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Cholesterol-lowering drugs: A primer

lower cholesterolHigh cholesterol can be tough to beat. For some people, diet and exercise alone are enough to bring their numbers down. For others, it doesn’t matter how many miles a week they run or how healthy the food on their plates—those numbers don’t seem to budge!

Lifestyle changes—revamping your diet, exercising regularly, keeping weight in check and not smoking—are the first line of defense in managing high cholesterol. But, if those measures aren’t working after six months to a year, your health care provider will likely recommend cholesterol-lowering medication. Here are some medications that your provider may recommend (note: cholesterol medications may not be suitable for everyone, including those with liver problems).

Statins
What they do: Statins block the liver from making cholesterol, which can lower total cholesterol, “bad” LDL cholesterol and triglycerides, while giving a slight boost to “good” HDL cholesterol. Statins may also help remove cholesterol buildup from artery walls.
Risks and side effects: gastrointestinal disturbances such as constipation, nausea, diarrhea, stomach pain and cramps; muscle issues ranging from soreness, pain and weakness

Selective cholesterol absorption inhibitor
What they do: These medications (ezetimibe is currently the only one approved by the U.S. Food and Drug Administration) lower the amount of cholesterol your intestine absorbs and force the body to meet its cholesterol needs by removing cholesterol from the bloodstream. They are commonly prescribed to lower LDL cholesterol and total cholesterol, and may also have modest beneficial effects on triglycerides and HDL cholesterol.
Risks and side effects: stomach pain, muscle weakness and fatigue

Bile acid resins
What they do: Bile acid resins remove bile acids, which are needed for digestion, from the body; in response, the body converts cholesterol into bile acids — essentially removing LDL cholesterol and lowering levels by up to 20 percent. It can also help improve HDL cholesterol.
Risks and side effects: constipation, gas, nausea and stomach upset; possible interference with absorption of some medications; may also raise levels of triglycerides

Fibrates
What they do: Fibrates lower triglycerides and raise HDL levels by activating a specific gene that makes the body produce more of the necessary components for HDL and break down triglycerides. They can also raise LDL levels, so they are typically only prescribed in those with normal LDL levels.
Risks and side effects: indigestion, gas, bloating, diarrhea and constipation

Lipid-lowering therapies
What they do: Other lipid-reducing therapies are available, such as niacin (a form of vitamin B3, which has been shown to increase HDL levels and lower triglyceride levels) and omega-3 fatty acid supplements (fish oil, which has been shown to lower triglycerides).
Risks and side effects: for niacin, facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar and peptic ulcers may occur; omega-3 supplements may trigger belching, fishy taste, and higher risk for infection