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Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

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Heart-healthy living is a lifelong practice. To help you get started, we’ve compiled a list of the top heart disease prevention actions to tackle during each decade of life.

How to Prevent Heart Disease at Any Age

You may associate heart disease with aging, and for good reason — individuals age 65 and older face a higher risk for the condition. This stems in part from how aging-related changes in your body overlap with risk factors for heart disease. For example, your arteries and heart muscle stiffen with age, making it more difficult to pump blood well during exercise.

Still, it’s never too early to prioritize a heart-healthy lifestyle. As heart disease-linked conditions like diabetes and high blood pressure grow increasingly common among young adults, many people are now becoming at risk for heart disease at an earlier age. 

And even if you are young and in good overall health, the choices you make today can affect your heart health for years to come. Cardiovascular health issues like heart attacks, strokes, and heart failure often stem from a lifetime’s worth of health choices, including many you have control over.

Since heart-healthy living is a lifelong practice, it may feel more manageable if you set specific goals and priorities impactful for your age group. To help you get started, we’ve compiled a list of the top heart disease prevention actions to tackle during each decade of life. This is intended to be a high-level guide to prevention, so consult with your healthcare provider about more targeted priorities based on your individual health needs.

2. Search for a primary care provider if you don’t have one

3. Find your favorite physical activity and develop a fitness routine

You’re out in the real world, exploring what you want your life to look like. It’s normal to experience some anxiety during this exciting but nerve-racking time. Your cardiovascular health may not be top of mind as you navigate a stressful job search, adjust to the pressure of beginning a career, or start a family, but taking several heart healthy actions during this decade of life will put you on the right track early on.

Focus on building a foundation for a healthy lifestyle. That means quitting smoking if you currently smoke, figuring out which physical activities work for you, and getting in the practice of staying up to date with yearly doctor’s appointments. If you don’t already have a primary care provider, now’s the time to search for one.

1. Create a weekly routine that makes time for exercise

2. Prioritize your mental health — whatever that looks like for you

3. Contact relatives to build your family medical tree

There’s a good chance your calendar’s looking pretty packed these days. Momentum in your career may come with more responsibilities and later nights in the virtual or physical office. And for those who already have a family, or are thinking of starting one, maintaining work-life balance may be a challenge.

As you continue to build on the foundation you set in your twenties, here are three new action items to add to your health routine. First, remember your favorite physical activity? Make sure there’s a block of time in your schedule for it each week.

Since your mental health can significantly impact your physical health — and your risk for heart disease in particular — be sure to give your emotional well-being some attention during what may be a hectic time. 

Some stress is to be expected when you have many responsibilities at work or home (or both), but if you’re concerned about your mental health, don’t be afraid to ask your doctor for suggestions or resources. You can also check out Moodfit, a free mood-tracking app, or Insight Timer, an app that offers free guided meditations.

Lastly, since your family’s health history is a big predictor of your own risk for cardiovascular disease, take some time to contact relatives and figure out if heart health issues run in your family tree.  

1. Continue to explore your exercise options

3. Stay current with annual check-ups and screenings

Does it feel like life has only gotten faster? Believe it or not, your metabolism has already begun to slow down. That means it’s time to amp up your workout routine, if you haven’t already. Enjoying your chosen exercise method is key to sticking with it in the long term, so if you haven’t found your go-to activity just yet, keep looking. If you’ve only ever worked out on your own, try a group class, online or in person.

It’s time to check in on your sleep hygiene, too. Regular sleepless nights have been linked to heart attacks, high blood pressure, and diabetes, so if you’re getting in less than an average of seven hours every night, try to set yourself up for a good night’s sleep. Winding down at the same time each night, avoiding heavy meals just before bed, and spending plenty of time outside are just a few of the simple steps that might be able to help you get more rest.

At your annual physicals, be sure to discuss your risk for heart disease with your doctor and ask about recommended screenings for your individual health needs, including a fasting blood glucose test to screen for diabetes.

2. Limit your sodium and cholesterol intake

3. Learn the warning signs of a heart attack

Your risk for high blood pressure and high cholesterol will continue to increase as you age, so it’s important to keep track of your blood pressure, cholesterol, and blood glucose levels. If you have high blood pressure or cholesterol, follow the treatment plan your doctor has recommended, which may include diet changes, medication, or a combination of both. Even if your blood pressure and cholesterol numbers are within a healthy range, you can only benefit from limiting your sodium and cholesterol intake.

