Drug treatment for cholesterol

How do I know if I should have drug treatment for raised cholesterol?

If you already have cardiovascular disease (CVD) or have the genetic form of high cholesterol, then you should be prescribed cholesterol drug treatment as we know this reduces your chance of more health problems. This treatment is needed irrespective of your cholesterol level as lipid treatments work in additional ways to help reduce your risk of CVD.
If you don’t have CVD but are over 40 or have another long term condition that may increase your chance of developing CVD, then your doctor or nurse will use your cholesterol result, combined with other information, including your blood pressure, BMI and other health problems, to calculate your CVD risk. CVD risk is measured using an approved online calculator, usually QRISK®3. If your CVD risk is more than 10% then you should be offered drug treatment for your cholesterol. You can also check out your own lifetime risk of developing CVD by accessing QRISK®3-lifetime; this can help if you are currently low risk and want to understand how your risk increases with age, or if you are high risk and want to check how this can decrease by improving your lifestyle.
Cholesterol lowering treatments are only effective whilst being taken and their effect reduces quickly on stopping, so medication is usually continued long term as it will continue to provide benefit through a normal lifespan.

Which drug treatments are recommended?

Statins are amongst the most common drug treatment and are used world-wide, and we know they are safe and work well. The two most effective and currently recommended statins are Atorvastatin and Rosuvastatin; others are less effective and generally less used now.

Cholesterol drug treatment cannot make you feel better as having a high cholesterol gives no symptoms. If you experience side effects with a statin it is possible to change the dose, preparation, or frequency of taking the tablets to try and improve how you feel on the medication. It’s important to remember as the number one prescribed medication world-wide, that most people have no problems at all taking statins.

When you start a statin, you will have a routine blood test after 3 months and then usually annually or sooner if the dose needs to be increased to achieve target cholesterol levels. Furthermore, if you don’t achieve target levels using a statin, there are other medications available now to help people achieve a better cholesterol and reduced risk of CVD. Newer medications are only prescribed if you can’t reach target cholesterol levels using a statin. There are injectable cholesterol treatments too, Inclisiran is an option for people who already have CVD.

NICE (National Institute for Health and Care Excellence) have a patient decision aid to help understand what to expect from using a statin.