All About Cholesterol-Lowering Medicines
Healthy lifestyle changes alone may be enough to help some people reach healthy cholesterol
levels. Other people will need to take a cholesterol-lowering medicine. If you need
medicine e, talk with your healthcare provider and work together to find the best
option for you.
There are 7 main types of medicine:
Statins. These include atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin,
rosuvastatin, and simvastatin. These medicines lower LDL ("bad") cholesterol. They
typically reduce LDL by about one-third. They can also help raise HDL ("good") cholesterol
and lower triglycerides (other blood fats). Statins slow the body's production of
cholesterol. They also increase the liver's ability to remove LDL from the blood.
In research on people who already had heart disease, statins greatly reduced heart
attacks and heart disease deaths. They may also prevent first heart attacks in people
who are at high risk for heart disease.
Bile acid sequestrants. These include cholestyramine, colesevelam, and colestipol. These medicines also lower
LDL, although somewhat less than statins. These medicines bind with bile acids in
the intestines and force them to leave the body in the stool instead of being absorbed
into the blood stream. The liver needs cholesterol to make bile acids and important
growth and stress hormones. So as more bile is lost, more cholesterol from your body
is used up to make more bile.
Nicotinic acid (niacin). This B vitamin increases HDL and lowers LDL and triglycerides when taken at levels
higher than needed in the diet. Nicotinic acid is sold as both a prescription medicine
and a dietary supplement. But only the prescription form should be used to lower cholesterol.
Some people don't tolerate the high doses because these medicines cause flushing or
a burning or itching sensation.
Fibrates. These include gemfibrozil and fenofibrate. These drugs lower triglycerides. They
may also lead to modest improvements in LDL and HDL levels.
Selective cholesterol absorption inhibitors. An example is ezetimibe. This medicine lowers cholesterol by reducing the amount
of cholesterol absorbed by the intestines. Ezetimibe, bile acid sequestrants, and
nicotinic acid are sometimes combined with a statin to help people reach their LDL
PCSK9 inhibitors. These include alirocumab and evolocumab. These newest medicines are injected in the
skin and contain antibodies that bind to an important enzyme involved in the removal
of LDL from the bloodstream. These medicines may lower LDL levels by almost half and
can reduce the risk of heart attack.
Omega 3 fatty acid ethyl esters. This includes fish oils. This type of medicine is used along with diet and lifestyle
to help people lower their triglycerides when the levels are above 500 mg/dL. This
type of cholesterol medicine should not be used by anyone with a severe allergy to
fish or shellfish due to the risk of a severe reaction.
Your healthcare provider can help you find out your own risk and if you need medicine
to control your cholesterol. Calculating a risk score is done looking at certain things
that are considered an increased risk for atherosclerosis. The risk calculator tool
Ages between 40 and 79 years
Blood pressure (systolic and diastolic measurements)
Total cholesterol, HDL cholesterol, and LDL cholesterol levels
History of diabetes
Current or past smoking history
Treatment for high blood pressure
Treatment of cholesterol with a statin medicine
Current use of aspirin
If you and your provider are unsure about your risk for developing heart disease,
you may have a test to look at the total amount of calcium (plaque) buildup in your
arteries called a coronary artery calcium score (CAC). This is measured using a CT
Discuss your treatment goals with your healthcare provider. Make sure you understand
how your cholesterol and other factors affect your risk for heart disease or other
complications. Plan to have regular monitoring and report any side effects from the
medicines. Sometimes you may need more than one medicine to reach your cholesterol
goals. Also make sure you also understand how to get ready for cholesterol testing.
You often need to fast before you have the test.