High Cholesterol Treatment Online

What is high cholesterol?

High cholesterol (hypercholesterolaemia) describes elevated levels of certain lipids in the blood. The two most relevant readings are low-density lipoprotein (LDL) cholesterol, often called "bad" cholesterol, and triglycerides, both of which contribute to the build-up of fatty deposits in blood vessels. Over time this may increase the risk of heart attack, stroke, and peripheral vascular disease.

High cholesterol generally has no symptoms and is detected through a blood test. Risk factors include family history, diet high in saturated and trans fats, physical inactivity, smoking, excess alcohol, obesity, and conditions such as diabetes and chronic kidney disease.

How a telehealth GP can help

A NewDoc GP can review your cardiovascular risk profile and order a fasting lipid blood test. At a follow-up consultation, your GP will interpret the results with you, prescribe statins or other lipid-lowering medications where clinically appropriate, and give dietary and lifestyle guidance. Later follow-ups check response to treatment and adjust the plan.

If your cardiovascular risk is high or you have other conditions, your GP can refer you to a cardiologist via telehealth. Pathology referrals are electronic and can be used at any collection centre in Australia. Stable patients may also request repeat prescriptions via telehealth.

Cholesterol medications: statins, ezetimibe, and PCSK9 inhibitors

Treatment depends on your absolute cardiovascular risk per the Australian CVD risk calculator, not the cholesterol number alone. Australian Therapeutic Guidelines (eTG) and the National Heart Foundation recommend a stepped pharmacotherapy approach where lifestyle alone is insufficient:

Statins — first-line lipid-lowering therapy

• Atorvastatin 10–80 mg daily (Lipitor and generics) — first-line for most patients; high-intensity dosing (40–80 mg) for established cardiovascular disease
• Rosuvastatin 5–40 mg daily (Crestor and generics) — most potent statin; useful for patients not at target on atorvastatin
• Pravastatin 20–80 mg daily (Pravachol) — lower-potency option for patients with statin sensitivity or drug-interaction concerns; safer with HIV antiretrovirals
• Simvastatin 10–40 mg daily (Zocor, Lipex) — established, but maximum dose is 40 mg due to myopathy risk
• Fluvastatin (Lescol) — alternative where others not tolerated

Statin myopathy is the main side effect — most muscle aches on statins are not true myopathy. Re-challenge at a lower dose, or switch to pravastatin or rosuvastatin twice weekly, is often successful. CK monitoring is reserved for severe muscle symptoms or rhabdomyolysis suspicion.

Add-on agents when statin alone doesn't reach target

• Ezetimibe 10 mg daily (Ezetrol) — cholesterol absorption inhibitor; added to statin where LDL target not met; combination products available (Atozet = atorvastatin + ezetimibe; Vytorin = simvastatin + ezetimibe)
• Fenofibrate — primarily for high triglycerides
• Gemfibrozil (Lopid) — alternative for triglycerides; not combined with statin due to myopathy risk

PCSK9 inhibitors — for severe, familial, or treatment-resistant cases

• Evolocumab (Repatha) or alirocumab (Praluent) — subcutaneous injection every 2–4 weeks; PBS-restricted for familial hypercholesterolaemia and selected high-risk patients
• Inclisiran (Leqvio) — newer twice-yearly subcutaneous injection; access pathway evolving

PCSK9 inhibitors are usually initiated by a cardiologist or lipid clinic. Your GP can provide ongoing prescriptions once stable.

Lifestyle foundations

Lifestyle changes amplify the effect of pharmacotherapy and remain first-line for low-risk patients: Mediterranean-style diet (or DASH), 150 minutes/week of moderate aerobic exercise, weight loss where relevant, smoking cessation, alcohol within recommended limits, and stress management. Your GP can refer you to a dietitian and exercise physiologist through a Chronic Disease Management Plan for Medicare-rebated allied health support.

Risk factors for high cholesterol

Some risk factors for high cholesterol are not modifiable, such as age, sex, and a strong family history, including familial hypercholesterolaemia (an inherited condition). Other conditions like high blood pressure and type 2 diabetes commonly cluster with high cholesterol and amplify overall cardiovascular risk.

Modifiable risk factors include diet high in saturated and trans fats, low intake of fibre, low physical activity, smoking, excess alcohol, and higher body weight. Certain medical conditions (such as chronic kidney disease or an underactive thyroid) and some medications may also affect lipid levels. Your GP will review your picture holistically and tailor advice accordingly.

Monitoring and follow-up

Cholesterol monitoring intervals depend on your baseline risk and whether you are on medication. In general, after starting or changing a statin, a repeat lipid panel is often done within a few months, along with liver function tests. Once stable, annual or less frequent monitoring is typical, guided by your GP.

Review also includes checking for side effects, reviewing other cardiovascular risk factors (blood pressure, weight, smoking status, glucose), and adjusting lifestyle and treatment plans over time. Telehealth is well suited to this kind of ongoing review, with in-person assessment arranged if physical examination is needed.

When to see a specialist

A referral to a cardiologist or lipid clinic may be considered in several situations: very high cholesterol levels, suspected familial hypercholesterolaemia (an inherited form), intolerance to multiple lipid-lowering medications, established cardiovascular disease, or targets not being met despite treatment. Your NewDoc GP can coordinate the referral and share relevant results with the specialist.