Do You Have High Cholesterol? What You Need to Know to Lower Your Risk of Heart Disease

By JoAnne Foody, MD, FACC, FAHA, Chief Medical Officer, Esperion

While most people are likely familiar with and know someone impacted by cardiovascular (heart) disease, many don’t know that it is the leading killer of men and women in this country.

Many so-called “risk factors” increase the chance that someone will have cardiovascular disease, which includes heart attacks and strokes and affects hundreds of millions of people, but one of the most common is high cholesterol — specifically the type known as low-density lipoprotein (LDL), or “bad,” cholesterol. This type of cholesterol is dangerous because it collects inside blood vessels and hardens as plaque, making it difficult for blood to flow through arteries. When the plaque is irritated or inflamed, a blood clot can form in the blood vessel, depriving the brain and heart of oxygen, causing a heart attack or stroke.

An estimated 93 million American adults have a cholesterol level above the recommended limit. People most likely to have high cholesterol are those who smoke, drink excess alcohol, have obesity, diabetes or a family history of high cholesterol, or aren’t active.

The most commonly prescribed cholesterol-lowering medicines are statins. Approved by the U.S. Food and Drug Administration, or FDA, statins are very effective in lowering cholesterol and have been proven to significantly reduce the risk of having a cardiovascular event and even dying from a cardiovascular event. In fact, statins have been considered the standard of care for treating high cholesterol for many years.

Challenges associated with taking statins

Unfortunately, statins are not appropriate for all people with high cholesterol. As many as 30% of patients do not tolerate statins because of serious side effects, particularly muscle pain or weakness. Other patients don’t have side effects from statins but can’t get their cholesterol level down low enough to reduce their risk of a cardiovascular event.

Lowering cholesterol is important both for primary and secondary prevention of cardiovascular disease. Primary prevention means preventing heart disease in people who have not had a prior heart attack, stroke or other cardiovascular event but are at high risk of having one. Secondary prevention means preventing a cardiovascular event in someone who already has existing heart disease.

However, in the United States, primary prevention patients are currently under-treated when it comes to cholesterol lowering. Research shows that half of people at high risk of having a cardiovascular event are not currently receiving cholesterol-lowering drugs.

Statins remain the gold standard when it comes to the first medicine doctors prescribe both for patients who have already had and those who have not yet had a cardiovascular event. But for those patients who can’t tolerate statins or can’t get their cholesterol low enough to meet their goal, it is important to know about other treatment options.

A recent analysis from a Cleveland Clinic-led clinical trial of nearly 14,000 patients showed the use of another cholesterol-lowering treatment in statin-intolerant patients who had not had a cardiovascular event but who had risk factors, such as diabetes, significantly reduced the chance of major adverse cardiovascular events, including:

  • heart attacks
  • strokes
  • a procedure to put a stent in a blocked coronary artery
  • death from cardiovascular disease

If you have high cholesterol and could benefit from lowering your cholesterol but can’t take a statin, talk to your doctor about treatment options for managing your high cholesterol and reducing your cardiovascular risk.

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