You should also learn the warning signs of a heart attack, as your risk for one also increases with age: 65 is the average age of a first heart attack for a man, and 72 is the average age of a first heart attack for a woman.

Keep in mind that heart attack symptoms may appear differently in women than in men.

Remember, these suggestions are intended as a starting point. Your doctor can advise you on a more individualized plan of action based on your health history. And not only is it never too early to begin prioritizing heart disease prevention, but it’s also never too late. Don’t worry about what you should or could have done earlier in life — instead focus on the actions you can take to be as healthy as possible in the present.

Staying physically active and avoiding foods that are high in sodium and trans fats are simple ways to take charge of your health at any stage of life. Here are more specific suggestions for heart-healthy living in terms of diet and exercise.

As you plan a heart-healthy diet, opt for foods that are low in saturated fats and trans fats, which increase levels of low-density lipoproteins (LDL) cholesterol — also referred to as “bad cholesterol” — in your blood. Low-fat dairy products and chicken are healthier alternatives to full-fat dairy products and red meats, which are high in saturated fats.

High sodium intake can increase your blood pressure, and the American Heart Association suggests aiming for 1,500 mg of sodium/day. Limit processed or prepackaged foods including soups, cold cuts, bread, and frozen meals since they contain sodium-based preservatives. And watch out for compounds that contain sodium as you scan the ingredient list, like sodium benzoate and sodium tripolyphosphate.

Regular exercise can help you maintain a healthy weight and keep your blood pressure, cholesterol, and blood sugar levels in a healthy range. Different activities offer various levels of intensity, and there are a variety of ways to get the American Heart Association’s recommended amount of aerobic activity . You should aim for about 150 minutes a week of moderate-intensity aerobic activity, like brisk walking, or 75 minutes a week of a more intense activity. Many people start off slower and build their way up to a more intense routine.

At Alto, we’re committed to making it as simple as possible to protect your heart health and stay on top of cholesterol-lowering or blood pressure management medications. We offer free same-day delivery and medication management tools like reminders and auto refills in our app. And our team of pharmacists is always here to answer your questions by phone or chat, and will even remind you when your medications are due for a refill.

Reach out any time by phone at 1-800-874-5881 or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

How to Prevent Heart Disease at Any Age 

Get an inside look at the patients team at Alto Pharmacy to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

Get to Know the Team That Builds Alto's Customer-Facing Apps

Imagine an app that allows you to buy things and have them delivered to you the same day, for free. Now take that app and put it in a highly regulated space like pharmacy. You face the challenge not only of building an e-commerce platform from scratch, but also of navigating medication pricing, federal and state regulations, and patient safety—and that's just the way the Patients Team likes it.

"It's a really exciting and fun problem to solve," says Mike Riess, the team's Engineering Manager. Software Engineer Angelique Nehmzow agrees: "There's a really strong product and design aspect, like more traditional startups, but then everything gets a little bit more interesting because it's healthcare."

Below, we chat with the team to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

What does the Patients Team do at Alto? 

Ask anyone on the team why they joined, and chances are, they'll tell you they wanted to be on the product team closest to Alto's customers: "We really try to own the customer experience," says Peter Zeng, the latest Software Engineer to join the team. "If a customer is coming to the web app, or they're coming to our mobile app, we want to make sure that they're able to onboard with us as easily and conveniently as possible."

The team is also responsible for the customer experience beyond onboarding, from the moment a customer schedules a medication for delivery to the time that it shows up on their doorstep. "We already offer great services like free, same-day delivery and cost savings. The Patients Team empowers customers to make the most of our offering," Nehmzow explains. "You can see what prescriptions you have, check on the status of your order, and schedule automatic refills. In a more traditional pharmacy, you don't get that kind of visibility. You have to call them up or even wait in line in person. At Alto, it's a different experience."

What was it like in the team's early days?

Today, there are eleven engineers on the team working to build that better end-to-end experience—but it wasn't always that way. When the team first formed in 2019, it consisted of just three members: Riess, Brian McRae, and Andy Lau, all of whom are still on the team.

