Table of ContentsView AllTable of ContentsStatinsPCSK9 InhibitorsEzetimibeBile Acid SequestrantsFibrates
Table of ContentsView All
View All
Table of Contents
Statins
PCSK9 Inhibitors
Ezetimibe
Bile Acid Sequestrants
Fibrates
Several medications are regularly prescribed to treat high cholesterol and triglyceride levels, from statins like Lipitor (atorvastatin), to PCSK9 inhibitors like Repatha (evolocumab), to niacin.
Which is most appropriate for you depends on several factors, but it’s likely your healthcare provider will want you to begintaking prescription medicationif diet and exercise are not enough tolower your levels, or if your risk for cardiovascular disease is particularly elevated.
This article will help you learn about the possible prescription options your healthcare provider might suggest so you can take an active role in your treatment discussions and decisions.
Take A Pix Media / Blend Images / Getty Images
Statins are the mainstay of therapy for cholesterol. These oral drugs inhibit the action of an enzyme called HMG-CoA reductase, reducing the liver’s ability to make cholesterol.
Statins alsoreduce vascular inflammation, decrease vascular thrombosis, and improve overall vascular function.
Statins are usually well tolerated, but you can experienceside effects. The most notable one ismuscle pain or weakness, which occurs in 0.3% to 33% of patients who take these drugs.
Currently available statins include:
Who Should Take Statins and When
PCSK9 inhibitors are a newer class of cholesterol-lowering drugs than statins.
The effect of these drugs is a therapeutic reduction of bad cholesterol.
Available PCSK9 inhibitors include:
PCSK9 Inhibitors for Cholesterol
Clinical trials with ezetimibe have been fairly disappointing, and the drug is not used often in clinical practice. It is mainly prescribed for people who have continued high cholesterol levels despite statin therapy or those unable to take statins.
Available versions of this drug include:
Bile acid sequestrants prevent the reabsorption of cholesterol-containing bile acids from the intestine.This causes the liver to remove more cholesterol from circulation.
Bile acid sequestrants include:
While these drugs also effectively reduce LDL cholesterol levels, they tend to cause gastrointestinal side effects that limit usefulness.
Clinical studies have yet to show that they improve outcomes.
Cholestyramine Bile Acid Sequestrant
Despite their favorable effect on blood lipids, several randomized trials have failed to show any improvement in clinical outcomes with fibrates.They are mainly used to treatsevere hypertriglyceridemia.
Available fibrates include:
The most common side effect of fibrates is that they can cause muscle toxicity, mainly when used with statins.
Using Fibrates to Lower Cholesterol
Summary
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Cholesterol medications.Yale Medicine.Should you take a statin for your high cholesterol?.Ward N, Watts G, Eckel R.Statin toxicity.Circulation Res. 2019 Jan;124(1):328-350. doi:10.1161/CIRCRESAHA.118.312782Diamantis E, Kyriakos G, Quiles-Sanchez L, Farmaki P, Troupis T.The anti-inflammatory effects of statins on coronary artery disease: An updated review of the literature.Curr Cardiol Rev. 2017 Aug;13(3):209-216. doi:10.2174/1573403X13666170426104611Hla D, Jones R, Blumenthal R, Martin SS.Assessing severity of statin side effects: fact versus fiction. American College of Cardiology.American Heart Association.Familial hypercholesterolemia (FH). Updated November 9, 2020.Cannon CP, Blazing MA, Giugliano RP, et al.Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015;372(25):2387-2397. doi:10.1056/NEJMoa1410489Wang Y, Zhan S, Du H, et al.Safety of ezetimibe in lipid-lowering treatment: A systematic review and meta-analysis of randomised controlled trials and cohort studies.BMJ Med. 2022 May;1(1):e000134. doi:10.1136/bmjmed-2022-000134Heřmánková E, Žák A, Poláková L, Hobzová R, Hromádka R, Širc J.Polymeric bile acid sequestrants: Review of design,in vitrobinding activities, and hypocholesterolemic effects.Euro J Med Chem. 2018 Jan;144(1):300-317. doi:10.1016/j.ejmech.2017.12.015Kumar A, Galbraith N, Al-Hassi H, et al.The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea.BMC Gastroenterol. 2022 Jul;22(1):325. doi:10.1186/s12876-022-02404-9Robert C, Trivette E, Westerfield K.Management of hypertriglyceridemia: Common questions and answers.Am Fam Phys. 2020;102(6):347-354.Kim N, Kim S.Fibrates revisited: Potential role in cardiovascular risk reduction.Diabetes Metab J.2020 Apr;44(2):213-221. doi:10.4093/dmj.2020.0001El-Bassouny D, Mansour A, Ellakkany A, Ayuob N, AbdElfattah A.Can coenzyme Q10 alleviate the toxic effect of fenofibrate on skeletal muscle?. 2023 Jun;160(2):147-158. doi:10.1007/s00418-023-02205-5Additional ReadingAmaro-Gahete FJ, De-la-O A, Jurado-Fasoli L, Martinez-Tellez B, Ruiz JR, Castillo MJ.Exercise training as a treatment for cardiometabolic risk in sedentary adults: are physical activity guidelines the best way to improve cardiometabolic health? The FIT-AGEING randomized controlled trial.J Clin Med.2019;8(12). doi:10.3390/jcm8122097American College of Cardiology,Guideline on the management of blood cholesterol.Mani P, Rohatgi A.Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct?Curr Atheroscler Rep. 2015;17(8):43. doi:10.1007/s11883-015-0521-x
