Four types of drug classes are used to lower cholesterol levels.
- Statins: A variety of statin drugs are on the market including simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), fluvastatin (Lescol), lovastatin (Mevacor), and rosuvastatin (Crestor). These drugs primarily decrease LDL.
- Niacin: Niaspan is the prescription form of niacin and decreases LDL and triglycerides as well as increases HDL.
- Bile acid resins: Cholestyramine (Questran) is a bile acid resin and decreases LDL.
- Fibric acid derivatives: Fibric acid resins lower LDL and include gemfibrozil (Lopid) and fenofibrate (Tricor).
Statins is the only class of cholesterol lowering drugs that have been directly related to reducing the risk of heart attack or stroke.
Alirocumab (Praluent) and evolocumab (Repatha) are two new medications that are antibodies to a protein, PCSK9, a receptor for LDL. These drugs are indicated for treatment in patients who have had heart attack or stroke or have familial hypercholesterolemia and are taking maximum therapy, but continue to have high LDL cholesterol levels in their blood.
You and your doctor will discuss what cholesterol medications are right for you based on your current and past medical history, your current health, and any other medications you are taking. These medications often need to be adjusted and monitored for side effects.
While all four medication groups may have a role in controlling cholesterol levels in association with diet, exercise, and smoking cessation, only statins are shown to decrease the risk of heart attack.
The American Heart Association and the American College of Cardiology recommend that statin therapy may benefit patients with a history of heart attack, those with elevated blood LDL cholesterol levels or type two diabetes, and those with a 10-year risk of heart disease greater than 7.5%. When monitoring how well statin therapy works, the goal for some individuals is no longer to reach a specific blood cholesterol level. Instead, patients with a high risk of heart disease will aim to decrease their cholesterol levels by 50% and those with a lesser risk will aim to lower their cholesterol levels by 30% to 50%. You need to discuss what levels are best for you to reach with your doctor.