"The first priority for us was just stabilizing the foundations," Riess says of the team's early days. Every other week, the three team members, along with Alto co-founders Matt Gamache-Asselin and Jamie Karraker, would meet to audit the app's core flows. "For the first three months we probably didn't make it through some flow at least 50% of the time," Riess recalls. "There would be a ton of bugs in the onboarding experience, things that weren't working with the flows or navigation or deep linking."

Among the team's first projects was a redesign of the checkout flow. "There was a lot of work to be done to streamline the checkout flow, which is pretty much the main function of the app," says McRae, who initially joined the team as a software engineer and later transitioned into product management. "We had to make it easier to add a payment, add your addresses, everything you need to do to schedule your prescription for delivery."

"The growth of the team, in terms of both size and stability of the platform, has allowed us to swing at more interesting bets for the company," Riess says. In particular, the Patients Team has turned their attention toward experiences personalized for specific medical conditions.

"Different customers have different needs. A customer who wishes to start a family will have a different experience than a customer who needs to order their routine heart medications that they've been taking for the last eight years,” McRae says. “The challenge for us is how we serve all these customers well through the app."

"I think that's where Alto can be such a differentiator," Riess adds. "A world-class pharmacy experience is about so much more than just dispensing medications. We want to build tools for customers that help them get the most out of their medications—everything from simple videos teaching them how to perform injections safely at home to the ability to synchronize deliveries for multiple prescriptions for managing complex health conditions."

With these new projects on the horizon, engineers have ample opportunity to focus on the areas that excite them most. "We're full-stack and mobile and web," Nehmzow says. "Part of the team focuses more on experimentation, iterating quickly, and using data to make decisions. Part of the team focuses more on platform work, tooling, and improving the developer experience. There are a lot of areas to explore and contribute to."

One spring night, the Patients Team gathered in a back yard in San Francisco’s Mission District for short ribs and an impressive spread of side dishes. "Kudos to Robbi, who's the grill master. I just provide the grill!" Nehmzow says, laughing. While the team barbecue was the first time some members had met in person, Zeng notes that the team has been supportive of one another even while working remotely during the pandemic.

"The first real project that I was assigned to was working with the communications system. Before writing my first piece of code, I spent two weeks exploring what already exists and understanding the different parts of the system," Zeng says. "I've been really impressed with how understanding my teammates have been. They make the space for you to learn all the different pieces of code we own."

That culture of support is by design, reflected in the six principles—complete with matching emojis—at the top of the #patients-team Slack channel: "Empower each other," "be an owner," "find the path," "learn by doing," "embrace complexity," and "foster trust." 

While these principles echo Alto's company-wide values, they are unique to the Patients Team. "For a long time, we were the only external-facing product team at Alto," Riess says. "These principles were intended to be this motivation around how we win. It's a combination of how we treat each other, how we reason about decision making, and how we approach solving a problem that's never existed before."

As the team looks toward the future, those principles have never been more relevant: "We have a goal and an area we want to focus on, but in terms of which projects we're going to do, it's not a top-down thing," Nehmzow says. "It's very much, 'We're going to figure out how to solve this problem together, even when it's difficult.' That's my favorite part about the team."

The Patients Team is hiring! Learn more about open positions here.

While gestational diabetes can be an upsetting diagnosis to receive, it is very manageable.  With an effective treatment plan you can manage your blood sugar levels and have a healthy pregnancy.

Gestational Diabetes: Signs, Causes, and Treatment

Gestational diabetes is a type of diabetes diagnosed during pregnancy. It affects approximately 10% of pregnancies, and millions of women, in the U.S. every year. Like all types of diabetes, the condition involves complications with the body’s production of insulin, a hormone that converts sugar into energy. If untreated, it can lead to high levels of blood glucose, which can lead to complications for both you and your baby.

While gestational diabetes can be an upsetting diagnosis to receive, it is very manageable.  With an effective treatment plan, including a healthy diet, exercise, and, if needed, medication, you can manage your blood sugar levels and have a healthy pregnancy.  

During your pregnancy, hormone level changes can affect how your body processes sugar. The placenta — an organ in your uterus that forms by week 12 of the pregnancy to deliver nutrients to your baby — produces a variety of hormones. Gestational diabetes occurs when some of these hormones, specifically estrogen, cortisol, and human placental lactogen, interfere with insulin function, causing blood sugar levels to rise.

