Medications That Lower Cholesterol
Managing high cholesterol, or hyperlipidemia, often involves a combination of lifestyle changes and medication. When diet and exercise are not enough, healthcare providers may prescribe one or more of several classes of drugs to help lower unhealthy lipid levels. These medications work in different ways to reduce LDL ('bad') cholesterol, lower triglycerides, or increase HDL ('good') cholesterol.
Statins (HMG-CoA Reductase Inhibitors)
Statins are the most widely prescribed medication for lowering cholesterol and are considered a cornerstone of treatment for many individuals at risk of cardiovascular events. They work by blocking an enzyme in the liver to reduce cholesterol production, which helps lower LDL cholesterol. Examples include atorvastatin, rosuvastatin, simvastatin, and pravastatin.
PCSK9 Inhibitors
These injectable medications block a protein that breaks down LDL receptors, allowing the liver to remove more LDL from the bloodstream. They are very effective at lowering LDL, especially for those with familial hypercholesterolemia or statin intolerance. Alirocumab and evolocumab are examples.
Cholesterol Absorption Inhibitors
These drugs reduce the amount of cholesterol absorbed from food in the intestines, lowering circulating LDL. Ezetimibe (Zetia) is a common example, often used with a statin.
Bile Acid Sequestrants (Resins)
By binding to bile acids in the gut, these medications force the body to use more cholesterol to produce new bile acids, thus lowering blood cholesterol. Examples include cholestyramine and colesevelam.
Fibrates
Primarily used for high triglycerides, fibrates reduce the liver's production of triglycerides and help remove them from the blood. Fenofibrate and gemfibrozil are examples.
ACL Inhibitors
This newer class blocks an enzyme involved in cholesterol synthesis in the liver, significantly lowering LDL. Bempedoic acid (Nexletol) is an example.
Medications That Can Raise Cholesterol
Some drugs for unrelated conditions can unintentionally increase cholesterol. Awareness of these effects is important, particularly for those with cardiovascular risks.
Diuretics
Certain diuretics, especially high doses of thiazides, can temporarily increase total and LDL cholesterol. Loop diuretics can have a similar, though less pronounced, effect.
Beta-blockers
Older beta-blockers used for high blood pressure may increase triglycerides and decrease HDL. Modern beta-blockers tend to have less impact.
Corticosteroids
Prolonged use of corticosteroids like prednisone can increase total cholesterol, LDL, and triglycerides.
Hormonal Medications
Certain oral contraceptives and anabolic steroids can affect cholesterol. Some progestins may lower HDL, while anabolic steroids significantly raise LDL and lower HDL.
Retinoids
Medications like isotretinoin, used for skin conditions, can increase total cholesterol and triglycerides.
Comparison of Major Cholesterol Medications
| Medication Class | Primary Action | Effect on LDL | Effect on Triglycerides | Typical Use |
|---|---|---|---|---|
| Statins | Reduces liver cholesterol production | Significantly lowers | Modestly lowers | First-line therapy for high LDL |
| PCSK9 Inhibitors | Blocks protein that destroys LDL receptors | Significantly lowers | Modestly lowers | Used for very high LDL or statin intolerance |
| Cholesterol Absorption Inhibitors | Decreases cholesterol absorption from food | Modestly lowers | Variable | Often combined with statins |
| Fibrates | Reduces liver's triglyceride production | Variable or modest increase | Significantly lowers | Primarily for high triglycerides |
| Bile Acid Sequestrants | Binds bile acids in the gut | Modestly lowers | Modest increase or no effect | Used when statins are not tolerated |
| ACL Inhibitors | Blocks cholesterol production in liver | Significantly lowers | Modestly lowers | Used for very high LDL or statin intolerance |
Understanding Individual Effects
How a medication affects your cholesterol is influenced by health, other drugs, and genetics. Some drugs affect cholesterol indirectly. Always consult your healthcare provider before changing medications. Regular lipid monitoring is crucial to track drug effects. For more information, the National Institutes of Health is an authoritative source. Read more on lipid-lowering drug therapy on the NIH website.
Conclusion
Many medications impact cholesterol, some to lower it, others as a side effect. Statins are primary for lowering LDL, with options like PCSK9 and ACL inhibitors, ezetimibe, and fibrates also playing key roles. Be aware of non-cholesterol drugs that can raise levels, such as certain diuretics, beta-blockers, and hormonal medications. Regular check-ups and open communication with your doctor are vital for managing your cholesterol and mitigating medication risks.
