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Among the effective options to reduce "bad" low-density lipoprotein (LDL) cholesterol levels, statins are the cornerstone of treatment.

These drugs reduce the cholesterol your body makes and help clear out LDL in your blood vessels where they can leave dangerous deposits that lead to blocked arteries, heart attacks, and strokes.

Risk prediction tools that take into account your cholesterol numbers, age, and sex help guide decisions by estimating the risk that you will develop atherosclerotic cardiovascular disease (ASCVD), such as a heart attack, over the next 10 years.

If your 10-year risk of ASCVD is 7.5% or more, you are generally recommended to start taking a statin. If your 10-year risk is at least 5% with an LDL cholesterol level of 70-189 mg/dL or if you already have ASCVD or diabetes, you would also likely benefit from a statin. A family history of early heart disease, chronic kidney disease, and other factors may also play into the decision to start on cholesterol-lowering medication.

If the risk decision remains uncertain, a coronary artery calcium (CAC) scan might be helpful. Finding a level of zero can move the decision toward no statin treatment, while anything higher favors taking a statin, especially after age 55.

Statins can reduce LDL levels by up to 49% at higher doses, and each 1% reduction cuts your ASCVD risk by about 1%. Experts recommend taking the maximally tolerated dose to reduce risk as much as possible.

Other types of medication that can lower cholesterol levels are:

• Ezetimibe (Zetia), which blocks absorption of cholesterol in the intestines and lowers LDL cholesterol by 13-20% when added to a statin

• Bile acid sequestrants like colesevelam, colestipol, and cholestyramine, which bind to bile acids in the intestines, get rid of cholesterol in the body and typically reduce LDL levels by 15-30%

• PCSK9 inhibitors -- alirocumab (Praluent), evolocumab (Repatha), and inclisiran (Leqvio) -- are injections that keep LDL receptors free to bind to LDL cholesterol and keep it out of the blood vessels, which can dramatically lower LDL levels by 43-46% when added to a statin

• Bempedoic acid (Nexletol) and its combination with ezetimibe (Nexlizet) target cholesterol in a way similar to how a statin works by helping clear LDL cholesterol from the circulation

Treatment usually starts with a statin at the level expected to bring your cholesterol level down to a healthy range. The dose is increased or other types of drugs are added from there to achieve that target.

Read previous installments in this series:

For Your Patients: Hypercholesterolemia: Understanding Your Diagnosis

For Your Patients: Why Do High Cholesterol Levels Matter?

For Your Patients: Who Gets Hypercholesterolemia?

For Your Patients: Screening and Diagnosis of High Cholesterol

For Your Patients: Understanding Inherited Cholesterol Disorders

For Your Patients: Daily Choices That Help Tackle Hypercholesterolemia

For Your Patients: What About Alternative Treatments and Supplements?

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.