Gestational diabetes typically develops in the middle of pregnancy, and most doctors test for it between weeks 24 and 28. There often aren’t any noticeable symptoms, and some of the key signs of gestational diabetes overlap with other changes that occur during pregnancy like being thirstier or hungrier and urinating more frequently than usual.

Most women who develop gestational diabetes are over 25. In addition, you are more likely to develop gestational diabetes if you:

Were overweight before you became pregnant

Are Black, Hispanic/Latino, Native American, Asian American, or Pacific Islander

Have prediabetes, a condition in which blood sugar levels are elevated but still below the official threshold for a diabetes diagnosis

Have had gestational diabetes during a previous pregnancy or gave birth to a baby over nine pounds

Have polycystic ovary syndrome (PCOS) or another health condition linked to problems with insulin

Have high blood pressure, high cholesterol, heart disease, or other medical complications

If any of these risk factors apply to you, you should consult with your doctor early on in your pregnancy to assess your risk and determine which preventative measures to take, if needed.

Your doctor will screen for gestational diabetes between weeks 24 and 28 of your pregnancy with a glucose tolerance test (or earlier if you have one or more of the key risk factors). During this test, you will drink a sweet beverage that contains 50 grams of glucose to raise your blood sugar. An hour later, your blood glucose levels will be checked to see how your body responded to the sugar in the drink.

If your blood sugar is higher than a certain threshold after the one-hour glucose tolerance test, your doctor will order additional testing. The most common follow-up is a three-hour glucose tolerance test. For this test, you will fast for eight hours and have your fasting blood sugar measured. You will then drink a beverage that contains 100 grams of sugar. Afterwards, your blood glucose will be tested one, two, and three hours later.

Your doctor may screen you again for gestational diabetes if your results are normal but you are at high risk.

Potential complications of gestational diabetes

Without prompt treatment, high blood sugar levels in a pregnant woman can affect the health of both her and her baby. For instance, unmanaged gestational diabetes can increase the baby’s blood sugar levels, which in turn increases its weight. A woman carrying an overweight baby may have to deliver it via a C-Section, which involves a longer recovery from childbirth.

Another complication that can potentially affect a pregnant woman as a result of gestational diabetes is preeclampsia, a condition characterized by high blood pressure and damage to the liver, kidneys, or other organs.

Despite these potential health risks, gestational diabetes is highly manageable. Your doctor can advise you on appropriate steps to keep your blood sugar levels in a normal range so that you can experience a healthy pregnancy. However, it’s critical to take action as soon as possible if you receive a diagnosis.

Eating healthy foods and exercising regularly play a big role in managing your blood sugar levels and controlling your gestational diabetes. Your doctor will advise you on specific dietary considerations.

In general, swapping sugary snacks for sources of natural sugar such as fruits and carrots and adding vegetables and whole grains to your diet can help keep you and your baby healthy. Portion control is also important, and it is often recommended to eat three small meals throughout the day along with several snacks.

Staying active is also key. Try to aim for about thirty minutes of moderate activity several days throughout the week. Opt for gentle workouts like swimming, or try a yoga class specifically tailored to pregnant women. Not only will this help manage your blood sugar levels, but it has the added bonus of helping you avoid fatigue and backaches during pregnancy.

Your doctor may advise you to check your blood sugar levels several times throughout the day using a blood glucose meter. The American Diabetes Association suggests the following blood sugar targets for pregnant women:

Two hours after a meal: 120 mg/dl or less

Depending on your specific blood sugar levels, your doctor may advise you to take insulin. If taking insulin, it’s important to pay regular attention to your blood sugar as insulin therapy can lead to hypoglycemia, or dangerously low blood sugar. Hypoglycemia often happens as a result of not eating enough or exercising too much.

Common hypoglycemia symptoms include shakiness, anxiety, feeling lightheaded, hunger, nausea, headaches, and seizures. The only way to confirm that you are experiencing hypoglycemia is to check your blood sugar with a blood glucose meter or a continuous glucose monitor (CGM). 

