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Key takeaways:
- An Ohio State University Wexner Medical Center survey shows 61% of Americans don’t know there are other medicines besides statins to help lower cholesterol.
- Other survey results show many haven’t heard about an inherited cholesterol called lipoprotein(a) or a test called coronary artery calcium score, which can show early signs of heart disease.
- It’s important to get your cholesterol and heart numbers checked, even if you feel fine, because you could be at risk for heart problems without knowing it.
COLUMBUS, Ohio – Unhealthy cholesterol levels are a major risk factor for heart disease and stroke. When lifestyle changes like diet and exercise aren’t enough to lower cholesterol, medications can help. A new national survey commissioned by The Ohio State University Wexner Medical Center shows that while most Americans have heard of statins – the most common medicine used to lower cholesterol – many do not know there are non-statin medications.
“Statins often get a bad reputation, but the evidence consistently shows they are highly effective and remain the cornerstone of cholesterol treatment and lowering heart disease risk. At the same time, we now have non-statin medication options that can also help lower LDL – the ‘bad’ cholesterol – for patients who need alternative therapies,” said Laxmi Mehta, MD, director of Preventative Cardiology and Women’s Cardiovascular Health at the Ohio State Wexner Medical Center and Sarah Ross Soter Endowed Chair for Women’s Cardiovascular Health Research.
Ohio State’s nationwide survey of 1,006 Americans about cholesterol medications and screenings found:
- 60% have heard of statins
- 61% didn’t know non-statin medicines exist
- 44% believe statins are an effective and proven treatment for lowering cholesterol
- 73% have never heard of lipoprotein(a), an inherited type of cholesterol that can’t be lowered by usual medication or lifestyle changes
- 67% didn’t know about the coronary artery calcium score (CAC), a scan that shows early signs of heart disease.
“Cardiovascular disease is the No. 1 killer of Americans. It’s also impacting people in their 20s and 30s much sooner than it has in the past for various reasons including a surge in risk factors such as high blood pressure, diabetes and high cholesterol. Lifestyle contributors like poor diet, physical inactivity, substance use and vaping are also playing a significant role,” Mehta said. “Most people don’t know their cholesterol or other heart numbers unless they are checked. They may feel normal but be at risk, which is why routine testing is so important.”
Non-statin medications are available in oral or injectable forms
Mehta recommends non-statin medication for patients who can’t tolerate the side effects of statins, need more LDL cholesterol lowering than statins alone can provide and have elevated atherosclerosis (buildup of fats and cholesterol in the arteries) or risk modifiers such as elevated lipoprotein(a). Sometimes these medications are used in combination with statins for optimal cholesterol management, Mehta said.
Examples of non-statin medications that reduce cardiovascular events in high risk patients are:
- Ezetimibe: An oral medication that blocks cholesterol absorption at the intestinal level, reducing LDL cholesterol by 18–25%.
- PCSK9 Inhibitors: A highly potent injectable medication, administered every two to four weeks that can lower LDL cholesterol by 45–64%.
- Inclisiran: An injectable medication, administered twice a year after the initial doses, which can reduce LDL cholesterol by about 50%.
- Bempedoic Acid: An oral medication, particularly for people who are intolerant to statins, used to help lower LDL cholesterol by 21-24%.
What to know about lipoprotein(a) and coronary artery calcium score
Mehta and other cardiologists have been trying to raise awareness about lipoprotein(a), also known as Lp(a). It’s an inherited heart risk that can’t be lowered by lifestyle changes. Newer medications to lower the levels are currently under research trials. High levels of Lp(a) can contribute to atherosclerosis as well as inflammation and increased clotting. Lp(a) affects about 1 in 5 people worldwide.
The Centers for Disease Control suggests screening patients who have had a heart attack, stroke or coronary artery disease before age 55 for men or 65 for women without known risk factors like high LDL, smoking, diabetes or obesity. Testing is also recommended for those with male family members who had a heart attack or stroke before age 55 or age 65 for female family members.
“If someone has an elevated Lp(a) level, their children have a 50% chance of inheriting it,” Mehta said. “If patients have elevated Lp(a) levels, they need to be on LDL lowering therapies to reduce their overall cardiovascular disease risk.”
A coronary CT calcium scan detects calcium (plaque) deposits in the heart arteries, which can help doctors diagnose patients with coronary heart disease (hardening of the arteries) in its earlier stages. Also known as a heart scan or calcium score, it can be useful for those age 40-65 who don’t show signs of heart problems but have several risk factors such as high cholesterol levels, family history of coronary heart disease, diabetes or smoking.
Lifestyle changes weren’t enough for patient with high cholesterol
One of Mehta’s patients, Toni Gundling, resisted going on cholesterol-lowering medication for years, thinking her healthy lifestyle was enough even though high cholesterol ran in her family. Her father had the first of two quadruple bypass surgeries when he was in his 40s, and her younger brother had a triple bypass. She has underlying coronary artery calcification as well as elevated levels of Lp(a), Mehta said.
“We can’t run away from our genetics,” said Gundling, 69. “I tried everything – exercise and healthy eating – but it wasn’t enough. I’m a personal trainer and had clients talk about the reactions they had from statins. But going on medication helped reduce what I can’t fix on my own, and I’ve had no reaction to the statin I’m on.”
When a statin didn’t lower Gundling’s LDL levels enough, Mehta added the non-statin ezetimibe, which worked but caused some side effects. Gundling has been working with Mehta to figure out what medications work best for her.
“Not everyone can take the same pill. You have to find what works for you,” Gundling said. “I would wholeheartedly tell somebody to go on a statin because it’s not what you may think it is. It’s given me peace of mind to know that not only am I doing something to help my health but the medication is helping reduce what I physically can’t do.”
