Cholesterol is a fat found in the blood. It’s produced by the liver and found in foods from animal sources, such as meat, poultry, and full-fat dairy products. The body needs some cholesterol to ensure organs grow and function properly. However, too much cholesterol in the blood can clog the arteries and lead to serious health conditions.
There are two main types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL cholesterol is considered the “good” type of cholesterol. It helps remove cholesterol from the blood vessels and carries it back to the liver, where it’s eliminated from the body through urination. LDL, on the other hand, is considered the “bad” type of cholesterol. It can cling to the blood vessels and block blood flow. This blockage makes the heart work much harder than it should. People with high levels of LDL are therefore at an increased risk for heart disease, heart attack, and stroke. This is why it’s critical to lower the amount of LDL in the blood.
Making healthy eating choices and increasing exercise are usually the first steps in improving cholesterol. However, diet and lifestyle adjustments alone may prove ineffective for some. In these cases, doctors may recommend using medications that either lower LDL cholesterol or raise HDL cholesterol. Here’s a breakdown of some of the drugs that can be used to treat high cholesterol.
Avoid taking statins if you have liver disease or if you’re pregnant. You should also avoid drinking grapefruit juice while taking this medication.
Note: When taken with statins, fibrates may increase the chance of muscle problems.
Prescription-strength niacin, also known as vitamin B-3, may help improve cholesterol by boosting HDL and lowering LDL and triglyceride levels. When used in combination with statins, niacin could raise HDL levels by 30 percent or more. Although you can buy niacin without a prescription, over-the-counter doses aren’t effective in treating high cholesterol. Due to side effects, niacin is now usually reserved for those who can’t tolerate statin therapy.
PCSK9 inhibitors are monoclonal antibodies, a type of biologic drug. These medications are a new class of drug being used to treat people who have high cholesterol. They help lower cholesterol by targeting and inactivating a protein called proprotein convertase subtilisin kexin 9. This particular protein reduces the number of receptors on the liver that remove LDL cholesterol from the blood. When PCSK9 is deactivated by a PCSK9 inhibitor, there are more receptors available to eliminate LDL cholesterol from the blood. As a result, cholesterol levels drop. These drugs are added to other treatments, for the most severe high cholesterol conditions, like familial hypercholesterolemia.
In 2015, the U.S. Food and Drug Administration (FDA) approved the first PCSK9 inhibitors: Praluent (alirocumab) and Repatha (evolocumab). Both are injections that may be used to treat people who are unable to lower their cholesterol using other medications. Studies show that both PCSK9 inhibitors are very effective in lowering cholesterol levels and improving overall health.
Like all medications, however, PCSK9 inhibitors do have their downsides. Both Praluent and Repatha need to be injected every two to four weeks. This can be inconvenient for many people. These medications are also expensive, with some officials estimating that a year’s worth of treatment could cost up to $12,000.
Most medications can lower cholesterol without causing serious side effects. But the effectiveness of each medication varies from person to person. You and your doctor will need to determine which class of medication is right for you. Make sure to notify your doctor about any other medications you’re currently taking, as certain drugs can interfere with the effectiveness of cholesterol-lowering medicines.
Once you’ve received your prescription, it’s important for you to take your medication exactly as directed. Let your doctor know if you experience any side effects. Your doctor may switch you to another medication or reduce your dosage. Never stop taking your medication unless your doctor instructs you to do so.