Your doctor can help you develop your blood sugar targets and identify specific numbers to watch for when checking for hypoglycemia. However, if you are experiencing signs of low blood sugar and unable to check blood sugar levels, treat symptoms with high-sugar foods or drinks.

Getting tested for diabetes after pregnancy

For most women with the condition, gestational diabetes typically goes away soon after delivery. However, 5-10% of women with gestational diabetes develop type 2 diabetes after giving birth. And about 50% of the new mothers whose blood sugar levels return to normal after delivery will develop type 2 diabetes later in life.

If you have had gestational diabetes, it’s important to regularly monitor your blood sugar and continue with exercise and a healthy diet after giving birth to avoid health complications. You should also get screened again for diabetes 6 to 12 weeks after giving birth, and then every 1 to 3 years.

We’re here to support your gestational diabetes treatment

Alto is here to help you manage your gestational diabetes, by consolidating medications into streamlined monthly deliveries, setting up automatic refills, and offering free same-day delivery. And if insulin therapy is a part of your treatment plan, our pharmacists are available to walk you through your first doses and discuss any symptoms or side effects.

Learn how we can support your gestational diabetes treatment plan by contacting us via phone at 1-800-874-5881 or in-app messaging.

For many transgender men and women, hormone replacement therapy is an important component of their transitioning process. Here is an overview of hormone replacement therapy medications and side effects.

What to Know About Transgender Hormone Therapy Side Effects

For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you. 

Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.

Hormone replacement therapy for transgender women

Estrogen and testosterone-blocking medications help transgender women develop a more feminized appearance in line with their gender identity while transitioning. It reduces the discomfort of gender dysphoria, the distress caused by having a gender identity that differs from the sex you were assigned at birth. Many transgender women experience less emotional distress, improved personal relationships, and a better overall quality of life as a result of hormone replacement therapy.

Feminizing hormone replacement therapy causes a variety of physical changes like breast development and facial and body hair reduction. You may also experience a loss of muscle tone and changes in your body shape as the body redistributes fat cells.

Feminizing hormone replacement therapy medication and timing

While your healthcare provider will help you develop an individualized treatment plan, feminizing hormone therapy often begins by taking 100 to 200 milligrams daily of a diuretic called spironolactone to begin blocking male hormone receptors and suppress testosterone production. Some individuals begin taking estrogen immediately, in tandem with spironolactone, to further reduce testosterone production and develop more feminine characteristics. In other cases, estrogen is introduced after several weeks of spironolactone use. Your doctor will recommend the best plan for your needs.

There are various methods for administering estrogen, including orally, by injection, or as a cream, gel, spray, or patch. Commonly used forms of estrogen during a male-to-female transition include:

Oral: Estradiol tablets. 
Note that your doctor may advise you to let the tablets dissolve under your tongue rather than swallowing them. This is called sublingual administration, which may lower your risk for blood clots since it bypasses the liver.

Injections: Estradiol valerate (branded options include Delestrogen®) and estradiol cypionate (branded options include DEPO®-Estradiol)

Feminizing hormone replacement therapy side effects

You may experience one or more of the following hormone replacement therapy side effects. Your doctor can advise you about the potential risks and benefits prior to starting hormones.

A blood clot in a deep vein (also known as deep vein thrombosis) or in your lungs

High levels of triglycerides, a type of fat found in the blood

Feminizing hormone replacement therapy may also increase your risk for some chronic health conditions. Since estrogen affects how your body responds to insulin, it can lead to changes in your blood sugar levels and a greater risk for type 2 diabetes. Research into the impact of estrogen on your cardiovascular system is ongoing, and some studies have found a connection between estrogen therapy and a greater risk for heart disease and stroke. You may also face a greater risk of breast cancer after starting hormone replacement therapy.

Certain underlying health conditions may increase your risk of health complications related to the use of estrogen and testosterone-blocking hormones. It’s important to share your full medical history with your doctor, especially if you’ve had a hormone-related cancer, like prostate cancer, or a history of blood clots.

Gender-affirming hormone replacement therapy may affect your fertility, as it impacts sperm production. While some transgender women can produce sperm again after stopping hormone treatment, research indicates that this may not be the case universally, and there is a risk of permanent infertility with long-term use of hormones. If you would like to have biological children, ask your doctor about your options with freezing your sperm before starting hormones.

