If you’re not reaching your targets with statins alone, these medicines may help.
If a doctor suggests that a patient takes medication to lower their cholesterol, they will often suggest a statin first. While there are many medications used to lower blood cholesterol levels, statins are the only cholesterol-lowering medication class that has been directly associated with reduced risk of heart attack or stroke.
“Statin[s] can reduce the bad cholesterol, LDL, almost 50 percent. However, in a good number of patients, a statin alone won't do it,” says Lawrence Phillips, MD, cardiologist at NYU Langone Health. “So once we have a patient on a statin, as well as have made significant lifestyle modifications, we look to second-line medications.”
Non-Statin Cholesterol-Lowering Treatment Options
Non-statin cholesterol-lowering medicines work in different ways. Some can be used alone or along with a statin to help patients reach their cholesterol targets. “Our goal in treating cholesterol is to get it as low as possible based on the patient's individual risk, so it's not uncommon to use two medications together to optimize somebody's health,” says Dr. Phillips.
Selective cholesterol absorption inhibitors
“Selective absorption inhibitors are actually medications that are going to block reuptake of cholesterol from the intestines, from the GI tract. They get used with statin medications and can reduce the LDL by an additional 13 to 20 percent,” says Dr. Phillips. These medicines are most effective at lowering LDL cholesterol and have modest effects on lowering triglycerides (blood fats) and raising HDL cholesterol.
Resins are another class of LDL-lowering medications. Also known as bile acid sequestrants or bile acid-binding drugs, resins bind bile acids as they're leaving the intestines, which promotes increased disposal of cholesterol.
PCSK9 inhibitors are a newer medication that works by inactivating a protein in the liver. This helps lower LDL cholesterol. “Compared to other medications, which are pills, a PCSK9 inhibitor is an injection that gets given every two to four weeks by the patient to themselves,” says Dr. Phillips. “This medication can reduce cholesterol by over 60 percent.”
Other lipid-lowering therapies
“There are other medications that can impact more of the other cholesterol numbers,” says Dr. Phillips. When you get a cholesterol panel done, it includes several numbers, including:
- Total cholesterol
- LDL (bad) cholesterol
- HDL (good) cholesterol
- And triglycerides (fat in the blood)
“Beyond the LDL, which is usually our first line of attack in reducing cholesterol, there are other medication classes that can specifically benefit the HDL and triglycerides,” says Dr. Phillips. These include:
- Omega-3 fatty acid ethyl esters
- Marine-derived omega-3 polyunsaturated fatty acids (Fish oils)
If you feel like you’re having challenges with your medicines, talk to your doctor. “We know that we have several medications that can be used, and we are often changing medication to medication,” says Dr. Phillips. “It's important, when a patient is frustrated with their progression and their treatment, that they have an open line of communication with their doctor.”
Lawrence Phillips, MD, is a cardiologist at NYU Langone Health. Dr. Phillips is the assistant professor of the Department of Medicine at NYU Grossman School of Medicine, the assistant clinical director for strategic affairs at Leon H. Charney Division of Cardiology, the director of the Nuclear Cardiology Laboratory, the medical director for Outpatient Clinical Cardiology, and the associate director of the Cardiovascular Disease Fellowship Program.