Medications

Many people who have excess LDL cholesterol also need to take medicine to lower their cholesterol levels at some point.

This is especially true for people with atherosclerotic cardiovascular disease or those who are at high risk for developing it. 

Statins

Statins – in combination with lifestyle changes – are still the drug treatment of choice. Research has shown that the use of statins can reduce the risk of cardiac events like heart attack, stroke and related death. There are at least seven statins available, and they work in different ways; for example by:

• Reducing the amount of cholesterol made by the liver
• Removing cholesterol from the blood
• Reducing cholesterol in plaque
• Reducing inflammation from plaque
• Preventing plaque from dislodging or forming a clot that may block an artery 

As with any medication, it is important to tell your doctor about any side effects or problems from statins. Though side effects are not common, your doctor may decide to:

• Order a blood test to find out if there may be another cause of your symptoms
• Lower the dose of the statin you are taking
• Switch you to a different statin
• Prescribe an alternative dosing schedule 

Other Medications to Lower LDL

Other non-statin medications used to lower LDL-cholesterol include: 

• Cholesterol absorption inhibitors (ezetimibe) to lower the amount of cholesterol in the blood.
• PCSK9 inhibitors for high-risk patients who either have a cholesterol disorder passed down in families (called familial hypercholesterolemia) or who have heart disease but haven't lowered their LDL-cholesterol levels enough even after taking the highest dose (amount) of statins (sometimes called maximally tolerated statin therapy) or ezetimibe.
• Bempedoic acid to block a slightly different step in cholesterol production than statins and is less likely to cause side effects on muscles sometimes experienced with statins. It is approved for use in high-risk patients with familial hypercholesterolemia or with heart disease who need to lower their LDL despite taking the highest dose of statins.
• Bile acid sequestrants or resins to bind cholesterol in the intestine and block absorption.

Medications to Lower Triglycerides

Also, medications to lower triglyceride levels might be used:

• High-dose omega-3 fatty acids lower triglyceride levels. Icosapent ethyl has been shown to lower recurrence of cardiac events in addition to lowering triglycerides. This is a prescription medicine.
• Fibrates and niacin mostly lower triglycerides but also lower LDL cholesterol to some extent.
  

Take as Directed

No matter which medication your health care team prescribes, take your medications exactly as directed. That’s the only way to make sure they work as intended. If you have side effects or concerns, talk with your care team before making any changes.

Work with your care team to make sure you get your cholesterol down to a level that will keep you healthy for the rest of your life. Your pharmacist is also a good resource if you have questions.