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High cholesterol guides
Each guide opens with the answer, then shows what trials and drug labels found. Every one links to its sources and to the longer version.
Medicines
What each cholesterol medicine does, what it costs and what trials found.
- Repatha Side Effects: What the Trials FoundThe most common Repatha side effects are cold symptoms, upper respiratory infections, flu, back pain and mild injection-site reactions. In the 52-week label trial, each affected about 1 in 10 people or fewer, and each also showed up on placebo at a similar rate.
- Repatha Cost: List, Cash and Copay Card PricesRepatha lists at $572.70 a month, but few people pay that. Amgen set the AmgenNow cash price at $239 a month in October 2025 (confirm the current price before you fill), and a commercial insurance copay card can lower a fill to as little as $5.
- Ezetimibe (Zetia): Uses, Side Effects and CostEzetimibe (Zetia) is a once-daily 10 mg pill that blocks cholesterol absorption in the gut. On its own it lowered LDL by about 18% in label trials, and added to a statin it lowered LDL about 21 percentage points more than placebo does.
- Leqvio (Inclisiran): Cost, Dosing and LDL ResultsLeqvio (inclisiran) is a shot that lowered LDL cholesterol by about 50% in its main trials. A healthcare professional gives it twice a year after the first two doses, and Novartis lists it at $3,587.73 per dose for uninsured patients, as of October 2026.
- Praluent (Alirocumab): Dose, Cost and Side EffectsPraluent (alirocumab) is a PCSK9 inhibitor you inject yourself every 2 or 4 weeks. It lowered LDL by 46 to 58% more than placebo in its trials, and as of October 2026 GoodRx lists it at $225 a month for self-pay patients.
- Nexletol (Bempedoic Acid): Dose, Side Effects, CostNexletol (bempedoic acid) is a once-daily 180 mg pill that blocks an enzyme in the liver one step before where statins act. It lowered LDL roughly 17 to 21% more than placebo, and gout, gallstones and tendon rupture are the risks to discuss with your clinician.
- PCSK9 Inhibitors Explained: All 5 OptionsA PCSK9 inhibitor helps your liver pull more LDL out of your blood, lowering LDL by about 50 to 60% on top of a statin. Five are available in the US as of October 2026, and they differ in how you take them.
- Cholesterol Shots: 4 Options ComparedFour cholesterol shots are FDA-approved in the US: Repatha, Praluent, Lerochol and Leqvio. Repatha and Praluent are given every 2 weeks or monthly, Lerochol monthly, and Leqvio twice a year. Each lowers LDL cholesterol by roughly 50 to 60%.
- Lerochol (Lerodalcibep): Monthly PCSK9 ShotLerochol (lerodalcibep) is a once-monthly PCSK9 inhibitor you inject at home. It lowered LDL cholesterol by about 56% versus placebo and carries a direct cash price of $199 a month.
- Lipfendra (Enlicitide): The Oral PCSK9 PillLipfendra (enlicitide) is the first oral PCSK9 inhibitor, a once-daily pill from Merck that the FDA approved in July 2026. It lowered LDL cholesterol by about 56 to 59% versus placebo.
- New Cholesterol Drugs in 2026: What Is AvailableThe newest cholesterol drugs in 2026 are Lipfendra, the first PCSK9 pill (approved July 2026), Lerochol, a monthly shot with a $199 cash price (launched May 2026), and Leqvio, a twice-a-year shot that no longer requires a statin first. Obicetrapib, Lp(a) drugs and gene editing remain in trials.
- Repatha Alternatives: Six Options ComparedThe closest Repatha alternative is Praluent, which works the same way and has its own outcomes trial. Leqvio, Lipfendra and Lerochol are the other PCSK9 options, and ezetimibe and bempedoic acid fit when you need a smaller LDL drop.
- Prescription Cholesterol Medications ExplainedStatins come first for most people. Ezetimibe, bempedoic acid, PCSK9 inhibitors and inclisiran add more LDL lowering when a statin alone leaves you above goal or causes side effects.
- Lp(a) Drugs in 2026: Status of Each TrialNo Lp(a)-lowering drug is FDA-approved yet, and none is likely before the outcome trials report. Registered completion dates run from 2028 for olpasiran to 2031 for muvalaplin. If your Lp(a) is high now, clinicians lower LDL and ApoB further with medicines already approved.
Statins
Side effects, which statin, and the options if one doesn't suit you.
- Statin Side Effects: What's Real and What To DoAbout 1 in 10 people on a statin report muscle aches, but in blinded trials only a small fraction of those symptoms trace back to the drug. Real side effects exist, and a structured stop-and-restart test can show whether yours are one of them.
- Rosuvastatin vs Atorvastatin: Which To Take?Both are strong, generic statins, and for many people either works. Rosuvastatin lowers LDL more per milligram, and at matched LDL lowering the two prevent heart attacks and strokes about equally well.
