Cardiovascular

Medicines for High cholesterol

Raised levels of harmful blood fats — chiefly LDL cholesterol — that build up in artery walls and increase the risk of heart attack and stroke, managed with lifestyle change and, where risk warrants it, cholesterol-lowering medicines.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is High cholesterol?

Cholesterol is a fatty substance the body needs, but too much of the harmful type — low-density lipoprotein (LDL) cholesterol — encourages fatty deposits to build up inside artery walls, narrowing them and raising the risk of heart attack, stroke and peripheral arterial disease. High cholesterol usually causes no symptoms and is found on a blood test, often as part of a wider check of cardiovascular risk.

  • How it is treated: The goal is to lower LDL cholesterol and, more broadly, to reduce the lifetime risk of cardiovascular events.
  • Self-care: A diet lower in saturated fat, more fibre, oily fish, a healthy weight, regular activity, less alcohol and stopping smoking all lower harmful cholesterol and cardiovascular risk, and can reduce how much medication is needed.
  • When to seek help: Chest pain, sudden breathlessness or signs of a stroke (face drooping, arm weakness, slurred speech) are emergencies — call 999.

What it is

Cholesterol is a fatty substance the body needs, but too much of the harmful type — low-density lipoprotein (LDL) cholesterol — encourages fatty deposits to build up inside artery walls, narrowing them and raising the risk of heart attack, stroke and peripheral arterial disease. High cholesterol usually causes no symptoms and is found on a blood test, often as part of a wider check of cardiovascular risk. Levels are influenced by diet, weight, activity, alcohol and genetics, and an inherited form called familial hypercholesterolaemia causes very high LDL from a young age. A high reading is rarely treated in isolation: it is weighed alongside blood pressure, smoking, diabetes, age and family history to estimate overall cardiovascular risk, which then guides how strongly to treat. Triglycerides, another blood fat, are also measured and managed where they are markedly raised.

How it is treated

The goal is to lower LDL cholesterol and, more broadly, to reduce the lifetime risk of cardiovascular events. Lifestyle measures come first and continue alongside any medicine. When the estimated risk is high enough — or where someone already has heart or vascular disease (secondary prevention) — a statin is the usual first medicine, and the choice and intensity are matched to the level of risk. Response is checked with a follow-up blood test, and if the LDL target is not reached, ezetimibe is commonly added before considering specialist injectable options. Treatment is tailored to the individual, taking account of other conditions, tolerability and the type of lipid problem, with raised triglycerides sometimes needing a different agent. Treatment is generally long-term, since the benefit comes from sustained lowering.

For this condition, these medicines

Medicine classes used for High cholesterol

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

Statins Cardiovascular First-line therapy; they reduce the liver's production of cholesterol, lower LDL and have strong evidence for cutting heart attacks and strokes. Ezetimibe Cardiovascular Reduces cholesterol absorbed from the gut; added when a statin alone does not reach target, or used when a statin is not tolerated. PCSK9 inhibitors Cardiovascular Injectable agents that lower LDL substantially; used under specialist guidance in very high-risk people and familial hypercholesterolaemia. Fibrates Cardiovascular Used mainly to lower markedly raised triglycerides rather than LDL cholesterol. Bile-acid sequestrants Cardiovascular Bind bile acids in the gut to lower cholesterol; an adjunct or option where other agents are unsuitable.

Symptom checker

Symptoms that can point to High cholesterol

High cholesterol can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

Pulsating lump in the abdomenA throbbing or pulsating feeling, or a visible lump, in the centre of the tummy that beats…

Clinical formulas & tools

Calculators used in High cholesterol

Risk scores and formulas that inform assessment and treatment decisions in this condition:

Body Mass Index (BMI)Weight-for-height screening measure.