Hormone replacement therapy for transgender men

Hormone replacement therapy for transgender men during a female-to-male transition also combats gender dysphoria, leading to reduced emotional discomfort and better overall mental health.

During the process, you will take testosterone, which decreases estrogen production and suppresses menstruation. Testosterone is typically administered by injection (branded options include Delatestryl® and Tesamone®) or as a gel applied to the skin (branded options include AndroGel®, Testim®, Fortesta®, and Axiron®). In some cases, it may be applied as a patch or pellets positioned under the skin. If you have a persistent menstrual flow, your doctor might recommend taking progesterone to control it.

You may observe some of the following physical changes within several months of starting hormones, though individual responses to treatment varies:

Masculinizing hormone replacement therapy side effects

There are several potential side effects that transgender men may experience as a result of hormone replacement therapy, including the following:

Masculinizing hormone replacement therapy may also increase your risk for type 2 diabetes and cardiovascular disease.

You are more likely to experience one or more of these health complications if you have had breast cancer or have a history of blood clots. It may be unsafe to continue with hormone treatment if you are pregnant or breastfeeding. Be sure to discuss the potential risks and benefits of hormone replacement therapy with your doctor, and make sure they are aware of your full medical history.

Masculinizing hormone therapy and fertility

While some transgender men have sucessfully undergone egg freezing or IVF after starting hormone therapy, long-term use of hormones may lead to permanent infertility. If you want to leave open the possibility of starting a family by having children biologically, consult your doctor about your options for egg freezing before starting treatment.

Given that individual responses to testosterone treatment vary, you have a chance of becoming pregnant even while taking hormones. Your doctor can advise you about your options for birth control.

Baseline and follow-up testing for hormone replacement therapy

Before you begin hormone replacement therapy, your doctor will order tests to measure your baseline lipid, blood sugar, liver enzyme, and electrolyte levels, which may change throughout the course of your treatment. Your doctor will also evaluate your medical history to identify any health conditions that may affect treatment. This is also a good opportunity to discuss reproductive health and fertility considerations, including potential contraception options if you are a transgender man.

Throughout hormone therapy, you will have regular follow-up appointments with your healthcare provider to document physical changes in your appearance and monitor the impact of hormones on your lipids, blood sugar, and liver enzymes.

Hormone replacement therapy affects you emotionally as well as physically. In the long term, gender-affirming treatment, including both hormone therapy and surgery, can lead to better mental health, reducing the need for depression and anxiety-related treatment. 

Your doctor will likely ask questions related to your mental health during your initial consultation — including any symptoms of gender dysphoria that you have experienced and how they impact you at work, school, or home — and continue the conversation throughout your treatment.

It’s important to be honest with your doctor about how you are feeling — your mental health matters as much as your physical health. Don’t be afraid to ask for mental health-related resources if you need extra support, and remember that your doctor is here to help you without judgment.

View the National Institute of Mental Health’s suggestions for finding mental health treatment, and the Human Rights Campaign’s list of LGBTQ mental health resources.

Alto is here to support your journey with hormone replacement therapy. Our team of patient care pharmacists has experience working with the LGBTQ+ community and is available to answer any questions you have about the process.

We also make it as simple as possible to stay on top of your medications, with same-day delivery and mediation management tools like reminders and auto refills in our app. Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging with our care team. 

High cholesterol is one of the heart disease risk factors that you have control over. Here’s an overview of how to manage high cholesterol through a combination of diet, lifestyle changes, and medication.

How to Manage High Cholesterol: Diet, Medications, and More

Cholesterol isn’t inherently bad. Your body needs the waxy, fat-like substance to produce cell membranes, hormones, and nutrients like vitamin D. But too much of it — especially low-density lipoproteins (LDL) cholesterol, which accumulates in the walls of your blood vessels and is also referred to as “bad” cholesterol — can increase your risk for heart disease and stroke.

The good news? High cholesterol is one of the heart disease risk factors that you have control over. There are many changes you can make to bring down your cholesterol levels, which in turn will strengthen your overall cardiovascular health. Here’s an overview of how to manage high cholesterol through a combination of diet, lifestyle changes, and medication.