- Alternatives to Statins: Your Options ComparedThe main non-statin cholesterol medicines are ezetimibe, bempedoic acid, PCSK9 inhibitors, and inclisiran. They lower LDL by about 18% up to 50 to 60%, and which one fits depends on how far your LDL needs to fall.
- Statin Gene Testing: SLCO1B1 ExplainedStatin gene testing checks a few genes, mainly SLCO1B1, that change how much statin reaches your bloodstream and muscles. The result helps choose which statin and what dose. It gives no reason to stop a statin you need.
Your numbers
LDL, HDL and triglycerides, and what moves them.
- How to Lower LDL Cholesterol: What WorksStart with food: less saturated fat, more soluble fiber, plant sterols and nuts. Diet usually lowers LDL by about 10 to 15%, exercise and weight loss add a little, and medicine closes a bigger gap.
- High Triglycerides: Causes and How to Lower ThemHigh triglycerides mean more fat circulates in your blood than is healthy, usually 150 mg/dL or higher. Added sugar, refined carbs, alcohol, excess weight, and diabetes cause most cases, and triglycerides respond to changes in those faster than almost any other number on your lipid panel.
- HDL Cholesterol: What Your Number MeansHDL cholesterol is the good cholesterol on your lipid panel. Higher HDL has long linked to lower heart risk, but drugs that raise HDL haven't prevented heart attacks, so clinicians read HDL as a marker of metabolic health and aim treatment at LDL-C and ApoB.
- LDL of 130 mg/dL: Is It High?An LDL-C of 130 mg/dL (3.4 mmol/L) falls in the borderline high range. For most adults it sits about 23% above the goal of 100, and about 46% above the goal of 70 for people at higher risk.
- LDL of 160 mg/dL: What It Means and Next StepsAn LDL-C of 160 mg/dL (4.1 mmol/L) is high. Reaching the usual goal of 100 takes a drop of about 38%, and reaching 70 takes about 56%, so most people also need medicine.
- LDL 190 or Higher: What to Do NextAn LDL-C of 190 mg/dL (4.9 mmol/L) or higher is severe hypercholesterolemia, and guidelines recommend treatment at this level whatever your other risk factors. Reaching 100 takes a drop of about 47%, and reaching 70 takes about 63%.
- High ApoB: What It Means and How to Lower ItA high ApoB means you carry more plaque-forming particles than your risk calls for. The 2026 ACC/AHA guideline sets goals of below 90, 70, or 55 mg/dL depending on your risk, and food plus medicine bring it down.
- How to Lower ApoB: What Works and How MuchCut saturated fat, add soluble fiber, lose excess weight, and keep triglycerides in check. Those changes lower ApoB by a modest amount, and when ApoB sits well above your goal, medicine closes the rest of the gap.
- How Heart Disease Develops Over DecadesCholesterol-carrying particles collect in artery walls over decades, starting as early as the teens and twenties. Lowering LDL earlier, and keeping it low longer, prevents more heart disease.
Tests and genetics
Lp(a), apoB, calcium scans and inherited cholesterol.
- Lipoprotein(a): What a High Lp(a) MeansLp(a), short for lipoprotein(a), is an inherited particle that raises the risk of heart attack, stroke, and aortic valve narrowing. Your genes set most of your level, a standard cholesterol test skips it, and one blood test tells you where you stand.
- How to Get an ApoB and Lp(a) TestApoB and Lp(a) are separate tests that have to be ordered by name. You can ask your clinician with specific wording, buy them from a direct-to-consumer lab, or use a lipid practice that orders the tests and treats the results.
- Familial Hypercholesterolemia: Signs and TreatmentFamilial hypercholesterolemia (FH) is an inherited condition that keeps LDL cholesterol very high from birth, whatever your diet or exercise. It affects about 1 in 250 to 1 in 313 people, and treatment usually means medication started early, often in combination.
- CAC Score: What Your Calcium Score MeansA coronary artery calcium (CAC) score is a number from a quick, low-dose CT scan that measures calcified plaque in your heart arteries. A score of 0 means no calcium was found, and 400 or above means extensive plaque and high risk.
- ApoB: What the Test and Your Level MeanApoB (apolipoprotein B) sits on every particle in your blood that can build plaque, one ApoB per particle, so an ApoB test counts them. That count gives one of the clearest single measures of how much cholesterol pushes into your artery walls.
- Advanced Lipid Panel: What It Tests and CostsAn advanced lipid panel is a lab bundle that goes beyond the standard cholesterol test. The two markers with the strongest evidence are ApoB and Lp(a), and for most people those two plus a standard lipid panel cover what matters.
- Family History of Heart Disease: What to DoA parent or sibling with heart disease at a young age roughly doubles your risk in long-term studies. Tests can measure most of the inherited pieces, and treatment can address most of them.
- Is High Cholesterol Genetic? FH and Lp(a)Yes, high cholesterol is often genetic. Genes set much of your LDL baseline, and in some families they push it high from birth, so healthy habits alone can fall short of a safe range.
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