Question: What are the various categories of cholesterol-lowering medications and which ones work best?
Answer: The physician today has a wide variety of choices for cholesterol-lowering medication. Clearly the most popular and effective class of compounds are the statin drugs. We now have six statins that the doctor can prescribe for cholesterol lowering. And these statins not only are very effective in lowering bad cholesterol, but they've been shown really without doubt now to reduce your risk for having another heart attack. And in patients with heart disease, these statin drugs, when given to patients for high cholesterol also reduced the risk of stroke.
Now, there are other compounds that also lower cholesterol. There's a compound called ezetimibe. There's a whole group of drugs that fit in within the drug class called bile acid sequestrants; that's a big term, but these are drugs that bind the bile salts in the intestinal tract, and those kinds of drugs have been around for a long time. They're still effective but they're probably the third line choice in lowering LDL cholesterol.
Then a few other compounds have more modest effects on cholesterol lowering. When I say cholesterol, I'm talking specifically about LDL because that's our target for cholesterol lowering. And those types of drugs would include nicotinic acid or niacin, and would include a fibrate like gemfibrozil or fenofibrate.