High cholesterol doesn’t usually hurt, but it raises your risk of heart attack and stroke. If your doctor talks about lipid-lowering drugs, you want straightforward facts: how each drug works, who should take it, and what to watch for. This page gives practical, no-nonsense info you can use in a conversation with your clinician.
There are several drug classes, each with a clear job:
- Statins (atorvastatin, simvastatin, rosuvastatin): lower LDL (“bad” cholesterol) by blocking the liver enzyme that makes cholesterol. They’re the first-line choice for most people.
- Ezetimibe: reduces cholesterol absorption from the gut. Often added when statins alone don’t hit the target.
- PCSK9 inhibitors (e.g., evolocumab, alirocumab): injectable monoclonal antibodies that greatly lower LDL. Used for very high LDL or when statins aren’t enough or tolerated.
- Fibrates (fenofibrate): mainly lower triglycerides and can modestly raise HDL (“good” cholesterol). Used when triglycerides are high.
- Bile acid sequestrants (cholestyramine, colesevelam): bind bile acids to lower LDL. They can cause constipation and may raise triglycerides, so they’re less common now.
Doctors decide based on your overall heart risk, not just one number. Typical situations that trigger treatment: known heart disease, diabetes with elevated risk, or very high LDL (often over 190 mg/dL). If you start medication, expect a follow-up lipid panel 6–12 weeks later to see the drop in LDL, then checks every 3–12 months.
Baseline liver tests are common before starting a statin and repeated if symptoms appear. Tell your provider about muscle pain, weakness, or dark urine—those can be signs of rare but serious muscle problems. If you’re pregnant, trying to become pregnant, or breastfeeding, most lipid drugs are avoided.
Practical tips and safety notes:
- Start with lifestyle: better food, weight loss, and regular activity often reduce the needed drug dose. But if your risk is high, don’t delay medication.
- Drug interactions matter. Grapefruit and some antifungals or antibiotics can raise statin levels. Always tell your doctor all medicines and supplements you take.
- If you get muscle aches on one statin, your doctor may try a lower dose, a different statin, or non-statin options like ezetimibe or a PCSK9 inhibitor.
- Cost and access vary. Generic statins are cheap; PCSK9 inhibitors are more expensive and may need prior authorization.
Want to prepare for an appointment? Bring a list of your meds, recent lab results if you have them, and any side effects you’ve noticed. Ask what the treatment goal is for your LDL and how long until your next check. That makes the conversation quick, clear, and useful.
Mar, 18 2025