What types of cholesterol-lowering medications are available?
There are five major categories of prescription drugs available for improving your cholesterol levels. Cholesterol is a lipid, or fat, found in the blood. LDL cholesterol, known as “bad” cholesterol, increases your risk for heart disease. You want a low level of LDL cholesterol (less than 100 mg/dL is best). HDL cholesterol is considered “good” cholesterol. You want a high level of HDL cholesterol (more than 50 mg/dL is best). Total cholesterol is the sum of all the cholesterol in your blood, including both LDL and HDL cholesterol (less than 200 mg/dL is best). Triglycerides are another type of lipid that can raise your risk of heart disease (less than 150 mg/dL is best). Your healthcare provider may prescribe a medication from one or more of the five drug categories depending on your lipid levels.
- Statins (e.g., Crestor, Lipitor). These drugs are the most effective cholesterol-lowering drugs available for reducing LDL cholesterol. If your LDL or total cholesterol is high, you will likely be prescribed a statin.
- Bile acid resins, or bile acid sequestrants (e.g., Welchol, Colestid). These drugs are used mainly to lower LDL cholesterol, but they also modestly increase HDL cholesterol. Bile acid resins are sometimes prescribed in addition to a statin or instead of a statin in people who experience side effects with statins.
- Niacin, or nicotinic acid (e.g., Niaspan). This is the most effective cholesterol medication for increasing HDL (“good”) cholesterol. It also lowers triglycerides.
- Fibrates, or fibric acid derivatives (e.g., Tricor, Lopid). They are used mostly for lowering triglycerides, but they also increase HDL cholesterol.
- Cholesterol absorption inhibitors (e.g., Zetia). This is a new class of cholesterol-lowering drug. So far, Zetia (or ezetimibe) is the only drug in this category that has been approved by the Food and Drug Administration (FDA). It lowers LDL cholesterol and is often prescribed along with a statin.
Not everyone who has high cholesterol levels will need to take medication. Treatment for high cholesterol always begins with diet and exercise, and some people are able to manage their cholesterol with diet and exercise alone. Even if you are taking medication for high cholesterol, it is still important to make lifestyle changes, such as eating a healthy diet and exercising regularly. One study showed that people who made such lifestyle changes in addition to taking medication were less likely to have heart problems (including heart attacks) than people who took medicine without making lifestyle changes.1
Are women less likely to be screened or treated for high cholesterol?
Some research indicates that women are less likely than men to be screened for high cholesterol or treated with appropriate medication.2-4 In a study of people with heart disease, 35% of women compared with 55% of men received cholesterol-lowering medications.5
How long does it take for cholesterol-lowering drugs to work?
Cholesterol-lowering drugs may lower your cholesterol within a few weeks. However, to get the full benefits in terms of lowering your risk of having a heart attack or dying from heart disease you have to take these medications for years and possibly the rest of your life. That's why it's very important that you continue taking your medication. Research shows that nearly half of all people prescribed a cholesterol-lowering medication stop taking it within three months; by 12 months about 60% of people have stopped taking their medication.6 If side effects from the medication are a problem, talk to your healthcare provider who may be able to lower your dose or switch you to a drug with fewer side effects.