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What are the cholesterol lowering medications?

It has been very clear for a number of years that high blood levels of lipid, otherwise known as blood fats, are detrimental and strongly contribute to the process of atherosclerotic coronary disease and vascular disease—otherwise known as clogged arteries. The principal bad actor appears to be a particle called LDL cholesterol.  Medications for lowering this are clearly of benefit. Statin drugs are the leading treatments. These include Lipitor, Provachol, Zocor and others. These medications can clearly lead to plaque stabilization and cut down on the risk of adverse events, such as heart attacks and strokes.

Currently, there are medications from five major classes of drugs to treat people with unhealthy lipid levels, as well as medications that combine drugs from the different classes. Each has a different mechanism of action and modifies blood lipids to varying degrees. The five classes are divided into the following categories:
  • HMG-CoA reductase inhibitors (statins)
  • Lipid lowering therapies (niacin, fibric acid derivatives, etc.)
  • Bile acid binding resins
  • Cholesterol absorption inhibitors
  • PCSK9 inhibitors (monoclonal antibodies)

There are many different types of medications available to lower cholesterol. The most common one used is a class of medicine called statin which block the body's ability to make cholesterol. Other medicines bind and block use of other components needed for cholesterol making. Your doctor can help determine which type of cholesterol medicine is best for you.

There are several classes of cholesterol-lowering medications.  The most common and best-studied are the "statins" which act on the liver where cholesterol is made.  These include the earlier generations: fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and the newer generations: simvastatin (Zocor), atorvastatin (Lipitor), rosuvastatin (Crestor), and the newest medication in the class, pitavastatin (Lovalo).

Another medication that has been in use for decades is niacin, or the prescription form, Niaspan, which helps lower bad cholesterol and also increase good cholesterol.  Niacin is available in many over-the-counter formats, however, these are less effective or not effective at all in changing cholesterol, so we typically recommend the prescription Niaspan.

Cholesterol absorption from the diet is another target for medications, the most notable of which is ezetimibe (Zetia).  Bile acid sequestrants (cholestyramine, colesevelam, colestipol) are also used to reduce cholesterol from the diet.  There are also drugs targeted against triglycerides, which are a type of fat that travels through the blood along with cholesterol and increase the risk of plaque buildup.  These "fibrates" include gemfibrozil, fenofibrate (Tricor) and fenofibric acid (Trilipix).

There are other classes of medications that will be coming out in the next few years to address cholesterol-lowering as it is such an important aspect of preventing heart attacks and strokes.

The most common cholesterol lowering medications are called statins. Statins work by slowing down the production of cholesterol in the liver.

Dr. Marcus J. Cox, MD
Cardiologist (Heart Specialist)

Cholesterol lowering medications include the statins, fibric acid derivatives, bile-acid resin fish oil, niacin, and Zetia. These medications can vary widely in their effects on LDL, HDL, and triglyceride levels. They also are considered most effective when combined with exercise and a healthy diet.

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