All About Cholesterol-Lowering Drugs

Making healthy lifestyle changes alone is enough to help some people reach the cholesterol goals prescribed by their doctor. Others, however, need to take a cholesterol-lowering medication, as well.

According to the American Heart Association, there are five main types:

• Statins (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin). These drugs work mainly by lowering LDL ("bad") cholesterol. They typically reduce LDL by 30 to 40 percent. They also help raise HDL ("good") cholesterol and lower triglycerides (other blood fats). Statins work by slowing down the body's production of cholesterol. They also increase the liver's ability to remove LDL from the blood. In research involving people who already had heart disease, statins led to significant reductions in heart attacks and heart disease deaths.

• Bile acid sequestrants (cholestyramine, colesevelam, colestipol). These drugs also lower LDL, although somewhat less than statins. These medications work by binding with bile acids in the intestines and forcing them to be eliminated in the stool rather than absorbed. The liver needs bile acids to make cholesterol, so less cholesterol is produced when fewer bile acids are available.

• Nicotinic acid (niacin). This B vitamin increases HDL and lowers LDL and triglycerides when taken at levels higher than dietary requirements. Nicotinic acid is sold as both a prescription drug and a dietary supplement, but only the prescription form should be used for cholesterol lowering.

• Fibrates (gemfibrozil, fenofibrate). These drugs help mainly by lowering triglycerides by about 20 to 50 percent. They may also lead to modest improvements in LDL and HDL levels.

• Ezetimibe. This drug lowers cholesterol by reducing the amount of cholesterol absorbed by the intestines. Ezetimibe, bile acid sequestrants, or nictonic acid are sometimes combined with a statin to help people reach their LDL cholesterol-lowering goals.