Understanding Cholesterol: Diagnosis and Treatment
Getting High Cholesterol Under Control continued...
Niacin. Doctors prescribe this to help raise HDL ("good") cholesterol. To be effective, it must be taken in large doses. Unfortunately, in these amounts it often causes skin flushing and upset stomach. Newer versions of niacin made to minimize these side effects may be easier to take. Despite its effects on cholesterol levels, an important scientific study recently found that adding niacin to statin therapy did not lower the risk of future heart problems.
Bile acid binders. Also known as cholestyramine and colestipol, these may lower total and LDL cholesterol in some people. Side effects include bloating, gas, and constipation. If your cholesterol level can't be controlled by using medication, your doctor may try to combine a bile acid binder and a statin.
Fibric acid derivatives. Doctors occasionally prescribe these to raise HDL cholesterol and lower triglyceride levels. They also mildly lower LDL.
Ezetimibe (Zetia). This drug limits the amount of cholesterol the small intestine can absorb. People who take it also usually take a statin, which can result reduce cholesterol another 25%. Zetia is controversial, however, because of less evidence that it lowers the risk of heart attack or death from heart disease.
LDL apheresis. This isn't a drug. It's a blood-cleansing procedure that may help with severe, genetic cholesterol disorders. Over several hours, blood is removed from the body, chemically cleansed of LDL cholesterol, and then returned to the body. Treatments every 2 to 3 weeks can cut average LDL cholesterol by 50% to 80%, but they’re costly in both time and money.
Proprotein convertase Substilisin Kexin type 9 (PCSK9) inhibitors. This is a new class of cholesterol lowering drugs which is used in patients who cannot control their cholesterol through diet and statin treatments in heterozygous familial hypercholesterolemia. It is also used in those with clinical atherosclerotic heart disease. The drugs alirocumab (Praulent) or evolocumab (Repatha) have been found to block the liver protein PCSK9, which hinders the liver’s ability to remove LDL-cholesterol from the blood. By doing so, it reduces the amount of bad cholesterol in the bloodstream.