How to lower cholesterol levels with diet

There are two sources of cholesterol: your liver and the foods you eat. This means that you can begin to lower your cholesterol simply by paying attention to your diet and limiting high-cholesterol foods.

There are several categories of high-cholesterol foods to pay attention to. Saturated fats, which are typically solid at room temperature, increase levels of LDL cholesterol in your blood. You don’t have to avoid saturated fats altogether, however you should try to decrease your consumption of them. The American Heart Association suggests aiming for a diet in which 5-6% of the total calories consumed come from saturated fat. Common sources of saturated fats include red meat and full-fat dairy products.

Trans fats, also known as partially hydrogenated oils, are mainly formed through an industrial process which causes oil to become solid at room temperature. These fats are considered the least healthy to eat and should be avoided altogether as much as possible. While the Food and Drug Administration has banned food manufacturers from adding trans fats to foods, it’s still a good idea to check the label of the following foods for partially hydrogenated oils (how trans fats appear on nutrition labels): 

Cookies, cakes, and other baked goods, including frozen products

On the other hand, unsaturated fats — found in plant-based oils such as olive oil and canola oil as well as tree nuts like almonds, walnuts, and pecans — can lower high cholesterol levels. Omega-3 fatty acids — found in fish like salmon, mackerel, herring, and tuna — and soluble fiber — found in beans, peas, lentils, oats, and whole grains — will round out a low-cholesterol diet.

Other lifestyle changes can significantly lower your LDL cholesterol levels naturally, including exercising regularly, maintaining a healthy weight, avoiding cigarette smoke, and limiting your alcohol consumption.

Moderate physical activity can help lower LDL cholesterol and increase high-density lipoprotein (HDL) cholesterol, or “good” cholesterol. Aim for about 30 minutes of moderate to intense exercise per day. Everyone’s fitness needs are different, and it’s okay to start slower and work your way up to more vigorous activity.

Being overweight or obese increases your levels of LDL cholesterol, since excess body fat impacts your body’s ability to clear LDL cholesterol from your bloodstream.

Doctors may calculate your body mass index (BMI) to determine if your weight is in a healthy range. Consult your doctor about what a healthy weight is for you, and work together on a diet and fitness plan to help you reach and maintain that weight.

Smoking when you have unhealthy cholesterol levels increases your risk of heart disease even further. In addition, both smoking and vaping lower HDL cholesterol. Quitting can both lower your LDL cholesterol (bad) and increase your HDL cholesterol (good) levels.

If you currently smoke, ask your doctor for smoking cessation resources such as nicotine replacement therapy (NRT), which reduces withdrawal symptoms. If you are a nonsmoker, try to avoid exposure to secondhand smoke.

Too much alcohol can increase your cholesterol levels, so it’s important to limit your intake as you work on managing your cholesterol. The CDC recommends no more than two drinks per day for men and no more than one for women.

How to manage high cholesterol with medication

For some people, diet and exercise may be enough to manage cholesterol levels. In other cases, medication may be necessary to lower LDL cholesterol levels, increase HDL cholesterol levels, or both. There are several different classes of cholesterol medications. Your doctor can advise you on the best option for your needs.

Statins, also known as HMG CoA reductase inhibitors, act on the liver to prevent cholesterol from forming and limit the overall amount of cholesterol circulating in your bloodstream. They are most effective at lowering LDL cholesterol but can also help increase HDL cholesterol and lower triglycerides, or blood fats.

In most cases, side effects are mild and often disappear as your body adjusts to the medications. Your doctor may order tests on liver function, but liver abnormalities are rare. Statins are not safe to take if you are pregnant or you have chronic liver disease.

Ezetimibe (Zetia®) is a cholesterol absorption inhibitor and the most commonly used non-statin cholesterol medication. Potential side effects include:

This medication is not safe to take during pregnancy or while breastfeeding.

PCSK9 inhibitors bind to a protein found in liver cells to lower LDL cholesterol. They are administered as injections every 2-4 weeks. Commonly prescribed medications in this class include:

The primary side effect is itching, swelling, pain, or bruising at the injection site.

ACL inhibitors act on the liver to block cholesterol production. They are often taken in combination with statins to help further lower LDL in people with heart disease and people with familial heterozygous hypercholesterolemia, a genetic condition that causes high LDL cholesterol.

