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 – 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 that predominantly lower LDL-cholesterol include:
- Cholesterol absorption inhibitors (ezetimibe) lower the amount of cholesterol in the blood.
- PCSK9 inhibitors are used for high-risk patients who either have a genetic cholesterol disorder (called familial hypercholesterolemia)
or who have established heart disease but have not had enough reduction in LDL cholesterol levels even after taking the maximum tolerated amounts of statins or ezetimibe.
- Bempedoic acid blocks 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 maximum tolerated amounts of statins.
- Bile acid sequestrants or resins bind cholesterol in the intestine and block absorption.
Medications to Lower Triglycerides
In addition, medications to lower triglyceride levels might be used:
- High-dose omega-3 fatty acids lower triglyceride levels. Icosapent ethyl (EPA) has been shown to lower recurrence of cardiac events in addition to lowering triglycerides.
- Fibrates and niacin mostly lower triglycerides but also lower LDL cholesterol to some extent.
Take as Directed
No matter which medication your clinician 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 health care provider before making any
Work with your provider 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.