The importance of cholesterol management is significant when you consider that having a high level of low-density lipoprotein cholesterol (LDL-C) is a major risk factor for heart disease and stroke. LDL-C is commonly called the “bad cholesterol.”
For some people, lifestyle changes, like a better diet and more exercise, may prevent or treat unhealthy cholesterol levels. For others with high cholesterol, medication may also be needed.
The most common treatment for high cholesterol are called statins. There are 3 main treatment regimens for statins:
- High intensity, which typically lowers LDL-C by 50% or more
- Moderate intensity, which lowers LDL-C by 30% to 49%
- Low intensity, which lowers LDL-C by 30% or less
Let's talk about the most common treatments for high cholesterol.
Statins
This class of drugs, also known as HMG CoA reductase inhibitors, work in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.
Statins are also found in the combination medications Advicor® (lovastatin + niacin), Caduet® (atorvastatin + amlodipine) and Vytorin™ (simvastatin + ezetimibe).
Some statin associated side effects include: muscle weakness and muscle pain.
Nonstatins
• Ezetimibe is the most commonly used nonstatin agent. It lowers LDL-C levels by 13% to 20% and has a low incidence of side effects. It works by preventing cholesterol from being absorbed in the intestine.
• Bile acid sequestrants reduce LDL-C levels by 15% to 30% depending on the dose and are associated with gastrointestinal complaints such as constipation. They work in the intestines by promoting increased disposal of cholesterol. Examples include:
- Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®, Locholest® Light)
- Colestipol (Colestid®)
- Colesevelam Hcl (WelChol®)
• PCSK9 inhibitors are powerful LDL-lowering drugs. Studies showed that the addition of a PCSK9 inhibitor to a statin regimen further reduced LDL-C levels by 43% to 64%. PCSK9 inhibitors bind to and inactivate a protein in liver in order to lower LDL (bad) cholesterol. Some names are:
Alirocumab and Evolocumab
Lipid-lowering therapies
Fibrates (fibric acid derivatives): are best at lowering triglycerides and in some cases increasing HDL levels. These drugs aren’t very effective in lowering LDL cholesterol. Available as:
- Gemfibrozil (Lopid®)
- Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)
- Clofibrate (Atromid-S)
Niacin (nicotinic acid): This drug works in the liver by affecting the production of blood fats.
Omega-3 Fatty Acid Ethyl Esters: these medications are derived from fish oils that are chemically changed and purified. They’re used in tandem with dietary changes, to help people with very high triglyceride levels. Available are:
- Lovaza®
- Vascepa™
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Written by Dr. Chitrali Sood | Edited by Hannah Kingston
