All About Cholesterol-Lowering Medicines

Healthy lifestyle changes alone may be enough to help some people reach their cholesterol goals. Other people will need to take a cholesterol-lowering medicine.

There are 5 main types of medicine:

• Statins (such as atorvastatin, fluvastatin, lovastatin, pravastatin, and others). 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 (such as cholestyramine, colesevelam, 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 absorbed. The liver needs cholesterol to make bile acids. 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.

• Fibrates (such as gemfibrozil, fenofibrate). These drugs lower triglycerides. They may also lead to modest improvements in LDL and HDL levels.

• Selective cholesterol absorption inhibitors (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 cholesterol-lowering goals.

High risk groups

Certain people are at higher risk for problems from high cholesterol. They may need to use anti-cholesterol medicines along with eating a healthy diet and exercising regularly to reduce cholesterol. The major risk groups include:

• Adults who have had a heart attack or stroke. Or they have some other disease that affects the blood vessels (atherosclerotic), a transient ischemic attack, or stable or unstable angina. This group also includes people who have had a procedure to restore blood flow through a blocked artery. These procedures include angioplasty or bypass surgery

• Adults who have diabetes or are a high risk of having a heart attack or stroke and have LDL cholesterol of 70  to 189 mg/dL

• People who are 21 years of age and older who have an LDL cholesterol level of 190 mg/dL or higher

If you are in a high risk group, discuss your treatment goals with your healthcare provider. Make sure you understand how your cholesterol and other factors affect your risk of 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. It often requires that you fast before you have the test.