Know Your Cholesterol Meds

Reviewed By:
Kerry Prewitt, M.D., FACC

In the maze of drugs on the market to lower cholesterol, finding the one that suits you best can be challenging.

For most people, "bad" cholesterol, or LDL, creeps up with age, much like those extra pounds. We all know our doctor's advice to exercise, lose weight, lower the amount of fats and change the kinds of fats in our diet. But even if we follow the advice, there may come a time we need to add meds to our daily routine.

Most medications to help lower LDL cholesterol also reduce the risk of heart attacks.

But some cholesterol medications have other cardiovascular benefits, like boosting HDL, or "good" cholesterol, and affecting other known risk factors for heart disease, like cardiac inflammation. So, what do you need to know when your doctor hands you a prescription?

Cholesterol meds can be grouped into categories:

• Statin drugs are the first line of treatment. Statins can lower LDL cholesterol by up to 30 to 60 percent for some drugs, reduce the risk for heart attacks and may also increase HDL cholesterol. Doctors prescribe statins for patients with high cholesterol, those with a family history of heart disease, smokers, and people with high blood pressure.
  
  
• Ezetimibe is a newer class of drug that blocks cholesterol absorption in the small intestine. It has been shown to reduce LDL cholesterol levels, although not as much as statins. Ezetimibe has been marketed alone and combined with statin drugs. The drug class was approved by the U.S. Food and Drug Administration in 2004, but a clinical study released in 2008 indicated that ezetimibe alone or in combination provided no benefits that could not be achieved with a statin drug. One specific measure in the study (the thickness of plaques in carotid arteries) did not improve at all and in some cases appeared worsened by the drug.
  
  
• Bile acid resins work by blocking how cholesterol is processed in the digestive system. They reduce LDL cholesterol, although not as well as statins. Bile acid resins may be prescribed for patients who are poor candidates for statins, such as pregnant women.
  
  
• Nicotinic acid is a form of vitamin B3, or niacin. In higher doses, nicotinic acid can serve to reduce LDL cholesterol and among cholesterol medications, nicotinic acid is best at increasing HDL cholesterol. You can get this drug over the counter and in prescription forms. However, high doses may produce side effects such as flushing or hot flashes , so even the over-the-counter type should be taken with a doctor's supervision.
  
  
• Fibrates are somewhat effective at reducing LDL cholesterol, though they are better at reducing another type of blood fat, triglycerides. They may be used for patients for whom elevated triglycerides are a larger problem--often those with diabetes.