Commonly prescribed ACL inhibitors include:

Bempedoic acid and ezetimibe (Nexlizet®)

There are several additional medication classes which are not as commonly prescribed but do have a proven mild LDL-lowering action, including fibrates and niacin.

Fibrates are primarily used to lower blood triglyceride levels, however they may also be used to raise HDL and lower LDL cholesterol. 

Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)

Potential side effects include nausea, stomach pain, and muscle pain.

Niacin is a B vitamin that reduces the liver’s production of blood fats. It is very effective at lowering triglycerides and is sometimes prescribed to lower LDL cholesterol.

Niacin comes in prescription form and as a dietary supplement. The latter is not a replacement for a prescription, and it’s important to only take niacin if your doctor has prescribed it.

Liver function should be closely monitored while taking niacin. If you have diabetes, it’s important to discuss the potential risks and benefits of niacin with your doctor, as it can raise blood sugar levels.

There often are not any visible signs or symptoms of high cholesterol, so the only way to determine your cholesterol levels is through a simple blood test called a lipid profile.

Most adults who are in good health have their cholesterol checked every four to six years. If you have heart disease, diabetes, or a family history of high cholesterol, you will need more frequent screening. Consult with your doctor about recommended screening frequency.

Exceptional pharmacy care to strengthen your health

At Alto, we’re committed to making it as simple as possible to stay on top of your cholesterol-lowering medications. We offer same-day delivery and medication management tools like reminders and auto refills  in our app. And our team of pharmacists are always here to answer your questions by phone or through our app, and will even remind you when your medications are due for a refill.

Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging!

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable.

Prioritize Your Health with Preventative Care

If you’ve ever waited until you’re sick to see a doctor, you’re not alone. Many adults in the U.S. put off routine doctor’s appointments — sometimes even when they don’t feel well. 

These delays can be serious: according to the Centers for Disease Control and Prevention, up to 40% of all fatalities linked to the five leading causes of death in the U.S. — heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries — could have been prevented. Untreated blood pressure or cholesterol and unhealthy lifestyle habits factors heavily into many of these cases.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable. Preventative care involves a combination of annual check-ups, vaccinations, screenings, and healthy lifestyle habits. 

If you haven’t been to the doctor in a while, don’t get discouraged. The important thing is to get back in the habit. Below is an overview of preventative care for both men and women, with recommendations from our pharmacists for how to ensure you’re prioritizing your health.

There are several important numbers that help your doctor understand your risk for health conditions such as heart disease and diabetes: your body mass index (BMI), blood pressure, cholesterol, and glucose levels.

Being overweight or obese increases your risk for many different health conditions, including high blood pressure, unhealthy cholesterol levels, type 2 diabetes, heart disease, and stroke. 

Body mass index (BMI) is a screening tool that doctors use for obesity. A healthy BMI is typically between 18.5 to 24.9, while a BMI between 25 to 29.9 is considered overweight and a BMI of 30 or higher is obese.

Keep in mind that while a BMI does help doctors understand your general risk for the chronic conditions mentioned above, it is merely a snapshot of your health and doesn’t account for other important health factors including age and genetics. Your healthcare provider can help you understand your overall priorities with preventative care beyond any single number, which is another important reason to stay up to date with doctor’s appointments.

Your blood pressure numbers are one of several factors that can help your doctor predict your risk for heart disease and cardiac events like a heart attack or stroke. There are five different blood pressure ranges recognized by the American Heart Association:

If your blood pressure is in the normal range, you should get screened at least once per year. If your blood pressure is in a higher range, consult with your doctor about recommended screening frequency.

Read our previous blog to learn more about managing blood pressure.

A cholesterol blood test, also called a lipid profile or lipid panel, gives results for several different readings: HDL (good) cholesterol, LDL (bad) cholesterol, triglycerides, and total blood (or serum) cholesterol. Your total cholesterol and HDL cholesterol levels are particularly important in helping your doctor identify if you are at risk for a heart attack or stroke.

A healthy range for total cholesterol is considered to be less than 200 mg/dL

A healthy range for HDL cholesterol is considered to be higher than 40 mg/dL for men and higher than 50 mg/dL for women

A healthy range for LDL cholesterol is considered to be less than 100 mg/dL

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