Heart Health

Understanding Cholesterol Medicines

High cholesterol can lead to strokes and heart disease. Doctors use several types of drugs to help people maintain optimal cholesterol levels. Knowing about these drugs can help patients talk to their doctors about their health and treatments for health problems.

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Sep 18, 2022 • 6 min read

How do cholesterol medications work?

You've probably heard of "good" and "bad" cholesterol. But unlike many people believe, cholesterol isn't some dangerous substance we only get from processed, fatty foods.

Not All Cholesterol Is Bad

It would surprise you to know our bodies actually produce cholesterol! That's right. The substance is produced in the liver and transported through the blood to wherever it’s needed.

We can also find cholesterol in foods that come from animals.

Truth is, we can’t live without cholesterol. It is used to make bile (which is important for digestion and absorption of food) and is a building block for our body cells and tissues.

Did you know cholesterol even plays a role in the production of vitamin D and sex hormones?

Yup.

Now, it's important to note that cholesterol is fatty and doesn’t quite mix well with blood, so it needs to be transported by "carriers" through the blood to target tissues and organs.

These carriers are called Lipoproteins and are classified based on their density, into Chylomicrons, Very low-density lipoproteins (VLDL), Intermediate-density lipoproteins (IDL), Low-density lipoproteins (LDL), and -you guessed it- High-density lipoproteins (HDL).

LDLs are the "bad" cholesterol, while HDLs are the "good" cholesterol.

When a person has high levels of LDL or low levels of HDL in the blood, that person is said to have hypercholesterolemia, which is the medical way of describing high cholesterol.

Hypercholesterolemia is a big problem today. According to the Center for Disease Control and Prevention, about 38% of American adults have high cholesterol and according to the World Health Organization, raised cholesterol is estimated to cause 2.6 million deaths.

Also, plaque buildup from high cholesterol is the most common cause of a heart condition called ischaemic heart disease, which is a leading cause of death worldwide.

Good and Bad Cholesterol

As we already established, cholesterol isn’t all bad, and neither are LDLs. The so-called “bad” cholesterol helps deliver most of the cholesterol needed by our body cells from the liver to the cells.

After their work is done, certain receptors, called LDL receptors, found on the outer part of our body cells, then remove the LDLs from our bodies. The liver has the highest number of these receptors, so it’s the major organ that helps remove LDL from the body.

Because LDLs carry most of the cholesterol in the body, any problems causing their overproduction or decreased clearance from the body lead to high cholesterol levels in the blood, forming plaques.

Over time, these plaques cause the arteries to harden and become narrow (a condition called atherosclerosis), leading to heart disease. This is why LDL is called bad cholesterol.

And because HDL helps reduce high cholesterol levels in the blood by taking the excess cholesterol back to the liver, which then flushes it out of the body, it is called good cholesterol.

People with too much bad cholesterol and not enough good cholesterol often encounter health problems.

The Risks of High Cholesterol

Cholesterol plaques can be very problematic. As they build up, they can narrow the arteries and reduce blood flow.

This can cause very serious health issues depending on where they form.

Chest pain: if plaques affect the arteries that feed the heart (called coronary arteries), they could cause coronary artery disease. People with this disease often experience chest pain (angina).
Heart attacks: if plaques tear or rupture, they may form clots at that site which could block the flow of blood or they could travel downstream and block an artery there. When this happens, it can cause blood to stop flowing to a part of the heart, leading to a heart attack.
Strokes: when the clots from plaques break off and block the arteries that supply the brain (carotid arteries), it could increase the risk of a stroke.
Peripheral artery disease (PAD): when plaques form in the arteries that supply the limbs, it could cause a condition called peripheral artery disease. Here, the legs and arms don't get enough blood to keep up with activities. This causes pain (especially around the calf) that is worse during activities such as walking, but immediately subsides at rest. This is a very serious condition that could cause the limbs to die and may end up being amputated.

Because you can’t feel the buildup of plaque in their arteries, people rarely know that their cholesterol is high. Sometimes, they only find out after a heart attack or stroke caused by the buildup or accidentally through screening tests.

If tests for hyperlipidemia (high fat levels) detect high levels of "bad" cholesterol, doctors would usually try to make changes to diet and exercise and can begin management with various drugs.