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Cholesterol medications.Yale Medicine.Should you take a statin for your high cholesterol?.Ward N, Watts G, Eckel R.Statin toxicity.Circulation Res. 2019 Jan;124(1):328-350. doi:10.1161/CIRCRESAHA.118.312782Diamantis E, Kyriakos G, Quiles-Sanchez L, Farmaki P, Troupis T.The anti-inflammatory effects of statins on coronary artery disease: An updated review of the literature.Curr Cardiol Rev. 2017 Aug;13(3):209-216. doi:10.2174/1573403X13666170426104611Hla D, Jones R, Blumenthal R, Martin SS.Assessing severity of statin side effects: fact versus fiction. American College of Cardiology.American Heart Association.Familial hypercholesterolemia (FH). Updated November 9, 2020.Cannon CP, Blazing MA, Giugliano RP, et al.Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015;372(25):2387-2397. doi:10.1056/NEJMoa1410489Wang Y, Zhan S, Du H, et al.Safety of ezetimibe in lipid-lowering treatment: A systematic review and meta-analysis of randomised controlled trials and cohort studies.BMJ Med. 2022 May;1(1):e000134. doi:10.1136/bmjmed-2022-000134Heřmánková E, Žák A, Poláková L, Hobzová R, Hromádka R, Širc J.Polymeric bile acid sequestrants: Review of design,in vitrobinding activities, and hypocholesterolemic effects.Euro J Med Chem. 2018 Jan;144(1):300-317. doi:10.1016/j.ejmech.2017.12.015Kumar A, Galbraith N, Al-Hassi H, et al.The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea.BMC Gastroenterol. 2022 Jul;22(1):325. doi:10.1186/s12876-022-02404-9Robert C, Trivette E, Westerfield K.Management of hypertriglyceridemia: Common questions and answers.Am Fam Phys. 2020;102(6):347-354.Kim N, Kim S.Fibrates revisited: Potential role in cardiovascular risk reduction.Diabetes Metab J.2020 Apr;44(2):213-221. doi:10.4093/dmj.2020.0001El-Bassouny D, Mansour A, Ellakkany A, Ayuob N, AbdElfattah A.Can coenzyme Q10 alleviate the toxic effect of fenofibrate on skeletal muscle?. 2023 Jun;160(2):147-158. doi:10.1007/s00418-023-02205-5Additional ReadingAmaro-Gahete FJ, De-la-O A, Jurado-Fasoli L, Martinez-Tellez B, Ruiz JR, Castillo MJ.Exercise training as a treatment for cardiometabolic risk in sedentary adults: are physical activity guidelines the best way to improve cardiometabolic health? The FIT-AGEING randomized controlled trial.J Clin Med.2019;8(12). doi:10.3390/jcm8122097American College of Cardiology,Guideline on the management of blood cholesterol.Mani P, Rohatgi A.Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct?Curr Atheroscler Rep. 2015;17(8):43. doi:10.1007/s11883-015-0521-x
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Cholesterol medications.Yale Medicine.Should you take a statin for your high cholesterol?.Ward N, Watts G, Eckel R.Statin toxicity.Circulation Res. 2019 Jan;124(1):328-350. doi:10.1161/CIRCRESAHA.118.312782Diamantis E, Kyriakos G, Quiles-Sanchez L, Farmaki P, Troupis T.The anti-inflammatory effects of statins on coronary artery disease: An updated review of the literature.Curr Cardiol Rev. 2017 Aug;13(3):209-216. doi:10.2174/1573403X13666170426104611Hla D, Jones R, Blumenthal R, Martin SS.Assessing severity of statin side effects: fact versus fiction. American College of Cardiology.American Heart Association.Familial hypercholesterolemia (FH). Updated November 9, 2020.Cannon CP, Blazing MA, Giugliano RP, et al.Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015;372(25):2387-2397. doi:10.1056/NEJMoa1410489Wang Y, Zhan S, Du H, et al.Safety of ezetimibe in lipid-lowering treatment: A systematic review and meta-analysis of randomised controlled trials and cohort studies.BMJ Med. 2022 May;1(1):e000134. doi:10.1136/bmjmed-2022-000134Heřmánková E, Žák A, Poláková L, Hobzová R, Hromádka R, Širc J.Polymeric bile acid sequestrants: Review of design,in vitrobinding activities, and hypocholesterolemic effects.Euro J Med Chem. 2018 Jan;144(1):300-317. doi:10.1016/j.ejmech.2017.12.015Kumar A, Galbraith N, Al-Hassi H, et al.The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea.BMC Gastroenterol. 2022 Jul;22(1):325. doi:10.1186/s12876-022-02404-9Robert C, Trivette E, Westerfield K.Management of hypertriglyceridemia: Common questions and answers.Am Fam Phys. 2020;102(6):347-354.Kim N, Kim S.Fibrates revisited: Potential role in cardiovascular risk reduction.Diabetes Metab J.2020 Apr;44(2):213-221. doi:10.4093/dmj.2020.0001El-Bassouny D, Mansour A, Ellakkany A, Ayuob N, AbdElfattah A.Can coenzyme Q10 alleviate the toxic effect of fenofibrate on skeletal muscle?. 2023 Jun;160(2):147-158. doi:10.1007/s00418-023-02205-5
American Heart Association.Cholesterol medications.
