There are five main types of drugs that lower cholesterol levels. They all work in different ways, and include groups of drugs known as: statins, cholesterol absorption inhibitors, bile acid sequestrants, niacin, and fibrates.

Statins
Statins lower the level of cholesterol in the blood by blocking an enzyme in the liver that is responsible for producing cholesterol. This enzyme is called
HMG-CoA reductase and therefore statins are also known as HMG-CoA reductase inhibitors.

Statins are the most commonly prescribed drugs for lowering cholesterol levels and there are many different statins available.

• The most commonly prescribed statins are: atorvastatin (Lipitor®),
  pravastatin (Pravachol®), rosuvastatin (CRESTOR^TM) and simvastatin
  (Zocor®).
• All statins reduce bad cholesterol (LDL), and fat (triglycerides) levels, and increase the good cholesterol (HDL) levels.
• Different statins change your good and bad cholesterol levels by different amounts.

By lowering the production of cholesterol, statins can slow the formation of fatty plaques and occasionally can reduce the size of an existing fatty plaque. Statins have been shown to help prevent heart attacks and strokes and have reduced the number of deaths in certain groups of patients.

	All statins lower bad cholesterol and raise your good cholesterol levels, but different statins do this by different amounts.

Cholesterol absorption inhibitors
Cholesterol absorption inhibitors inhibit the body absorbing cholesterol from the gut into the blood.

• Ezetimibe is a commonly prescribed cholesterol absorption inhibitor. Most drugs also have a second ‘brand’ name, for example Ezetimibe is also referred to as Zetia®.

The cholesterol absorption inhibitors lower bad cholesterol (LDL) levels but have no effect on the good cholesterol (HDL) levels or other fat levels. This class of drug is most useful in treating people who cannot take statins. They can be used along side a statin if the statin is not working well enough by itself.

	Cholesterol absorption inhibitors only lower bad cholesterol, and don’t help raise your good cholesterol.

Bile acid sequestrants
Bile acid sequestrants, also known as resins, are used to lower the bad
cholesterol (LDL) in your blood. Bile acid is used by your body to help you digest your food. Bile acid sequestrants (or resins) bind to these bile acids when they are then excreted in the stool. This makes the level of bile acid in your body drop. The body then has to replace this lost bile acid by converting cholesterol into bile acid. This in turn lowers the level of cholesterol in your blood.

• Bile acid sequestrants alone are not as useful as statins in lowering
  cholesterol levels and are more useful when given along side other drugs such as statins or niacin.
• Bile acid sequestrants are not absorbed by the body and therefore have very few side-effects. These medicines can however reduce the absorption of other drugs and vitamins. You may need to take a vitamin supplement whilst you are taking bile acid sequestrants, but your doctor will talk to you about this.
• Examples of bile acid sequestrants include colestipol (Colestid®), colestyramine (Questran®), and colesevelam (Welchol®). 

	Up to 80% of the cholesterol in your body is produced by your liver. Your diet may be responsible for 20% or more of the cholesterol in your blood.

Niacin (Nicotinic acid)
Niacin is a B vitamin (B3) which lowers the level of cholesterol and other fats in the blood. Niacin specifically lowers the bad (LDL) cholesterol and raises the good (HDL) cholesterol levels.

Niacin should only be taken under the supervision of your doctor. You are
probably wondering why, after all niacin is only a vitamin. For niacin to be
effective it needs to be taken at a high dose and the dose needs to be gradually increased so that your body can get used to the medication. This will reduce any unwanted side-effects.

	Niacin reduces bad (LDL) cholesterol levels by 10–20%, and raises good (HDL) cholesterol by 15–35%.

Fibrates (Fibric acid derivatives)
Fibrates are used to decrease the levels of fat (triglycerides) and bad cholesterol (LDL) in the blood whilst increasing the levels of good cholesterol (HDL).

• Examples of fibrates include: bezafibrate (Bezalip®), fenofibrate (TriCor®) and gemfibrozil (Lopid®).

Fibrates have been shown to reduce the risk of fatty plaque build-up in the
arteries of the heart (coronary artery disease) in people with low levels of good cholesterol (HDL) or with raised levels of other fats called triglycerides.

	Fibrates are mainly used to reduce the level of fat (triglycerides) in your blood, but they also reduce bad cholesterol (LDL) levels.

If you are being treated for high cholesterol, it is important to take your
medication regularly and make any healthy lifestyle changes recommended to you by your doctor. If you follow these steps you should be able to continue with your daily life as normal. If you do experience any side-effects you must see your doctor. If one medicine does not suit you, there are other medicines available that will. It is important that you work with your doctor to get the best treatment for you.

	There are a number of different medicines used to treat high cholesterol. Statins are the most popular medicine used to treat high cholesterol.

In certain individuals, high cholesterol levels may have already caused large fatty plaques to build-up in the artery walls (atherosclerosis). Learn more about how cholesterol clogs your arteries here.

When these fatty plaques become severe enough to cause complications, the complications themselves must be treated. The next section looks at the different treatments available for these complications.