When you have high cholesterol, the first thing to do is to change your diet and fitness: less saturated fat, no trans fat, less sugar, and more activity. If that doesn’t bring down your “bad” (LDL) cholesterol enough, your doctor may suggest that you also take medicine to help out. (You’ll still need to keep up those lifestyle habits.) Several types of prescription drugs can lower LDL. Get to know what each of them does, as well as some tips for taking these medications. What they are: These are usually the first type of drug that doctors prescribe to lower LDL. They also lower triglycerides, which are another type of blood fat, and mildly raise your "good" (HDL) cholesterol. Statins include: Studies show that statins lower the chance of a “cardiovascular event” such as a heart attack. Side effects: They can include intestinal problems, liver damage (rarely), and muscle inflammation. High blood sugar and type 2 diabetes may also be more likely with statins, although the risk is about 1 in 250 and the benefits outweigh the risks, according to the FDA. Statin drugs may also interact with other medications you take. Your doctor should check on that first. Some people who take statins have reported memory loss and confusion. The FDA is looking into those reports and notes that in general, the symptoms weren’t serious and were gone within a few weeks after the person stopped taking the drug. Avoid grapefruit and grapefruit juice when you take statins. Grapefruit makes it harder for your body to use these medicines. What they are: Your doctor may call these “bile acid resin” drugs or “bile acid sequestrants.” The work inside your intestines. They attach to bile from the liver and keep it from being absorbed back into your blood. Bile is made largely from cholesterol, so these drugs whittle down the body's supply of cholesterol. Examples include: A different type of drug, ezetimibe (Zetia), lowers “bad” LDL cholesterol by blocking cholesterol absorption in your small intestine. Studies have found that in people who have had a heart attack, it can make a small cut in the risk of heart “events,” such as another heart attack, when you also take a statin. Side effects: For bile acid drugs, the most common side effects are constipation, gas, and upset stomach. For ezetimibe, the most common ones include muscle or back pain, diarrhea, and abdominal pain.
What they are: These drugs are used in people who can’t manage their cholesterol through lifestyle and statin treatments. They block a protein called PCSK9 to make it easier for the body to remove LDL from your blood. They are mainly used in adults who inherit a genetic condition called heterozygous familial hypercholesterolemia (HeFH) that makes it hard to bring down their cholesterol level, or for people who have heart disease and need more than a statin. You get them as a shot every 2 weeks. Examples: Side effects: Because these drugs are newer, it will take more time to get to know their side effects. In clinical trials, the most common ones for alirocumab are itching, swelling, pain, or bruising where you get the shot, as well as colds and flu. For evolocumab, they include colds, flu, back pain, and skin reactions where you get the shot. What it is: This B vitamin, also known as nicotinic acid, is found in food but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. Examples include: Research has not shown that adding niacin, when you already take a statin, further lowers your risk of heart disease. Side effects: The main ones are flushing, itching, tingling, and headache. Fibrates are drugs that cut down on how much triglyceride your body makes and can boost your “good” HDL cholesterol. Examples include: What it is: Bempedoic (Nexletol) keeps your liver from processing cholesterol. It is designed to help lower LDL in adults who have HeFH. It can also help lower the LDL in people with atherosclerotic cardiovascular disease (ASCVD). Side effects: Upper respiratory tract infection, muscle spasms, excess uric acid in the blood, back pain, belly pain or discomfort, bronchitis, anemia, and higher liver enzymes. Some people wonder if dietary fish oil supplements rich in omega-3 fatty acids can help reduce the chances of heart disease. There's no evidence that they do. But experts say prescription-strength omega-3 medications can help lower high triglycerides and reduce heart disease risks in those at risk. They caution people not to use nonprescription fish oil dietary supplements to try lowering triglycerides.
When you take medication to lower your LDL levels, you need to follow your doctor’s directions carefully. If you don’t take them as prescribed, they may not work the way they’re supposed to. Cholesterol drug tips
Tips for remembering your medication
