More than 102 million Americans have high cholesterol, according to the Centers for Disease Control and Prevention (CDC). It’s a condition that greatly raises the risk of heart disease in one-third of the people who have it. Although high cholesterol levels are often due to genetics or an unhealthy diet, lesser-known factors can also raise your cholesterol — including the medications that you take for other conditions.
Medication side effects are quite common, and often they’re minor, but side effects like an increase in your cholesterol level can be serious. To counter medication-related high cholesterol, your doctor can prescribe an alternative medication to treat the original condition, or add a cholesterol-lowering medication to your treatment regimen.
Drugs That Cause High Cholesterol
Why certain drugs raise cholesterol levels as a side effect isn’t exactly understood. Most of the time, cholesterol elevation is minimal. But any increase in cholesterol is still a concern, especially for people with risk factors for heart disease or for those who already have high cholesterol or are taking cholesterol-lowering medication.
The following types of drugs, used to treat a variety of health conditions, may raise cholesterol levels:
- Steroids These drugs, sometimes prescribed for allergies and asthma as well as other conditions, are known to be associated with modest elevations in triglyceride and total cholesterol levels, says Stanley L. Hazen, MD, PhD, chair of the department of cellular and molecular medicine and the section head of preventative cardiology at the Cleveland Clinic in Ohio. Research shows that steroid treatment for asthma, rheumatoid arthritis, and connective-tissue disorders can cause elevations in total cholesterol, LDL-C, and serum TG (triglyderides), in some cases because of dosage. “More often, insulin resistance is observed, which also helps to cause mild TG elevation and HDL cholesterol reduction,” says Dr. Hazen.
- Progestin This hormone, used in birth control pills, can be associated with the elevation of “bad” LDL cholesterol and a reduction in “good” HDL cholesterol. “Studies have definitively proven that most common hormone replacement therapy forms are not protective for cardiovascular disease in people without known CVD,” says Hazen. Indeed, Hazen continues, the most commonly used forms of hormone therapy (typically estrogen alone or a combination of estrogen and progestin) do not stop the progression of heart disease in women who have already been diagnosed with CVD or in healthy women with no CVD. On the contrary: Women without known heart disease are more likely to experience heart attacks, strokes, pulmonary embolism, and deep-vein thrombosis if they are taking an estrogen–progestin medication or estrogen alone
- Retinoids These drugs, often used to treat skin problems like acne, can cause slightly elevated cholesterol levels. They contain vitamin A, known to cause problems with the liver, which produces cholesterol. According to Hazen, subjects taking vitamin A derivatives as an acne medicine should have their lipid profile checked after being on the medication to make sure there hasn’t been an unsafe elevation in their cholesterol.
- Beta blockers While beta blockers generally do not increase cholesterol levels in most people, they can cause what’s known as secondary hyperlipidemia (increased blood fats) in a very small number of individuals, says Hazen. More often, beta blockers that are used to treat high blood pressure — another risk factor for heart disease — actually raise triglyceride levels (another blood fat). According to the Mayo Clinic, some blood pressure medications can affect triglyceride and cholesterol levels, most often in people who have several conditions, including high blood pressure and blood sugar. However, beta blockers, such as Coreg (carvedilol) and Bystolic (nebivolol), are less likely to affect your cholesterol levels, according to Mayo.
- Diuretics These drugs are also commonly prescribed to treat high blood pressure. “Only hydrochlorothiazide [Microzide] is associated with potential for secondary hyperlipidemia,” says Hazen, and this is also rare. Again, these drugs most often cause elevated triglyceride levels rather than higher total cholesterol, and for only partially understood reasons.
High Cholesterol: Other Medication Choices
Especially for people taking diuretics or beta blockers to control high blood pressure and reduce heart disease risk, alternative treatments that don’t raise cholesterol levels should be sought. “It’s something we’ve known for a long time about beta blockers and diuretics,” says Stephen J. Nicholls, MD, PhD, a professor of cardiology at the South Australian Health and Medical Research Institute in Adelaide, Australia.
People with high cholesterol and high blood pressure would not typically be started on beta blockers or diuretics as the first-choice treatment, says Dr. Nicholls. Instead, a physician might prescribe an ACE (angiotensin-converting enzyme) inhibitor or calcium-channel blocker to treat high blood pressure without raising cholesterol.