.

Bempedoic Acid

Bempedoic acid (Nexletol®) offers another oral option for lowering cholesterol.

Taken alone, it can lower LDL by approximately 20% to 25%. Combining it with ezetimibe can produce an even greater reduction.

People who cannot tolerate statins may particularly benefit from this option. However, your provider may recommend something else if you have a history of gout or certain tendon problems.

What About Triglycerides?

Triglycerides are different from LDL, but they also provide important information about cardiovascular and metabolic health.

Several factors can raise triglycerides, including insulin resistance, high blood sugar, nutrition, alcohol intake, excess body fat, and genetics.

Treatment depends on the cause. Improving nutrition, exercise, body composition, and metabolic health may help. Some patients may also benefit from statins, prescription omega-3 medications, or medications such as fenofibrate.

Looking Beyond LDL

A standard cholesterol panel does not tell the whole story.

ApoB helps us estimate the number of cholesterol-containing particles that can enter artery walls and contribute to plaque.

Lp(a) is a largely inherited cardiovascular risk factor. Because genetics primarily determine your level, most people only need to have Lp(a) measured once.

A coronary artery calcium (CAC) scan can add another important piece of information. When appropriate, this quick imaging test can show whether calcified plaque has already developed in the arteries that supply your heart.

Together, these tools help us better understand your cardiovascular risk and decide how aggressively to treat it.

What’s Next for Cholesterol Treatment?

Cardiovascular medicine is moving quickly, and some of the most interesting advances target risks that have traditionally been difficult to treat.

Researchers are developing medications specifically for Lp(a). Currently, no FDA-approved medication specifically targets Lp(a), but several promising treatments are in clinical trials.

Lepodisiran is an injectable treatment designed to dramatically reduce the body’s production of Lp(a). Clinical trials have produced reductions of more than 90%. Researchers are now studying whether lowering Lp(a) this much can prevent heart attacks, strokes, and other cardiovascular events.

Muvalaplin takes a different approach. This daily oral medication is designed specifically to lower Lp(a), and researchers are studying whether it can improve cardiovascular outcomes.

Other emerging treatments include oral PCSK9 medications, gene-editing therapies, and medications targeting ApoC-III and ANGPTL3.

At Flow Wellness, we are committed to innovation in medicine and to bringing evidence-based advances into patient care as they become available. We continually follow new research so we can offer patients better ways to understand and manage their long-term health.