How Hyperlipidemia Is Treated

Hyperlipidemia means you have too many lipids (or fats), such as cholesterol and triglycerides, in your blood. High cholesterol and triglycerides put you at risk for cardiovascular disease, which can result in heart attack and stroke.

A combination of lifestyle changes, like eating a heart-healthy diet, engaging in routine exercise, and, if necessary, taking a statin or other cholesterol-lowering medication, has been proven to decrease lipid levels and the likelihood of having life-altering medical complications.

This article will discuss lifestyle changes, over-the-counter medications, prescription medications, and complementary and alternative remedies for hyperlipidemia.

Home Remedies and Lifestyle

No matter where you are in your health journey, living a healthy life is the best way to limit your risk of developing heart disease. Limiting your saturated fat and trans fat intake and eating a balanced diet with fruits and vegetables is a great place to start.

Quitting smoking, limiting your alcohol intake, and managing your stress are also important ways to feel your best for the long haul.

Heart-Healthy Diet

To maximize your heart health, you may want to consider making the following changes:

• Use healthier cooking methods: If you prefer to eat meat, try baking, broiling, and roasting it rather than frying. Also, consider trimming any outside fat or skin before cooking and using a nonstick pan or nonstick cooking spray instead of adding fats such as butter or margarine. 
• Look for other sources of protein: Meats are good sources of protein, but beans, tree nuts, peas, and lentils are even better because they offer protein without saturated fat. Fish has less saturated fat. Plant-based protein sources also often contain fiber and other beneficial nutrients.
• Get more fiber in your diet: Add good sources of fiber to your meals, like rolled oats, peas, and ground flaxseed, and substitute whole wheat flour for white flour.
• Eat more fish: Fish has high levels of unsaturated fat and omega-3 fatty acids. These are fats that are good for your heart. Salmon, tuna, mackerel, and sardines are best, but all fish contain some amount of this beneficial fatty acid. To meet your health goals, aim for two six-ounce servings per week.

If you’re looking for a good place to start, try cutting out the late-night snacks or substituting these high-fiber, low-sugar foods for heart-clogging junk food:

• Oats
• Barley and other grains
• Fish, like sardines, tuna, salmon, and mackerel 
• Eggplant and okra
• Nuts
• Apples, grapes, strawberries, and citrus fruits
• Beans
• Soy

Lifestyle

Additional lifestyle changes include losing excess weight to lower your low-density lipoprotein (LDL or LDL-C) “bad” cholesterol levels.

Performing at least 30 minutes of moderate-intensity cardio exercise or weight lifting per day has been shown to reduce LDL levels and increase high-density lipoprotein (HDL or HDL-C) “good” cholesterol levels.

If you have hypertension (high blood pressure) or diabetes alongside your hyperlipidemia, treating it is also an essential step. This not only improves your lipid levels but also decreases your cardiovascular risk.

Over-the-Counter (OTC) Therapies

Over-the-counter medications and supplements are becoming a common adjunctive therapy in cholesterol management. Adjunctive means it is used together with the primary treatment, which is lifestyle changes and perhaps prescription medication.

The most popular supplements are:

• Psyllium husk (brand name Metamucil) or other soluble fiber tablets: Adding this bulk-forming type of fiber to your diet can help you clear extra cholesterol more efficiently.
• Omega-3 fatty acids or fish oil supplements: These are often added to statin therapy for those who need more help reaching their optimal cholesterol levels.
• Niacin, also known as vitamin B3 

Niacin and omega-3 fatty acids raise HDL (good cholesterol) levels. Soluble fiber and psyllium husk provide the added benefit of excreting excess cholesterol from the body and promoting regularity and overall digestive health.

Prescriptions

A simple blood test can reveal whether your cholesterol and triglycerides fall into a healthy range. Optimal levels for triglycerides are less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L).

For LDL, optimal levels are less than 100 mg/dL. For people with heart disease, optimal levels are less than 70 mg/dL.

If you fall in the intermediate range—150 to 199 mg/dL (1.8 to 2.2 mmol/L) for triglycerides and 100 to 129 mg/dL for LDL—you can sometimes reach near-optimal levels with therapeutic lifestyle changes (exercise, weight management, and heart-healthy eating) alone.

Unfortunately, for some people lifestyle changes alone may not be enough to lower cholesterol to healthy levels. This is when medications are needed. Statins are the most commonly used cholesterol-lowering drug for their potent impact and low side effect profile.

Statins

The American Heart Association and other medical organizations recommend that people in the following high-risk groups talk to their doctors about the risks and benefits of statin therapy:

• Adults with a history of cardiovascular disease, including stroke, caused by atherosclerosis
• Those with an LDL level of greater than 190 mg/dL
• Adults 40 to 75 years old with diabetes
• Adults 40 to 75 years old with an LDL level of 70 to 189 mg/dL and a 5% to 19.9% 10-year risk of developing cardiovascular disease from atherosclerosis and risk-enhancing factors
• Adults 40 to 75 years old with an LDL level of 70 to 189 mg/dL and a 20% or greater 10-year risk of developing cardiovascular disease from atherosclerosis

The higher your baseline LDL levels are, the higher your risk is of experiencing a cardiovascular event (such as a heart attack or stroke). Therefore, the strength and type of statin you take will depend on the severity of your hyperlipidemia and how your body responds to the medication.

