If you have high cholesterol, you probably know you need to get your numbers down. Cleaning up your diet and exercising can make a big difference. But your doctor might also recommend you take medicine to bring your levels under control. Chances are the first thing they’ll prescribe is a statin.
About 25 million Americans take statins. And with good reason. "Statins are the first-line drug treatment for treating high cholesterol because they are so effective at lowering LDL cholesterol and preventing heart attacks,” says Christopher Cannon, MD, at Brigham and Women’s Hospital in Boston.
The problem? These drugs don’t work for everyone.
For instance, some people have genetic conditions that make their cholesterol levels really high. In others, side effects such as muscle pain, or liver problems, make it too hard to take statins.
If a statin doesn’t help you, that doesn’t mean you’re out of luck. Other medications can lower “bad” LDL cholesterol and increase “good” HDL cholesterol, which can lower your risk for heart attacks and strokes. And scientists are researching newer medications, too.
There are many non-statin medications your doctor might prescribe:
Bile acid-binding resins, like cholestyramine (Locholest, Prevalite, Questran), colesevelam (WelChol), and colestipol (Colestid) stick to cholesterol-rich bile acids in your intestines and lower your LDL levels.
Fibrates such as clofibrate (Atromid-S), fenofibrate (Antara, Fenoglide, Lipofen, TriCor, Triglide, Trilipix), and gemfibrozil (Lopid) mostly help your heart by reducing the amount of blood fat (called triglycerides) and raising “good” HDL levels. They don’t do much to lower LDL though.
Niacin, a B vitamin, affects how your body makes blood fats and can also lower LDL.
Ezetimibe (Zetia) lowers the amount of cholesterol your intestines absorb. When paired with statins, ezetimibe further lowers LDL levels.
Omega-3s are found in fatty fish like mackerel, trout, herring, sardines, albacore tuna, and salmon. You can also get them in supplements and medication. You mainly take them to lower triglycerides.
PCSK9 inhibitors help clear cholesterol from your blood. They “have been developed for people who are not at their goal cholesterol despite current treatments,” Cannon says. The FDA has approved two of these drugs: alirocumab (Praluent) and evolocumab (Repatha). Evolocumab, in particular, has been approved as a preventative treatment for heart attacks, stroke, and coronary revascularizations in adults with cardiovascular disease.
New Drugs on the Way
Scientists also are researching new types of medicines that can bring down cholesterol. None of them are available yet, but possibilities include:
ETC-1002 works inside the liver to change how the body uses cholesterol and fats.
CETP inhibitors such as anacetrapib and evacetrapib raise HDL and lower LDL. Previous studies found that these drugs didn't work well, but scientists are now looking at more promising versions.