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Cholesterol medications: Consider the options

A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough. You might also need to take cholesterol medications to help:

  • Decrease your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol that increases the risk of heart disease
  • Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
  • Increase your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol that offers protection from heart disease

Your doctor might suggest a single drug or a combination of cholesterol medications. Here's an overview of the pros and cons for common classes of cholesterol medications.

Drug class Benefits Possible side effects
Statins
Atorvastatin (Lipitor)
Fluvastatin (Lescol XL)
Lovastatin (Altoprev)
Pitavastatin (Livalo)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Decrease LDL and triglycerides; slightly increase HDL Muscle pain, increased blood sugar levels, constipation, nausea, diarrhea, stomach pain, cramps, elevation of liver enzymes
Cholesterol absorption inhibitor
Ezetimibe (Zetia)
Decreases LDL; slightly decreases triglycerides; slightly increases HDL Stomach pain, diarrhea, fatigue, muscle soreness; avoid during pregnancy and lactation
PCSK9 inhibitors
Alirocumab (Praluent)
Evolocumab (Repatha)
Decrease LDL; usually reserved for people who have a genetic condition that causes very high LDL levels or people with heart disease who cannot tolerate statins or other cholesterol lowering drugs Itching, swelling, pain or bruising at injection site
Citrate lyase inhibitors
Bempedoic acid (Nexletol)
Bempedoic acid-ezetimibe (Nexlizet)
Decrease LDL Muscle spasms and joint pain, including acute gout
Bile acid sequestrants
Cholestyramine (Prevalite)
Colesevelam (Welchol)
Colestipol (Colestid)
Decrease LDL; may slightly increase HDL Constipation, bloating, nausea, gas, heartburn
Combination cholesterol absorption inhibitor and statin
Ezetimibe-simvastatin (Vytorin)
Decreases LDL and triglycerides; increases HDL Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness
Combination calcium channel blocker and statin
Amlodipine-atorvastatin (Caduet)
The statin component decreases LDL and triglycerides; the calcium channel blocker lowers blood pressure Facial and neck flushing, dizziness, heart palpitations, muscle soreness and pain, increased blood sugar levels, constipation, nausea, diarrhea, stomach pain, cramps, elevation of liver enzymes
Fibrates
Fenofibrate (Antara, Lipofen, others)
Gemfibrozil (Lopid)
Decrease triglycerides; modestly decrease LDL; increase HDL Nausea, stomach pain, muscle pain
Niacin
Prescription niacin (Niacor, Niaspan)
Decreases LDL and triglycerides; increases HDL Facial and neck flushing, itching, stomach upset, increase in blood sugar
Omega-3 fatty acids
Prescription versions include Lovaza, Omacor and Vascepa
Decrease triglycerides; may increase HDL Belching, fishy taste, indigestion; may increase risk of bleeding

In many people, the muscle pain often associated with statins may not actually be caused by the drug. In studies where participants don't know if they're getting a statin or a placebo, muscle pain is a common complaint in both groups. It appears that the expectation of the side effect makes it more likely to occur.

Most cholesterol medications lower cholesterol with few side effects, but effectiveness varies from person to person. It's also still important to follow a healthy diet and get enough exercise. Cholesterol medications and lifestyle choices can work together to help reduce your risk of heart attacks and stroke.

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