By active ingredient

Specific medicines used for High cholesterol

Dose-free guides to individual active ingredients used in high cholesterol — what each is, how it works, how to take it, and its advantages and disadvantages:

AtorvastatinA widely used statin that lowers LDL ("bad") cholesterol to reduce the risk of heart attac…SimvastatinA long-established statin that lowers LDL ("bad") cholesterol to reduce the risk of heart …RosuvastatinA potent statin that strongly lowers LDL ("bad") cholesterol to reduce the risk of heart a…PravastatinA statin that lowers LDL ("bad") cholesterol and is notable for having fewer drug interact…FenofibrateA fibrate used mainly to lower high triglycerides (a type of blood fat); it can cause musc…BezafibrateA fibrate used mainly to lower high triglycerides (a type of blood fat); it can cause musc…ColestyramineA powder mixed with water or juice that lowers cholesterol by binding bile acids in the gu…FluvastatinA statin that lowers LDL ("bad") cholesterol to reduce the risk of heart attack and stroke…ColesevelamA bile-acid sequestrant that lowers cholesterol by binding bile acids in the gut; it must …PitavastatinA statin taken once a day to lower 'bad' LDL cholesterol and cut the risk of heart attack …Bempedoic acidAn oral medicine that lowers LDL (bad) cholesterol, used when statins are not tolerated or…InclisiranAn injection given by a healthcare professional that lowers LDL cholesterol and, after sta…Icosapent ethylA purified fish-oil (EPA) capsule used to reduce cardiovascular risk in people with high t…ColestipolA medicine that lowers cholesterol by binding bile acids in the gut, often used when other…AcipimoxA nicotinic-acid-related medicine used to lower high triglycerides and cholesterol in sele…LovastatinA statin used to lower cholesterol and reduce the risk of heart attacks and strokes.…GemfibrozilA fibrate medicine used to lower high levels of blood fats, especially triglycerides.…LomitapideA specialist cholesterol-lowering medicine used for a rare inherited condition with very h…CiprofibrateA tablet from the fibrate group used to lower raised blood fats, particularly triglyceride…AlirocumabA self-injection used to lower harmful LDL cholesterol when statins are not enough or cann…EvolocumabA self-injection used to lower harmful LDL cholesterol when statins are not enough or cann…Nicotinic acid (niacin, vitamin B3)A B-vitamin that, at higher medicinal strength, has been used to improve cholesterol and b…EzetimibeA cholesterol-lowering tablet that works in the gut rather than the liver — used alongside…

Beyond medication

Lifestyle and self-care

A diet lower in saturated fat, more fibre, oily fish, a healthy weight, regular activity, less alcohol and stopping smoking all lower harmful cholesterol and cardiovascular risk, and can reduce how much medication is needed.

When to get help

When to see a doctor

Chest pain, sudden breathlessness or signs of a stroke (face drooping, arm weakness, slurred speech) are emergencies — call 999. A high cholesterol result without symptoms should be discussed with your GP or pharmacist to plan testing and treatment.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

High cholesterol: frequently asked questions

What medicines are used for high cholesterol?

Statins are first-line and suit most people. If they do not lower cholesterol enough, ezetimibe is commonly added, and very high-risk people may be referred for injectable PCSK9 inhibitors. Fibrates are used mainly for high triglycerides, and bile-acid sequestrants are an option where other agents are unsuitable.

Do I have to take a statin for life?

Usually, yes — the protection comes from keeping cholesterol low over the long term, and stopping often allows it to rise again. Some people who substantially change their diet, weight and activity can reduce their need for medication, but this should always be decided with your doctor rather than by stopping on your own.

Are statins safe, and what about muscle aches?

Statins are among the most studied and widely used medicines, and serious side effects are uncommon. Some people get muscle aches; often this can be managed by checking for other causes, switching statin or adjusting how it is taken. Tell your prescriber about new or severe muscle pain rather than simply stopping.

Can I lower my cholesterol with diet alone?

Diet and lifestyle can meaningfully lower cholesterol and should always be part of the plan. For people at higher overall cardiovascular risk, or with an inherited form, lifestyle alone is usually not enough and medicine is recommended as well to bring the risk down.

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Sources

Where this is drawn from

  • NICE NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification.
  • NICE CKS: High cholesterol.

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