Cholesterol medications: When diet and exercise aren't enough

Imperial, California - If diet and lifestyle changes aren't enough to lower your blood cholesterol to healthy levels, your doctor may recommend a cholesterol-lowering drug. Knowing the pros and cons of the different types of medications used to lower cholesterol can lead to more informed decisions about your options.

Statins

These drugs, such as atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor), work by suppressing the activity of an enzyme that controls cholesterol production.

  • Benefits. Statins lower low-density lipoprotein (LDL), or "bad," cholesterol by 20 to 55 percent — more than any other drug. They also raise high-density lipoprotein (HDL), or "good," cholesterol. LDL clogs the arteries, while HDL prevents cholesterol buildup in the arteries.
  • Possible side effects. In rare instances, muscle pain and changes in liver enzyme levels may occur. People using statins have reported joint pain as well. Don't take statins if you're pregnant or have liver disease.

Ezetimibe (Zetia)

This drug lowers the amount of cholesterol absorbed by the body.

  • Benefits. Ezetimibe lowers bad cholesterol by 18 to 25 percent. It can be taken in combination with statins to lower LDL levels even further. It can also raise good cholesterol.
  • Possible side effects. Ezetimibe may cause diarrhea, joint pain and tiredness.

Bile acid resins

These drugs, such as cholestyramine (Prevalite), colestipol (Colestid) and colesevelam (Welchol), bind to bile acids in the intestine. These acids contain cholesterol, which are then eliminated from the body.

  • Benefits. Bile acid resins can lower LDL cholesterol by 15 to 30 percent.
  • Possible side effects. Bile acid resins may need to be taken in combination with other cholesterol-lowering drugs to effectively lower LDL levels. They may cause stomach and intestinal issues such as constipation.

Nicotinic acid

Nicotinic acid (Niacin) is a water-soluble B vitamin that lowers bad cholesterol and increases good cholesterol.

  • Benefits. Nicotinic acid reduces LDL levels by 5 to 15 percent, and up to 25 percent in some people.
  • Possible side effects. Nicotinic acid may cause flushing, itchiness and upset stomach. Your doctor must monitor your liver function if you're taking this drug. Don't use it if you have diabetes because it can raise blood sugar levels.

Fibrates

Fibrates, such as gemfibrozil (Lopid) and fenofibrate (Tricor), can raise good cholesterol if you have low HDL levels.

  • Benefits. Fibrates can improve HDL levels.
  • Possible side effects. Among all cholesterol-lowering medications, fibrates are the least effective at lowering bad cholesterol. They can also cause muscle pain when prescribed with statins, as well as digestive problems.

Your doctor will recommend a specific choice of medication or combination of medications based on a variety of factors, such as your individual risk factors, your age, your current health and possible side effects. Your doctor will also monitor your medication regularly and recommend lifestyle changes that will allow you to take less medication and lower your risk of heart disease.

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