Cholesterol Medications

Updated:Apr 24,2017

your doctor will determine what's best for you


For some people, lifestyle changes like a healthier diet and more exercise may prevent or treat unhealthy cholesterol levels. For others, medication may also be needed.

Your doctor can assess your risk for a heart attack or stroke based on your cholesterol levels and other risk factors. From there, you can work with your doctor to develop a treatment and prevention plan that's right for you.

If you have to take medication, you may feel disappointed. That’s OK – it’s normal. But don’t let your feelings stop you from taking your meds. Set up a routine, and stick to it. The minor inconvenience of medication vastly outweighs the devastation of a cardiovascular event.

Cholesterol-Lowering Drugs

Various medications are used to lower blood cholesterol levels. Statins are recommended for most patients because they’re the only cholesterol-lowering drug class that’s been directly associated with reducing the risk of a heart attack or stroke. Your doctor may consider other medications too, especially if statins cause serious side effects or they don’t help you enough.

View a cholesterol animationGuidelines recommend that people in any of these four groups talk to their doctor about the risks and benefits of statin therapy:

  • Adults 40-75 years of age with LDL (bad) cholesterol of 70-189 mg/dL and a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.
  • People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
  • People 21 and older who have a very high level of LDL (bad) cholesterol (190 mg/dL or higher).
  • People with diabetes and a LDL (bad) cholesterol level of 70-189 mg/dL who are 40 to 75 years old.

Some patients who do not fall into these categories may also benefit from statin therapy.

View an animation to see how cholesterol drugs work.

*Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. We’ve included generic names as well as major trade names to help you identify what you may be taking. Please understand that the American Heart Association is not recommending or endorsing any specific products. If your prescription medication isn't on this list, your healthcare provider and pharmacist are your best sources of information. It's important to discuss all the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication or change your dose or frequency without first consulting your doctor.

*Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your health care provider about any potential risks.


Learn more about cholesterol drugs

Statins (also known as HMG CoA reductase inhibitors)

This class of drugs works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.
 
Talk to your doctor about the possible side effects before starting statins. Most side effects are mild and go away as your body adjusts. Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests. People who are pregnant or who have active or chronic liver disease should not take statins.

Statins now available in the U.S. include:

Atorvastatin (Lipitor®)**
Fluvastatin (Lescol®)**
Lovastatin (Mevacor®, Altoprev™)**
Pravastatin (Pravachol®)**
Rosuvastatin Calcium (Crestor®)**
Simvastatin (Zocor®)**
Statins are also found in the combination medications Advicor®** (lovastatin + niacin), Caduet®** (atorvastatin + amlodipine), and Vytorin™** (simvastatin + ezetimibe).
 

This class of drugs works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.
 
Talk to your doctor about the possible side effects before starting statins. Most side effects are mild and go away as your body adjusts. Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests. People who are pregnant or who have active or chronic liver disease should not take statins.

Statins now available in the U.S. include:

Atorvastatin (Lipitor®)**
Fluvastatin (Lescol®)**
Lovastatin (Mevacor®, Altoprev™)**
Pravastatin (Pravachol®)**
Rosuvastatin Calcium (Crestor®)**
Simvastatin (Zocor®)**
Statins are also found in the combination medications Advicor®** (lovastatin + niacin), Caduet®** (atorvastatin + amlodipine), and Vytorin™** (simvastatin + ezetimibe).
 

This relatively new class of cholesterol-lowering medications works by preventing cholesterol from being absorbed in the intestine. Selective cholesterol absorption inhibitors are most effective at lowering LDL cholesterol. They may also have modest effects on lowering triglycerides (blood fats) and raising HDL cholesterol.

The first medication of this class, ezetimibe (Zetia®)**, was approved in 2002 for treating high cholesterol and certain inherited lipid abnormalities.

This class of LDL-lowering drugs works in the intestines by promoting increased disposal of cholesterol. Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so they can't be used during digestion. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. That means less cholesterol is left to circulate through your bloodstream.

Resins now available in the U.S. include:

Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®, Locholest® Light)**
Colestipol (Colestid®)**
Colesevelam Hcl (WelChol®)**

Fibrates (fibric acid derivatives):

Fibrates are best at lowering triglycerides and in some cases increasing HDL levels. These drugs aren't very effective in lowering LDL cholesterol.

Fibrates now available in the U.S. include:

Gemfibrozil (Lopid®)**
Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)**
Clofibrate (Atromid-S)**


Niacin (nicotinic acid):
 
This drug works in the liver by affecting the production of blood fats. 

Niacin side effects may include flushing, itching and stomach upset. Your liver functions may be closely monitored because niacin can cause toxicity. Nonprescription immediate-release forms of niacin usually have the most side effects, especially at higher doses. Niacin is used cautiously in diabetic patients because it can raise blood sugar levels.

Niacin comes in prescription form and as a dietary supplement. Dietary supplement niacin must not be used as a substitute for prescription niacin because of potentially serious side effects. Dietary supplement niacin is not regulated by the Food and Drug Administration and may contain widely variable amounts of niacin — from none to much more than the label states. The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy.

Omega-3 Fatty Acid Ethyl Esters

These medications are derived from fish oils that are chemically changed and purified.  They’re meant to be used with dietary changes to help in people with very high triglyceride levels (over 500 mg/dL) lower their levels.

Omega-3 fatty acid ethyl esters may cause serious side effects. They may also interact negatively with other medications, herbal preparations and nutritional supplements. People with allergies/sensitivities to fish, shellfish or both and/or any other drug component(s) may have a severe adverse reaction to using these medications.

 

Omega-3 fatty acid ethyl esters available in the U.S. include:
Lovaza®
Vascepa™

Marine-Derived Omega-3 Polyunsaturated Fatty Acids (PUFA)

Marine derived omega-3 PUFAs, commonly referred to as omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high blood triglyceride levels. They help decrease triglyceride secretion and facilitate triglyceride clearance.  The amount of marine-derived omega-3 PUFAs needed to significantly lower triglyceride (2 to 4 g) is hard to get from a daily diet alone, so supplementation with capsules may be needed. 

Use these supplements only under a doctor’s direction and care, because large doses may cause serious side effects. These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics. Negative interactions with other medications, herbal preparations and nutritional supplements are also possible. People with allergies to fish, shellfish or both may have a severe adverse reaction to using these supplements.  
 

Clinical Trials

Clinical trials are scientific studies that determine if a possible new medical advance can help people and whether it has harmful side effects. Find answers to common questions about clinical trials in our Guide to Understanding Clinical Trials.





This content was last reviewed April 2017.

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