How to Manage Your Cholesterol After a Heart Attack

This article is for people who have had a recent heart attack and may need cholesterol-lowering drugs, their care partner, as well as others who want to learn more about cholesterol-lowering medicines. The goal of this activity is to increase your knowledge about cholesterol-lowering treatments your doctor may prescribe for you.

You will learn:

• The link between high cholesterol and heart disease

• The importance of starting lipid-lowering medicines after a heart attack

• What medicines are available to help lower cholesterol

• How to discuss your treatment goals with your doctor

• Questions to ask your doctor

Cholesterol is a waxy, fat-like substance found in every cell in your body. It is in your blood, and helps your brain, skin, and other organs function properly.

When too much LDL cholesterol is in your blood, it builds up and can forms "plaques" in the walls of your arteries. This causes the arteries to narrow, which slows down the flow of blood to your heart, causing heart disease.

When arteries become too narrow, blood supply to your heart may be blocked, which can cause a heart attack.

Anyone who has had a heart attack is at greater risk for having another one. Because abnormal cholesterol levels can lead to a heart attack, it is important to keep your levels normal to stay healthy.

There are 2 forms of cholesterol:

• Low-density lipoprotein (LDL) or "bad" cholesterol, is the main source of artery-clogging plaques

• High-density lipoprotein (HDL) or "good" cholesterol, works to clear cholesterol from the blood

Your doctor will prescribe medicines to reduce your LDL level.

After a heart attack, one of your goals is to keep your LDL level at 70 milligrams per deciliter (mg/dL) or less.

In addition to LDL, other lipid levels in your blood need to be routinely checked to make sure they stay normal. These include total cholesterol, HDL, and triglycerides.

Your doctor will review all of your cholesterol level goals and talk to you about the best treatment plan to help keep your levels normal.

Reaching your goal requires a combination of LDL-lowering medicine and changes to your diet and activity level. Some medicines to help lower cholesterol include:

• Statins: Work by blocking an enzyme that your liver cells need to make cholesterol, which lowers LDL levels

• Bile acid sequestrants: Work to lower LDL by binding to bile acids in the liver, which causes the amount of LDL in the intestine to go down

• Ezetimibe (selective cholesterol absorption inhibitor): Works to lower LDL by preventing the absorption of cholesterol in the intestine

• PCSK9 inhibitors: Work to lower LDL by removing LDL cholesterol from the blood

After a heart attack, it is recommended that you start taking a high-intensity statin. Your doctor may also prescribe another medicine.

Yes, there are some side effects associated with cholesterol-lowering drugs.

The side effects of statins, which are the most commonly prescribed lipid-lowering agent, can include muscle aches, abnormal liver function, allergic reaction (skin rashes), heartburn, dizziness, abdominal pain, constipation, decreased sexual desire, and memory problems.

Your doctor will help you select the best medicine and dose (amount of the medicine) to fit your needs and preferences.

Lifestyle changes that may help lower LDL cholesterol levels in the blood include:

• Maintaining a healthy weight: Being overweight can increase your LDL and strain your heart

• Being active: Exercise can improve blood cholesterol levels and control weight

• Eating right: Choose vegetables, fruits, whole grains, lean meats, skinless poultry, and fatty fish; avoid saturated fats

• Not smoking: If you smoke, ask about smoking cessation programs

Make sure you understand what cholesterol is, what your cholesterol levels are, and why it's important to reach your goals for cholesterol levels.

It is also important to make sure your doctor knows about:

• Your other medical conditions

• Any prescription or over-the-counter medicines you are taking

• Any vitamins or nutritional supplements you are taking

Talk with your doctor if your cholesterol medicine is not working for you; he or she may be able to recommend an alternative that works with your lifestyle and preferences.

Treating high LDL levels is a lifelong process.

Although medicines can lower your LDL levels rapidly, it can take as long as 6 to 12 months before you see the effects of lifestyle modifications.

Once you have an effective treatment plan and you begin to see results, it is important to stay committed to your plan. Stopping treatment can allow your LDL level to rise again and increase your risk of heart attack, stroke, or other heart problems.

• What is cholesterol?

• Why is it important for heart health to keep cholesterol levels normal?

• What puts me at risk for high LDL levels?

• What are my cholesterol levels and what do they mean?

• What are healthy cholesterol goals for me?

• How often do I need to get my cholesterol levels checked?

• Since I've already had a heart attack, what else should I know so I can keep my heart healthy?

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