Generally, the worse your cholesterol levels are, the more potent a statin you will need to dramatically lower your levels. 

Statin therapy is divided into three categories of intensity:

High-intensity, aiming for at least a 50% reduction in LDL:

Moderate-intensity, aiming for a 30% to 49% reduction in LDL:

• Altoprev or Mevacor (lovastatin): 40 to 80 mg daily
• Crestor (rosuvastatin): 5 to 10 mg daily
• Lescol (fluvastatin): 80 mg daily
• Lipitor (atorvastatin): 10 to 20 mg daily
• Livalo (pitavastatin): 1 to 4 mg daily
• Pravachol (pravastatin): 40 to 80 mg daily
• Zocor (simvastatin): 20 to 40 mg daily

Low-intensity, aiming for an LDL reduction of less than 30%:

• Altoprev or Mevacor (lovastatin): 20 mg daily
• Lescol (fluvastatin): 20 to 40 mg daily
• Pravachol (pravastatin): 10 to 20 mg daily
• Zocor (simvastatin): 10 mg daily

Muscle pain and an increase in the enzyme levels that signal liver damage are two side effects, but they are not common. But generally, statins should not be discontinued unless your symptoms persist or it is otherwise specified by a healthcare professional.

Other Medications

Fish oils that are chemically changed and purified can be taken in prescription form. Lovaza, Epanova, and Vascepa are prescription forms of omega-3s.

Non-statin drugs such as Zetia (ezetimibe) and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can be added to statin therapy or used alone to lower cholesterol levels.

PCSK9 inhibitors, such as Repatha (evolocumab) and Praluent (alirocumab), lower LDL by 50% to 60% by binding to the PCSK9 protein, which inhibits labeling of LDL receptors for degradation.

The addition of ezetimibe or PCSK9 inhibitors to moderate- or high-intensity statin therapy in patients with stable atherosclerotic cardiovascular disease or recent acute coronary syndromes lowers LDL-C levels by as much as 20%.

PCSK9 inhibitors are most commonly used for those with heterozygous familial hypercholesterolemia, an inherited condition that causes chronically high cholesterol levels, or clinical atherosclerotic cardiovascular disease (ASCVD) when additional lowering of LDL is needed.

Some studies have found that adenosine triphosphate-citrate lyase (ACL) inhibitors, which block cholesterol production from the liver, may be used in place of PCSK9 inhibitors. But they are not in the current guidelines on the management of blood cholesterol, as they were approved by the Food and Drug Administration (FDA) in 2020.

Surgeries and Specialist-Driven Procedures

For those with genetic conditions such as familial hypercholesterolemia (FH), following a strict heart-healthy diet and taking medication may not adequately lower LDL levels. This small subset of people may have to undergo lipoprotein apheresis—a blood-filtering treatment that removes LDL from the blood and returns it back to the person.

Complementary and Alternative Medicine (CAM)

The following supplements have been proven to help improve your cholesterol levels. They are often used as adjunctive medications to statin therapy. Some examples include:

Plant sterols and stanols stop your body from absorbing cholesterol. They are often added to foods such as margarines and spreads, orange juice, and yogurt, but they may also be taken as supplements.

Red yeast rice, a common seasoning in Asian countries, contains monacolin K, a chemical that’s identical to the active ingredient in the cholesterol-lowering drug lovastatin. Red yeast rice lowers your total blood cholesterol, LDL, and triglyceride level.

It is generally considered safe, but side effects of abdominal discomfort, heartburn, gas, headache, and dizziness have been reported. Check the safety and efficacy of red yeast supplements with your doctor. If they approve, be sure to take the recommended dose of 1,200 milligrams twice a day to get maximum cholesterol-lowering benefits.

Soy has been shown to reduce LDL cholesterol levels.

Summary

Hyperlipidemia is treated by diet and lifestyle changes. If these do not reduce cholesterol and triglycerides to an acceptable level, medication such as a statin may be prescribed as well. Supplements may be used as an additional measure.

A Word From Verywell

Elevated lipid levels are bad for your blood vessels. If left unchecked, it may lead to atherosclerosis, which can morph into full-blown heart disease.

Getting plenty of exercise, eating a heart-healthy diet, quitting smoking, and treating underlying health conditions like hypertension and diabetes are essential to lowering your cardiovascular risk.

Limiting your red meat intake and dairy can also keep your lipid levels in a healthy range, especially if you have a family history of high lipid levels or heart disease.