One-Third of Americans Don’t Control High Cholesterol

One-Third of Americans Don’t Control High Cholesterol

High LDL cholesterol can have a serious impact on your heart health. Follow these simple steps to help lower it.

One of the main ways to protect yourself from atherosclerosis—hardening of the arteries that can lead to stroke or heart attack—is to control your cholesterol. So why aren’t more people doing it?

A 2015 report from the Centers for Disease Control and Prevention (CDC) found that approximately 78 million people age 21 and up were on cholesterol treatment or eligible for it. Within this group, a little more than a third of the people took cholesterol-lowering medication and made lifestyle changes, such as improving their diet and exercising, to control their cholesterol; a little less than a third did one or the other. But the remaining one-third took no steps at all to improve cholesterol.

Women were more likely than men to take medication to control their cholesterol, and whites were more likely than Hispanics and African Americans to do the same. The older a person was the more likely he or she was to control high cholesterol with medication. The study did not break down demographics for people making lifestyle changes, but was one of the first studies to look at gender and racial differences in medication use.

A wake-up call
High cholesterol can lead to atherosclerosis, which is plaque buildup in the arteries. If the plaque ruptures, a blood clot forms on it, then blocks blood flow or breaks off and travels elsewhere in the body such as your brain, heart or lungs.

Guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) recommend five ways to control cholesterol: eating a heart-healthy diet, regular exercise, not smoking, maintaining a healthy weight and taking cholesterol-lowering medication. Optimally lifestyle changes should be made both before and in conjunction with medication. “If I had to have a patient choose between lifestyle changes and medications, I’d tell them to change their lifestyle almost every time,” says Keith Roach, MD, Sharecare’s chief medical officer. “But lifestyle changes with medication are synergistic. You’ll get more out of doing both than one or the other.”

Simple steps to boost heart health
While starting a cholesterol-lowering medication is an easy fix, making lifestyle changes can be more challenging. Here’s a breakdown of ways you can improve your health and lower cholesterol:

Improve your diet
If you tend to eat a lot of fast and processed foods, desserts and sweetened drinks, Dr. Roach says to start small when it comes to eating better. “I tell people to find the worst thing in their diet and change that,” he says. “If someone really likes hamburgers and eats two or three a week, I try to get them to change it to once a week. Making small changes incrementally, that works.”

If diet is one part of the lifestyle change equation, exercise is the other. A 2014 review of some 13 previous studies showed that cardiovascular exercise, such as jogging or biking, raised HDL cholesterol (think “H” for “healthy”) and lowered “bad” LDL cholesterol. Low to moderate-intensity resistance training, such as weight lifting and bodyweight exercises, had similar benefits.

Maintain a healthy weight 
A 2010 study of more than 2,000 people showed that the higher a person’s body mass index (BMI), the higher their cholesterol tends to be. BMI is a ratio of height compared to weight, and a healthy BMI is between 18.5 and 24.9. The best way to control your BMI? Diet and exercise. Follow the two tips above and you’ll be well on your way to a healthy weight and a healthy heart.

Consider medication
Statins are a popular and effective medication used for lowering cholesterol. But some 5 to 20 percent of patients who have taken statins find them intolerable, reporting muscle pain and cramping so severe that they stop taking the drug. Statin-intolerance has been controversial since it’s not always clear whether the statin is the source of the aches and pains. But a 2016 study published in The Journal of the American Medical Association found that some patients did, in fact, suffer serious muscle pain when taking a statin. In the study, participants were alternately given a statin and a placebo. Of those, 43 percent reported muscle aches when taking statins but not the placebo. In the second stage of the study participants with muscle aches were given one of two non-statin drugs, ezetemibe or evolocumab.

The researchers found that evolocumab lowered LDL cholesterol by an average 54.5 percent, compared with 17 percent for the other drug; some still reported muscle aches. Evolocumab can be an alternative for people who can’t or won’t take statins, but it’s much more expensive: about $14,000 wholesale for a year’s worth, according to the drug maker. Out-of-pocket costs to patients will vary, depending on insurance and whether patients qualify for financial assistance.

Give it time
Whether you’re using lifestyle changes, medication or both to control your cholesterol, it takes time and effort to see results. “I can’t tell you how many people come to see me after 30 days of taking medication and think they’re cured,” says Roach. “It takes time to accrue, about a year before it’s as effective as it’s supposed to be.”

Medically reviewed in October 2018.

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