Types of Cholesterol Medications

Doctors have a lot of medicines to choose from to help their patients control high cholesterol. Let’s see some of them.

Statins

Atorvastatin(Lipitor) and Fluvastatin(Lescol) are some of the commonest and most effective drugs doctors prescribe to treat high cholesterol. These drugs reduce cholesterol production by blocking an enzyme that the liver uses to make cholesterol, causing the liver to remove more LDL from the body.

Statins can also help reduce swelling and the risk of blood clots.

Here’s a quick fact about the drug. Did you know ‌grapefruit can increase the risk of side effects associated with some Statins?

PCSK9 Inhibitors

As great as statins are at controlling high cholesterol, most of them have unbearable side effects such as intense muscle pain and weakness. Also statins don't work for everyone. Some people have high cholesterol that doesn't respond to treatment with statins.

These limitations (side effects of statins and statin-resistant hypercholesterolemia) showed a need for alternative drugs to lower high cholesterol.

That's where PCSK9 inhibitors come in.

They are a new class of drugs that are especially helpful for people with high cholesterol that’s not easily controlled by statins and for people suffering from the side effects of statins.

They indirectly reduce LDL levels by attaching to a protein on the surface of liver cells. This lowers the rate of breakdown of LDL receptors and leads to an increase in the removal of LDLs.

Studies show that PCSK9 inhibitors can even prevent heart attacks and strokes.

Doctors may prescribe PCSK9 inhibitors to high-risk patients, occasionally in combination with statins.

Ezetimibe

These are cholesterol absorption inhibitors. They work by inhibiting the absorption of cholesterol. They are the commonest non-statin drugs used in the management of high cholesterol and are sometimes prescribed with certain statins.

Fibrates

Fibrates help lower the amount of high-cholesterol fat in the blood by blocking their production and increasing their breakdown. They can also help raise the levels of good cholesterol.

Bile Acid Resins

Bile is a kind of cholesterol that the liver makes to help digest food. Bile acid resins can help lower cholesterol by attaching to bile, leaving less room for bad cholesterol and, in this way, reducing it.

Niacin

Niacin is a B-complex vitamin. It is available over the counter but the form used to treat high cholesterol can only be gotten by prescription from a doctor.

Niacin lowers fat in the blood by blocking an enzyme used in the production of high-cholesterol fat, which leads to a decrease in the formation of VLDLs and LDLs.

Polyunsaturated Fatty Acids

Aka PUFAs. These drugs are also called fish oils. They lower the amount of VLDL in the blood, leading to a decrease in LDL levels. Like niacin, PUFAs can be purchased both over the counter and in a stronger form prescribed by a doctor.

These drugs should, of course, only be taken when prescribed by a doctor.

Other Ways to Lower Cholesterol

If you have already been diagnosed with high cholesterol, it is important to keep taking the medications that your doctor has prescribed.

There are also positive lifestyle changes ‌you can make to help keep your cholesterol low. The following suggestions can be especially effective.

Replace high-fat red meat with lean red meat preferably grass-fed. Lean red meat can help reduce bad cholesterol levels, while grass-fed beef can help raise good cholesterol levels.
Cut back on full-fat dairy products as the saturated fats in these foods raise cholesterol levels, so eating less of them can reduce bad cholesterol. ,
Consume foods rich in omega-3 fatty acids, which help lower blood pressure. Examples include salmon, herring, flaxseed, and walnuts.
Eat foods with fiber that the body can break down. These include oatmeal, kidney beans, pears, and apples. The fiber in these foods makes it harder for cholesterol to find its way into the bloodstream.
Exercise regularly to help raise good cholesterol levels.
Quit smoking.
Maintain a healthy weight.
Use alcohol only in moderation.

To Learn More, Consider Registering for a Health Study

If your cholesterol isn’t optimal even though you are maintaining a healthy lifestyle, don’t worry. As discussed, some medications can help.

Doctors know that cholesterol drugs work because medical researchers have studied them in clinical trials with the help of people like you. Clinical research doesn’t happen unless volunteers are willing to try new drugs (naturally, under close supervision). Those interested in participating in clinical research can register with StudyPages.

StudyPages connects people interested in supporting scientific advances with opportunities to take part in innovative research!