List of cholesterol medications
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Comprehensive Overview of Cholesterol Medications
Statins: The Primary Cholesterol-Lowering Agents
Statins are the most commonly prescribed medications for lowering cholesterol. They work by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. The widespread use of statins is supported by extensive evidence demonstrating their efficacy in reducing cardiovascular events and mortality.
Common Statins
- Simvastatin: The most frequently used statin, accounting for 42% of all cholesterol-lowering medication users.
- Atorvastatin: Another widely used statin, representing 20.2% of users.
- Other Statins: Include rosuvastatin, pravastatin, and lovastatin, which are also effective in lowering LDL cholesterol and reducing cardiovascular risk .
Non-Statin Lipid-Modifying Medications
While statins are the cornerstone of cholesterol management, non-statin medications are also used, particularly in patients who cannot tolerate statins or require additional lipid-lowering effects.
Ezetimibe
Ezetimibe works by inhibiting the absorption of cholesterol in the small intestine. It is often used in combination with statins to achieve greater reductions in LDL cholesterol. Studies have shown that ezetimibe, when added to statin therapy, can significantly reduce cardiovascular events.
PCSK9 Inhibitors
PCSK9 inhibitors, such as evolocumab and alirocumab, are monoclonal antibodies that enhance the liver's ability to remove LDL cholesterol from the blood. These medications have been shown to reduce cardiovascular events and are particularly useful in patients with familial hypercholesterolemia or those who require substantial LDL reduction.
Niacin
Niacin, or vitamin B3, has been used to lower cholesterol levels, but recent evidence suggests it does not provide additional cardiovascular benefits when added to statin therapy.
CETP Inhibitors
Cholesterol ester transfer protein (CETP) inhibitors aim to raise HDL cholesterol and lower LDL cholesterol. However, their efficacy in reducing cardiovascular events has been inconsistent, and they are not widely recommended.
Emerging Therapies
Mipomersen
Mipomersen is an antisense oligonucleotide that inhibits the synthesis of apolipoprotein B, a key component of LDL cholesterol. It has shown promise in reducing LDL levels in patients with homozygous familial hypercholesterolemia, a severe genetic disorder.
ETC-1002 (Bempedoic Acid)
ETC-1002 is a novel oral medication that inhibits ATP citrate lyase, an enzyme involved in cholesterol synthesis. It has demonstrated significant LDL cholesterol reduction when used alone or in combination with ezetimibe, and it is particularly beneficial for patients with statin intolerance .
Oligonucleotide Therapeutics
Small interfering RNA (siRNA) therapies represent a new class of cholesterol-lowering drugs. These therapies work by destroying RNA before protein synthesis, effectively reducing cholesterol levels.
Conclusion
Cholesterol-lowering medications are essential in managing hypercholesterolemia and reducing the risk of cardiovascular disease. Statins remain the primary treatment, but non-statin medications and emerging therapies offer additional options for patients who need further lipid-lowering or cannot tolerate statins. The choice of therapy should be individualized based on patient-specific factors, including the severity of hypercholesterolemia, risk of cardiovascular events, and tolerance to medications.
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