Medications

For many people with high cholesterol, diet and lifestyle changes alone often aren’t enough to lower their chance of heart disease or stroke, despite their best efforts. Medications can help to further lower cholesterol. 

Statins

Statins remain the first treatment – in combination with lifestyle changes – to lower cholesterol and reduce the risk of cardiac events like heart attack, stroke and related death. There are at least seven statins available, and they work in different ways. For example they help by:

• Reducing the amount of cholesterol made by the liver
• Removing cholesterol from the blood
• Reducing cholesterol in plaque
• Reducing inflammation from plaque
• Helping keep a plaque from dislodging or forming a clot that may block an artery 

The goal is for someone to be on the highest dose of a statin possible to gain the most benefit.

As with any medication, it is important to tell your doctor about any side effects or problems from statins. Though side effects are not common, your doctor may decide to:

• Order a blood test to find out if there may be another cause of your symptoms
• Lower the dose of the statin you are taking
• Switch you to a different statin
• Prescribe something other than a statin, if appropriate  

Other Medications to Lower LDL

Other non-statin medications used to lower LDL-cholesterol include: 

• Cholesterol absorption inhibitors (ezetimibe) to lower the amount of cholesterol in the blood. There is also a medication that combines ezetimibe and a statin. 
• Therapies that target PCSK9 are recommended for high-risk patients with genetic disorders that lead to very high levels of cholesterol (FH, for example) or with existing heart disease whose LDL-cholesterol levels haven’t been lowered enough after taking the highest dose of statins (sometimes called maximally tolerated statin therapy) or ezetimibe. These medications are injected under the skin, but they work in different ways to target a protein called PCSK9.
• Evolocumab and alirocumab are monoclonal antibodies that inhibit PCSK9 activity.
• Inclisiran stops proteins from being made, allowing the liver to keep removing bad cholesterol.
• Bempedoic acid to block a slightly different step in cholesterol production than statins. It is approved for use in high-risk patients with familial hypercholesterolemia or with heart disease who need to lower their LDL despite taking the highest dose of statins.
• Bile acid sequestrants or resins bind to cholesterol in the intestine and block absorption.

There are other medications that are used for people with FH.

Medications to Lower Triglycerides

Also, medications to lower triglyceride levels might be used:

• High-dose omega-3 fatty acids lower triglyceride levels. Icosapent ethyl has been shown to lower recurrence of cardiac events in addition to lowering triglycerides. This is a prescription medicine.
• Fibrates and niacin mostly lower triglycerides but also lower LDL cholesterol to some extent.
  

Take as Directed

As always, take your medications exactly as directed. That’s the only way to make sure they work as intended. If you have side effects or concerns, talk with your care team before making any changes. Your cholesterol will be re-checked over time. It’s not unusual for your care team to make changes to your medications, perhaps adding a medication or adjusting the amount (dose) you take.

Work with your care team to make sure you get your cholesterol down to a level that will keep you healthy for the rest of your life. Your pharmacist is also a good resource if you have questions.