Cholesterol Medications

Help to control your cholesterol levels

For some people, lifestyle changes, such as a healthier diet and more physical activity, may prevent or treat unhealthy cholesterol levels. For others with high cholesterol, medication may also be needed.

Work with your health care professional to develop a treatment plan that’s right for you. If medication is required, be sure to take it as prescribed. The potential benefit to your health is worth making these medications part of your normal routine.

Types of cholesterol-lowering drugs

Various medications can lower blood cholesterol levels.

Statins are recommended for most patients and have been directly associated with a reduction in the risk of heart attack or stroke. Statins continue to provide the most effective lipid-lowering treatment in most cases.

Guidelines recommend that people in any of these groups talk to their health care professional about the risks and benefits of statin therapy:

• Adults with a history of cardiovascular disease, including stroke, caused by atherosclerosis
• Those with LDL-C level of greater than 190 mg/dL
• Adults 40-75 years with diabetes
• Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 5% to 19.9% 10-year risk of developing cardiovascular disease from atherosclerosis and risk-enhancing factors
• Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 20% or greater 10-year risk of developing cardiovascular disease from atherosclerosis

Some people who don't fall into these categories may also benefit from statin therapy.

It's important to talk to your health care professional about your 10-year or lifetime risk. They will assess your risk factors to determine your level of risk and work with you to choose the best treatment.

View an interactive slideshow 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 health care professional and pharmacist are your best sources of information. It’s important to discuss all the drugs you take with your health care professional and to understand their desired effects and possible side effects. Never stop taking a medication or change your dosage (or frequency) without first consulting your health care professional. Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your health care professional about any potential risks.

Statins

This class of drugs, also known as HMG CoA reductase inhibitors, 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 health care professional about the possible side effects before starting statins. Most side effects are mild and go away as your body adjusts. Muscle pain is uncommon and liver abnormalities are rare, but your health care professional may order regular liver function tests. Women who are pregnant and those with active or chronic liver disease should discuss the use of statins with their health care professional 

Statins available in the U.S. include:

• Atorvastatin (Lipitor®)
• Fluvastatin (Lescol®)
• Pitavastatin (Livalo®)
• Lovastatin (Mevacor®, Altoprev™)
• Pravastatin (Pravachol®)
• Rosuvastatin Calcium (Crestor®)
• Simvastatin (Zocor®)
• Combination products:
  • Lovastatin/niacin extended-release (Advicor®)
  • Simvastatin/niacin extended-release (Simcor®)
  • Simvastatin/ezetimibe (Vytorin®)

If statins don’t help you enough, or if you develop side effects, your health care professional may recommend different medications. 

If you have CVD and are already taking the highest-tolerated statin and your LDL-C is still 70 or above, one or more of the following medicines may be prescribed. They all can be taken in combination with a statin.

Ezetimibe (cholesterol absorption inhibitors)

Prevents cholesterol from being absorbed in the intestine. It’s the most commonly used non-statin agent.

Bile acid sequestrants

Also called bile acid-binding agents, cause the intestine to get rid of more cholesterol. 

Those available in the U.S. include:

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

PCSK9 inhibitors

PCSK9 inhibitors are powerful LDL-lowering drugs. They bind to and inactivate a protein on cells found in the liver to lower LDL (bad) cholesterol. Some names are alirocumab and evolocumab.

Adenosine triphosphate-citrate lyase (ACLY) inhibitors*

ACLY inhibitors work in the liver to block the production of cholesterol. They are used in combination with lifestyle changes and statins to further decrease LDL cholesterol in adults with hereditary high cholesterol and people with heart disease who need to further lower their LDL.

• Bempedoic acid (Nexletol)
• Bempedoic acid and ezetimibe (Nexlizet)

*Adenosine triphosphate-citrate lyase (ACLY) inhibitors are not in the current Guideline on the Management of Blood Cholesterol, as they were FDA approved in 2020. For more information on ACL inhibitors visit the National Library of Medicine(link opens in new window).

The following triglyceride-lowering drugs have mild LDL-lowering action, but data doesn’t support their use as an add-on treatment to statins.

Fibrates

Fibrates are especially good for lowering triglyceride (blood fat) levels and have a mild LDL-lowering action. 

Fibrates available in the U.S. include:

• Gemfibrozil (Lopid®)
• Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)
• Fenofibric Acid (Fibricor® and Trilipix®)

Niacin (nicotinic acid)

Niacin is a B vitamin that limits the production of blood fats in the liver. Take this only if your health care professional has prescribed it. It lowers triglycerides and has mild LDL-lowering action.

Niacin side effects may include flushing, itching and upset stomach. 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 people with diabetes 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 health care professional before starting any niacin therapy.

Omega-3 fatty acid ethyl esters

These are derived from fish oils that are chemically changed and purified. They’re used in tandem with dietary changes, to help people with high triglyceride levels.

Omega-3 fatty acid ethyl esters available in the U.S. include:

• Lovaza®
• Vascepa™
• Epanova®
• Omtryg®

Marine-derived omega-3 polyunsaturated fatty acids (PUFA)

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

Use these supplements only under a health care professional'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 people with diabetes. 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. Ask your health care professional if these are appropriate for you to take.