This section of the website is for UK healthcare professionals only. If you are not a healthcare professional, please click here.
This section of the website is for UK healthcare professionals only. If you are not a healthcare professional, please click here.

This section of the website is for members of the public. If you are a healthcare professional,  visit the HCP section of the site. This website is not intended to replace the advice of a healthcare professional. You should consult your doctor or another suitably trained healthcare provider when considering what type of treatment is most appropriate for you.

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High cholesterol and its treatment

This web page is to help you understand why it is important to lower high cholesterol and how a healthy lifestyle, including diet and cholesterol lowering medication can help improve your heart health.

Also included is information about medications to treat high cholesterol.

About coronary heart disease

High cholesterol is linked to the development of coronary heart disease (CHD) and can lead to an early death if not treated.

Brief information about CHD caused by high cholesterol is provided here. For further information about high cholesterol, CHD and available treatments, please follow the links below.

British Heart Foundation
The British Heart Foundation (BHF) is a charity that provides advice on how to prevent CHD and improve heart health.

HEART UK
HEART UK is a charity that advocates lowering high cholesterol to prevent premature death from cardiovascular disease.

NHS Choices – High Cholesterol
Information about high cholesterol provided by the National Health Service

NHS Choices – Coronary Heart Disease
Information about CHD provided by the National Health Service.

What is CHD?

CHD is a type of heart disease that affects the blood vessels (the coronary arteries) that supply the heart with blood. As CHD affects the coronary arteries, it may also be called coronary artery disease.

What causes CHD?

When there is too much cholesterol in the blood – due to dietary intake or a genetic condition – excess fat may be deposited in the walls of the blood vessels causing them to narrow.

In time, these fatty deposits, together with blood clots that may form over the top, can reduce or even prevent blood flow to the heart muscle and can cause chest pain (angina) and heart attacks if not treated.

What are the symptoms of CHD?

CHD symptoms vary by individual, but may include some of the following:

  • Chest pain (angina)
  • Breathlessness
  • Arm pain
  • Neck pain
  • Sweating
  • fom
  • Feeling light-headed

How many people have CHD?

Heart disease is the most common cause of death around the world. According to the British Heart Foundation, there are around 2.3 million people living with CHD in the UK.

What are the risk factors for CHD?

High cholesterol (hypercholesterolaemia), along with high blood pressure (hypertension), obesity, smoking and physical inactivity and eating a poor diet are some of the major modifiable risk factors that can increase the risk of CHD.

Other factors that may increase the risk of CHD are older age, family history, diabetes and ethnicity.

Treatment of CHD therefore aims to lower the impact of all these risk factors, which can have additive effects.

How is high cholesterol treated?

Treatment for high cholesterol involves living a heart-healthy lifestyle. This means eating a low-fat diet and undertaking regular exercise and physical activity.

In addition to these important lifestyle changes, there are several types of medications that may be used in patients with high cholesterol. Cholesterol lowering treatments used in the UK include:

Bile acid sequestrants

What do they do?
Bile sequestrants are used to lower your body’s level of cholesterol by working in the digestive system to absorb the cholesterol-containing bile acids, which then pass out through the body in the faeces.

How effective are they?
Bile acid sequestrants can effectively lower cholesterol but can increase the severity of some side effects associated with high triglycerides, such as pancreatitis.

Possible side effects
Bile acid sequestrants are not absorbed by the gut so can cause gastrointestinal problems such as diarrhoea, nausea, vomiting and general gastrointestinal discomfort.

Cholesterol absorption inhibitors

What do they do?
Cholesterol absorption inhibitors block the absorption of cholesterol into the blood stream from the small intestine. The cholesterol-lowering effect is enhanced when used in combination with a statin. Cholesterol absorption inhibitors can also be used alone when patients cannot take statins.

How effective are they?
Cholesterol absorption inhibitors are most commonly used in combination with a statin and have been shown to lower cholesterol levels.

Possible side effects
Cholesterol absorption inhibitors are generally well tolerated but, as with all medicines, may cause side effects in some people. Side effects may include gastrointestinal disturbances such as abdominal pain, diarrhoea or flatulence, headache, feeling tired, muscle pain, tenderness or weakness and potential elevation in some laboratory blood tests or liver function.

Fibrates

What do they do?
Fibrates are used to lower the level of fats such as triglycerides in the blood alongside a low fat diet and other non-medical treatments such as exercise and weight loss. These medicines may also be used in addition to other medicines such as statins in some circumstances when levels of fats in the blood are not controlled with a statin alone.

How effective are they?
Fibrates are an old and established treatment. They are effective in lowering triglycerides and raising HDL-C, as well as having small and variable cholesterol-lowering effects.

Possible side effects
Fibrates are generally well tolerated but may cause gastrointestinal discomfort, nausea, headache and skin rash. Rarely, liver disturbances or muscle aches occur.

Omega-3 fatty acids (fish oil)

What do they do?
Omega-3 fatty acids are found in oily fish such as tuna, salmon and mackerel. Medicines containing purified fish oils are available and can help to lower levels of triglycerides, which is important in patients with high cholesterol.

How effective are they?
Omega-3 fatty acids can lower triglycerides in some people who are unable to lower these through dietary changes alone. Medicinal preparations are generally considered adjunctive therapy and are used in combination with other lipid-lowering drugs (e.g. statins).

Possible side effects
Omega-3 fatty acids are generally well tolerated but may cause gastrointestinal upset and nausea in some patients.

PCSK9 inhibitors

What do they do?
PCSK9 inhibitors are injectable prescription medicines that act on the PCSK9 protein, which is produced by liver cells. Inhibition of this protein lowers cholesterol

How effective are they?
PCSK9 inhibitors cut LDL cholesterol levels by more than half. They are also effective alongside other cholesterol lowering treatments such as statins.

Possible side effects
PCSK9 inhibitors appear to be generally well tolerated. The most common side effects include: redness, itching, swelling, or pain/ tenderness at the injection site, symptoms of the common cold, flu or flu-like symptoms, rash, nausea, back pain and joint pain.

Statins

What do they do?
Statins block an enzyme produced by the liver called HMG-CoA reductase and are sometimes called HMG-CoA reductase inhibitors. This enzyme is important for cholesterol production so inhibiting its activity can help to reduce cholesterol levels.

How effective are they?
Statins have been shown to lower cholesterol in multiple clinical trials and in routine daily practice and thus reduce the chances of having a heart attack or premature death due to coronary heart disease.

Possible side effects
Statins are generally well tolerated but may cause muscle pain. They may also damage the liver with prolonged use, so patients need to be monitored for this potential side effect.


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