Yale Medicine.Should you take a statin for your high cholesterol?.
Ward N, Watts G, Eckel R.Statin toxicity.Circulation Res. 2019 Jan;124(1):328-350. doi:10.1161/CIRCRESAHA.118.312782
Diamantis E, Kyriakos G, Quiles-Sanchez L, Farmaki P, Troupis T.The anti-inflammatory effects of statins on coronary artery disease: An updated review of the literature.Curr Cardiol Rev. 2017 Aug;13(3):209-216. doi:10.2174/1573403X13666170426104611
Hla D, Jones R, Blumenthal R, Martin SS.Assessing severity of statin side effects: fact versus fiction. American College of Cardiology.
American Heart Association.Familial hypercholesterolemia (FH). Updated November 9, 2020.
Cannon CP, Blazing MA, Giugliano RP, et al.Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015;372(25):2387-2397. doi:10.1056/NEJMoa1410489
Wang Y, Zhan S, Du H, et al.Safety of ezetimibe in lipid-lowering treatment: A systematic review and meta-analysis of randomised controlled trials and cohort studies.BMJ Med. 2022 May;1(1):e000134. doi:10.1136/bmjmed-2022-000134
Heřmánková E, Žák A, Poláková L, Hobzová R, Hromádka R, Širc J.Polymeric bile acid sequestrants: Review of design,in vitrobinding activities, and hypocholesterolemic effects.Euro J Med Chem. 2018 Jan;144(1):300-317. doi:10.1016/j.ejmech.2017.12.015
Kumar A, Galbraith N, Al-Hassi H, et al.The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea.BMC Gastroenterol. 2022 Jul;22(1):325. doi:10.1186/s12876-022-02404-9
Robert C, Trivette E, Westerfield K.Management of hypertriglyceridemia: Common questions and answers.Am Fam Phys. 2020;102(6):347-354.
Kim N, Kim S.Fibrates revisited: Potential role in cardiovascular risk reduction.Diabetes Metab J.2020 Apr;44(2):213-221. doi:10.4093/dmj.2020.0001
El-Bassouny D, Mansour A, Ellakkany A, Ayuob N, AbdElfattah A.Can coenzyme Q10 alleviate the toxic effect of fenofibrate on skeletal muscle?. 2023 Jun;160(2):147-158. doi:10.1007/s00418-023-02205-5
Amaro-Gahete FJ, De-la-O A, Jurado-Fasoli L, Martinez-Tellez B, Ruiz JR, Castillo MJ.Exercise training as a treatment for cardiometabolic risk in sedentary adults: are physical activity guidelines the best way to improve cardiometabolic health? The FIT-AGEING randomized controlled trial.J Clin Med.2019;8(12). doi:10.3390/jcm8122097American College of Cardiology,Guideline on the management of blood cholesterol.Mani P, Rohatgi A.Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct?Curr Atheroscler Rep. 2015;17(8):43. doi:10.1007/s11883-015-0521-x
Amaro-Gahete FJ, De-la-O A, Jurado-Fasoli L, Martinez-Tellez B, Ruiz JR, Castillo MJ.Exercise training as a treatment for cardiometabolic risk in sedentary adults: are physical activity guidelines the best way to improve cardiometabolic health? The FIT-AGEING randomized controlled trial.J Clin Med.2019;8(12). doi:10.3390/jcm8122097
American College of Cardiology,Guideline on the management of blood cholesterol.
Mani P, Rohatgi A.Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct?Curr Atheroscler Rep. 2015;17(8):43. doi:10.1007/s11883-015-0521-x
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